Politics

Missouri GOP wants to limit gender-affirming care. What is it?

Published

2 years ago

April 4, 2023

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Missouri Republicans in recent months have attacked health care options for transgender minors in the state, launching legislative, investigative and media campaigns to drastically curtail gender-affirming care in the St. Louis area.Legislators in the Senate last month passed bills to bar children under the age of 18 from receiving puberty blockers or hormone treatments. House GOP leaders have said passing their own version of the legislation will be a priority in the waning weeks of the legislative session. Trans minors and their parents are bracing for those bills to become laws.Also last month, Attorney General Andrew Bailey announced plans to issue temporary restrictions that would prevent doctors and other clinicians from providing gender-affirming medical treatment to minors unless they met several stringent requirements, including prohibiting care for patients with mental health problems.Bailey and U.S. Sen. Josh Hawley, both Republicans, have launched investigations into one of the only clinics in the region to provide such care. The efforts followed the publication of an op-ed essay by The Free Press and a sworn affidavit by a former case worker at Washington University Transgender Center at Children’s Hospital, alleging the center overlooked mental health needs of patients and did not inform adolescents and their parents of potential side effects of treatment. Transgender patients and medical professionals say those descriptions don’t match their own experience at the center.As the campaign against gender-affirming care continues across the nation, often lost is an explanation of what it entails. Here are some basics:What is gender affirming care?Gender-affirming care includes an variety of medical and mental health care treatments and social support for people whose sex at birth doesn’t match their perception of themselves.The practice is supported by major professional medical associations including the American Academy of Pediatrics, the American Medical Association and the American Psychiatric Association, among dozens of others. Studies show gender-affirming care is correlated with lower risks of suicidal thoughts and depression. “There is a limited but growing body of evidence that suggests that using an integrated affirmative model results in young people having fewer mental health concerns whether they ultimately identify as transgender,” according to a 2018 policy statement from the American Academy of Pediatrics. For Tony La Mantia, who told his parents he was a transgender boy when he was 12, gender-affirming care looked like him wearing men’s clothing and using different pronouns around his Webster Groves home. He eventually came out at school, and after years of therapy and doctors’ visits, he began taking testosterone hormone treatment at 16. That deepened his voice and allowed him to grow a mustache. At 18, he got surgery to remove his breasts.La Mantia changing his name, clothing, taking hormones and getting surgery are all examples of gender-affirming care.Because everyone’s perception of their gender is different, their care plans won’t look the same either, according to Jason Rafferty, a pediatrician who wrote the American Academy of Pediatrics policy statement on gender-affirming care.Some transgender people may only want to transition socially, without medical interventions or procedures. Common types of medical interventions that trans people seek include:Hormone therapy — administering testosterone, estrogen or other sex hormones through patches, gels or injectionsPuberty blockers — medications that delay the onset of physical developments in prepubescent children Top surgery — removing or constructing breastsBottom surgery — reconstructing genitaliaSome transgender people seeking medical interventions may only be interested in one or two of those treatments. “A lot of trans men that I know only want hormones; a lot of trans men I know, maybe only want a mastectomy,” said E.H., a trans man from south St. Louis who began transitioning in his teens. St. Louis Public Radio is not using his full name because he fears discrimination“Gender affirming care can mean so many things,” EH said. “It can mean just changing your pronouns, it can mean just changing your name. When it comes to actual medical transitions. There is a whole world.”

Brian Munoz

St. Louis Public RadioE.H. is one of the many Missourians who have faced a barrage of anti-transgender legislation — including attacks on access to gender affirming care. St. Louis Public Radio is not using his full name because he fears discrimination.

