With Missouri AG set to restrict care for transgender adults, not all Republicans agree

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Missouri Attorney General Andrew Bailey’s emergency rule targeting transgender health care, set to go into effect Thursday but facing a legal challenge, is exposing a rift among Republicans over access to gender-affirming care for adults.

Bailey, a Republican, has put forward regulations that will severely limit care for both minors and adults. The rules require 15 separate hourly therapy sessions over 18 months before a person can receive care. They would make Missouri the first state to severely restrict adult access to gender-affirming treatment.

The sweeping nature of the rule is dividing Missouri Republicans, with some voicing full-throated support for making restrictions on gender-affirming care as broad as possible, while others say adults should have the freedom to make their own decisions even as they back bans on the care for children.

Sen. Mike Moon, an Ash Grove Republican who is sponsoring legislation to restrict gender-affirming care for minors, said although he is pleased with Bailey’s sense of urgency, he questions whether the state attorney general has the authority to enact the rule because he is not part of the legislature. Moon also said he doesn’t support the rule applying to adults.

“Our premise was protecting kids,” Moon said. “And once someone reaches the age of maturity, they should be able to make those choices themselves.”

Sen. Mike Moon, R-Ash Grove, left, on the Missouri Senate floor in 2022.
Sen. Mike Moon, R-Ash Grove, left, on the Missouri Senate floor in 2022.

The divisions reflect tensions between the social conservative and libertarian wings of the party, as well as early jostling ahead of the 2024 Republican primary elections for governor and state attorney general. Missouri Secretary of State Jay Ashcroft, a Republican running for governor, has been outspoken in his skepticism of Bailey’s rule even as he has aggressively supported prohibitions on care for children.

The conflicting perspectives could hold consequences for how far Missouri goes in restricting care.

The American Civil Liberties Union of Missouri and LGBTQ civil rights group Lambda Legal filed a lawsuit Monday in St. Louis County Court. The suit alleges Bailey’s restrictions violate the state constitution by legislating “behind closed doors through Missouri’s limited emergency rulemaking procedures…without any input from the Missourians the rule will affect most.”

If the groups are successful in blocking or limiting the rules on procedural grounds, implementing restrictions may fall to the Missouri General Assembly, where Republicans hold supermajorities but aren’t in lockstep on whether to restrict care for adults.

Sen. Rick Brattin, a Harrisonville Republican, said in an interview this week the emergency rule is a necessary stopgap before any restrictions the legislature may pass goes into effect. Still, Brattin said adults can make the decision for themselves and said his own approach has been to focus on children.

“I think he sees a potential public health crisis and risk for people,” Brattin said of Bailey. “And he’s taken action to protect the well being of especially minors. I think that he has a responsibility as chief law enforcement officer to act.”

Brattin was more clear during a speech on the Senate floor last month. “If you’re an adult and you want to go do whatever you want to do, that’s at your own accord, if you’re an adult,” he said at the time.

The most prominent Missouri Republican voicing skepticism about Bailey’s rule has been Ashcroft, who launched his campaign for governor earlier this month.

Ashcroft, who has promised to make the state “the front line of freedom” if elected, has said adults can make their own decisions about treatment. But he has also maintained that gender-affirming care cannot fundamentally change whether someone is a man or woman.

“I don’t think anyone should go through this process because it’s a lie to say that you can change from a man to a woman or a woman to a man through surgery... But if you have someone who is an adult, they can make their own decision as to what they want to do, and I support them,” Ashcroft said during a Tuesday appearance on CNN.

Ashcroft’s office didn’t make him available for an interview with The Star. But in a Friday appearance on NewsTalkSTL, Ashcroft voiced concern the legislature would use Bailey’s rule as an excuse not to pass legislation on transgender care. He said rulemaking authority is limited and said there “are real questions about whether or not that rule will survive in the courts.”

Ashcroft spokesperson JoDonn Chaney said in a statement that the Missouri Secretary of State’s Office had processed and posted the emergency rule as required by law.

Andrew Bailey speaks to reporters outside Missouri Republican Gov. Mike Parson’s Capitol office in Jefferson City, Mo., after being named state attorney general on Wednesday, Nov. 23, 2022. Bailey is Parson’s general counsel and will replace U.S. Sen.-elect Eric Schmitt as the state’s top prosecutor.
Andrew Bailey speaks to reporters outside Missouri Republican Gov. Mike Parson’s Capitol office in Jefferson City, Mo., after being named state attorney general on Wednesday, Nov. 23, 2022. Bailey is Parson’s general counsel and will replace U.S. Sen.-elect Eric Schmitt as the state’s top prosecutor.

Bailey says he’s protecting patients

Missouri Republicans have aggressively pursued legislation to regulate the lives of transgender residents this year and at one point had more anti-LGBTQ bills than other states, according to a database from the American Civil Liberties Union that tracks legislation nationwide. Efforts kicked into high gear in early February, however, after a former employee of Washington University’s Transgender Center publicly accused the clinic of misconduct.

GOP legislators have cited the claims made by the former employee, Jamie Reed, in the months since, even as current and former patients and their families have sharply disputed her account. Washington University released the results of its internal review on Friday, which found that children weren’t harmed at the center and also said the center had tightened up its policies to require written consent before prescribing gender-affirming medications.

Kendall Martinez-Wright, a 29-year-old transgender woman from Palmyra in northeastern Missouri, said she believes a small group of Republicans understand Bailey’s rule oversteps the conservative tenets of small government.

“He is superseding his own limited powers that he has as attorney general, he’s doing an overreach, which, for some members of the Republican Party, that could be an issue,” she said.

Martinez-Wright said she was frustrated that some Republicans who are against Bailey’s restrictions appear unwilling to speak out.

For his part, Bailey has acknowledged his restrictions would affect adults as well as children, but has largely portrayed the rule as intended to protect children. He has called gender-affirming care experimental, and has cited a state consumer protection law to justify the emergency rule.

“The safeguards that I’ve put into place are intended to protect all patients: to ensure patients have access to the information necessary to make health decisions that can have long-term deleterious health consequences. My rule ensures all patients have access to mental health services, and that all patients understand the experimental nature of these drugs,” Bailey said in a statement Monday.

Bailey added that he is proud to be the first state attorney general in the nation to use his rulemaking authority “to protect patients and require that providers abide by basic standards of care.”

Bailey was appointed to the job in January by Republican Gov. Mike Parson after working as his general counsel. He faces a primary challenge from Will Scharf, a former federal prosecutor and an ex-aide to former Gov. Eric Greitens. Scharf declined to comment.

State Sen. Greg Razer, D-Kansas City, filibusters Senate Bill 49 on Tuesday, March 7, 2023, in Jefferson City. The bill, filed by state Sen. Mike Moon, an Ash Grove Republican, would ban all “gender transition procedures” for people under the age of 18 except for a few specific instances. Doctors who violate the restrictions could face professional discipline as well as lawsuits.

Has AG ‘crossed a line’?

Several Republican officials this week either refused to talk about whether gender-affirming care should be available for adults or didn’t respond to requests for comment, underscoring how Bailey’s first-in-the-nation restrictions have become a fraught topic in a party where many would prefer to keep the conversation focused on children.

Missouri House Majority Leader Jonathan Patterson, a Lee’s Summit Republican, is typically open to speaking with reporters about most topics. He declined to discuss restrictions on adults or Bailey’s rule on Monday.

Rep. Jamie Burger, a Benton Republican, filed a bill this year that would ban transgender athletes from competing in women’s sports. But when stopped by a reporter in the hallway of the Missouri Capitol on Monday, Burger claimed to be unaware of Bailey’s proposed restrictions.

Half a dozen other GOP legislators or their offices also declined to comment or didn’t respond to requests for comment. A spokesperson for Parson didn’t respond to a request for comment.

Sen. Greg Razer, a Kansas City Democrat, said most Republicans don’t want to deal with banning gender-affirming care for adults, but the ones that do are running for election.

“I don’t know when it stops,” Razer said. “When the attorney general of the state of Missouri puts a page on his website, asking Missourians to turn in their neighbors because of their health care decisions, you have crossed a line.”

Transgender friends, family and communities gathered Sunday, April 16 at Mill Creek Park on the plaza to protest Attorney General Andrew Bailey’s new executive action so strict that it will essentially ban gender-affirming care for many adults and minors in Missouri.
Transgender friends, family and communities gathered Sunday, April 16 at Mill Creek Park on the plaza to protest Attorney General Andrew Bailey’s new executive action so strict that it will essentially ban gender-affirming care for many adults and minors in Missouri.

Bailey in March launched a tip line to collect reports of questionable or harmful gender-affirming care. The tip line was later shut down amid what his office said was numerous false reports.

Razer said Missourians should pause and ask if lawmakers really understand the medical ramifications of what they are discussing.

“I believe their answer is ‘I want to win the Republican primary, and we’ll do it at anyone’s expense,’” Razer said.

One GOP lawmaker has been outspoken in his opposition to restrictions. Rep. Chris Sander, a Lone Jack Republican who is openly gay, said Monday he believes Bailey’s rule and bills restricting gender-affirming care violate the U.S. Constitution’s equal protection rights for adults seeking health care for gender dysphoria.

“Clearly the legislation is seeking to discriminate a minority class of adult LGBT Missourians,” Sander said in a text message to The Star. “I have voted NO on all legislation that seeks to destroy civil rights and MO/US Constitutional rights.”

Sen. Denny Hoskins, a Warrensburg Republican, tried to find a rhetorical middle ground Monday on limiting gender-affirming care for adults. He said Republican colleagues he has spoken with agree that if adults do want the care, it needs to be done safely.

“I would encourage Attorney General Bailey to use every power that he has, according to the Missouri Constitution, as the attorney general, to make sure that any types of these procedures are not performed on kids, and any that are performed on adults are safe,” Hoskins said.