What is the Wash U trans center? What happens there?The Washington University Transgender Center at Children’s Hospital in St. Louis that opened in 2017. It’s one of the only places in the region that provides gender-affirming medical care to people under 18. Endocrinologists and adolescent medicine doctors opened the clinic after observing an increase in young people seeking treatment.The center will accept new patients until they’re 18 and will treat existing patients through their early 20s.The center offers a spectrum of care to kids and teens, including birth control, puberty blockers and hormone replacement therapy. According to the center’s website, the clinic offers surgical treatment to people 18 and older.The center also offers legal advice, voice therapy, community education and referrals to therapists and other mental health specialists. The center’s stated goal is to not sway patients to move from one gender identity to another or push people to transition. Wash U did not make someone available for an interview for this story.Wash U officials said in February that they were alarmed by allegations of misconduct and descriptions of care at the clinic by Jamie Reed, a former case worker at the center, and would investigate those claims.“Our highest priority is the health and well-being of our patients,” the Wash U statement read. “We are committed to providing compassionate, family-centered care to all of our patients and we hold our medical practitioners to the highest professional and ethical standards.”What are the best practices for providing gender-affirming care for minors? The World Professional Association for Transgender Health, an international organization of doctors and medical providers that treat transgender patients, distributes widely used guidelines considered by many to be the gold standard for providing gender-affirming care. Many providers that treat transgender patients say they consult these guidelines, though the Wash U clinic does not publicly say if the guidelines are used at the St. Louis center.The association’s standards for children receiving care call for providers to not discourage kids from expressing their gender identity and recommend that children explore their gender expression through clothing and other social transitions. The standards also recommend providing therapy and supplying families information about potential medical interventions and their benefits and risks.Once children begin puberty, the association’s standards say medical interventions are recommended when a person has sustained gender dysphoria or gender incongruity over time. A patient should be mentally and emotionally mature and able to provide informed consent for treatment, the standards say.“It’s quite clear that this is not something that you just wake up one day, walk into a doctor’s office and get,” said Dr. Maddie Deutsch, the president of the association’s U.S. chapter and one of the dozens of authors of the latest guidelines. “I’ll say that if there are clinics that are doing that, then they’re doing it wrong.”Once patients reach their mid-teens, they can potentially receive hormones with a doctor’s referral. Doctors say it’s rare to perform any kind of surgery on patients before they’re 18.But Deutsch explained the standards of care are guidelines, not rules. Even people within the medical community sometimes disagree about whether they’re the best course to take.Both the World Professional Association for Transgender Health and American Academy of Pediatrics have stopped short of prescribing appropriate ages or other concrete standards for different procedures. Such benchmarks can seem arbitrary, said Rafferty, the AAP pediatrician. “Instead, what we’ve emphasized is really the need to assess the physical readiness, cognitive readiness and emotional readiness of the child.”Some critics say medical models of care can actually create more barriers to treatment that make health worse for transgender and gender nonconforming people.“I’ve seen too many transgender people get turned away from hormones for being, ‘too depressed’ or ‘too anxious,’ when so much of that is tied in with our dysphoria, or the discrimination we face in our day to day lives,” said Jess Jones, who runs a consultant business that educates organizations about transgender issues.Experts say they’d like to see more research that looks at the relationship between mental health and gender-affirming care and how those who receive it fare over their lifetimes.“We know cross sectionally pretty well, at this point, that there’s a relationship, it’s pretty consistent across almost all studies,” said Jeremy Goldbach, a clinical social worker and a professor at Washington University’s Brown School. ”What we what we still are trying to understand is the exact relationship over time.”What does it take to get treatment as a minor?St. Louis-area patients who received gender-affirming treatment as minors say they’re confused when they hear accusations that patients have been rushed through treatment:“It took years to get some of the things I wanted. And so I was just kind of shocked when they were like, ‘it was very easy,’” Tony La Mantia said. “Even with everybody being supportive of my transition, it was an incredibly difficult process to get through.”

Brian Munoz

St. Louis Public RadioTony La Mantia, 19, sits during an interview in March at his family’s home in Webster Groves. La Mantia is one of the transgender Missourians who is questioning whether to stay in the state after a barrage of anti-trans legislation in Jefferson City.

La Mantia said he went through years of therapy and even put a pause on medically transitioning to focus on treating other mental health issues before getting hormone replacement therapy.Because of a limited number of doctors who provide transgender care to minors, many patients wait months to get into the clinicJoey Borrelli, who grew up in St. Louis, started taking hormones just before his 17th birthday, more than a year after he came out to his parents.Not everyone can afford the costs and copays of multiple medical appointments, Borelli said, which puts up another barrier to getting treatment quickly. He’s seen people on GoFundMe and other fundraising sites asking for money to purchase health care.“Do our politicians really think that people are going and getting medical care for fun all willy-nilly?” Borelli said. “Months and months of therapy? Are you serious?”Borrelli also had to wait months to get his treatment approved by doctors, therapists and insurance companies. Borelli said he had to acknowledge the risks of every procedure before receiving treatment.

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Poll: Support for Missouri abortion rights amendment growing

Published

3 months ago

August 29, 2024

Natural Bridge

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A proposed constitutional amendment legalizing abortion in Missouri received support from more than half of respondents in a new poll from St. Louis University and YouGov.That’s a boost from a poll earlier this year, which could mean what’s known as Amendment 3 is in a solid position to pass in November.SLU/YouGov’s poll of 900 likely Missouri voters from Aug. 8-16 found that 52% of respondents would vote for Amendment 3, which would place constitutional protections for abortion up to fetal viability. Thirty-four percent would vote against the measure, while 14% aren’t sure.By comparison, the SLU/YouGov poll from February found that 44% of voters would back the abortion legalization amendment.St. Louis University political science professor Steven Rogers said 32% of Republicans and 53% of independents would vote for the amendment. That’s in addition to nearly 80% of Democratic respondents who would approve the measure. In the previous poll, 24% of Republicans supported the amendment.Rogers noted that neither Amendment 3 nor a separate ballot item raising the state’s minimum wage is helping Democratic candidates. GOP contenders for U.S. Senate, governor, lieutenant governor, treasurer and secretary of state all hold comfortable leads.“We are seeing this kind of crossover voting, a little bit, where there are voters who are basically saying, ‘I am going to the polls and I’m going to support a Republican candidate, but I’m also going to go to the polls and then I’m also going to try to expand abortion access and then raise the minimum wage,’” Rogers said.Republican gubernatorial nominee Mike Kehoe has a 51%-41% lead over Democrat Crystal Quade. And U.S. Sen. Josh Hawley is leading Democrat Lucas Kunce by 53% to 42%. Some GOP candidates for attorney general, secretary of state and treasurer have even larger leads over their Democratic rivals.

Brian Munoz

St. Louis Public RadioHundreds of demonstrators pack into a parking lot at Planned Parenthood of St. Louis and Southwest Missouri on June 24, 2022, during a demonstration following the Supreme Court’s reversal of a case that guaranteed the constitutional right to an abortion.

One of the biggest challenges for foes of Amendment 3 could be financial.Typically, Missouri ballot initiatives with well-funded and well-organized campaigns have a better chance of passing — especially if the opposition is underfunded and disorganized. Since the end of July, the campaign committee formed to pass Amendment 3 received more than $3 million in donations of $5,000 or more.That money could be used for television advertisements to improve the proposal’s standing further, Rogers said, as well as point out that Missouri’s current abortion ban doesn’t allow the procedure in the case of rape or incest.“Meanwhile, the anti side won’t have those resources to kind of try to make that counter argument as strongly, and they don’t have public opinion as strongly on their side,” Rogers said.There is precedent of a well-funded initiative almost failing due to opposition from socially conservative voters.In 2006, a measure providing constitutional protections for embryonic stem cell research nearly failed — even though a campaign committee aimed at passing it had a commanding financial advantage.Former state Sen. Bob Onder was part of the opposition campaign to that measure. He said earlier this month it is possible to create a similar dynamic in 2024 against Amendment 3, if social conservatives who oppose abortion rights can band together.“This is not about reproductive rights or care for miscarriages or IVF or anything else,” said Onder, the GOP nominee for Missouri’s 3rd Congressional District seat. “Missourians will learn that out-of-state special interests and dark money from out of state is lying to them and they will reject this amendment.”Quade said earlier this month that Missourians of all political ideologies are ready to roll back the state’s abortion ban.“Regardless of political party, we hear from folks who are tired of politicians being in their doctor’s offices,” Quade said. “They want politicians to mind their own business. So this is going to excite folks all across the political spectrum.”

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Democrat Mark Osmack makes his case for Missouri treasurer

Published

3 months ago

August 29, 2024

Natural Bridge

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Mark Osmack has been out of the electoral fray for awhile, but he never completely abandoned his passion for Missouri politics.Osmack, a Valley Park native and U.S. Army veteran, previously ran for Missouri’s 2nd Congressional District seat and for state Senate. Now he’s the Democratic nominee for state treasurer after receiving a phone call from Missouri Democratic Party Chairman Russ Carnahan asking him to run.“There’s a lot of decision making and processing and evaluation that goes into it, which is something I am very passionate and interested in,” Osmack said this week on an episode of Politically Speaking.Osmack is squaring off against state Treasurer Vivek Malek, who was able to easily win a crowded GOP primary against several veteran lawmakers including House Budget Chairman Cody Smith and state Sen. Andrew Koenig.While Malek was able to attract big donations to his political action committee and pour his own money into the campaign, Osmack isn’t worried that he won’t be able to compete in November. Since Malek was appointed to his post, Osmack contends he hasn’t proven that he’s a formidable opponent in a general election.“His actions and his decision making so far in his roughly two year tenure in that office have been questionable,” Osmack said.Among other things, Osmack was critical of Malek for placing unclaimed property notices on video gaming machines which are usually found in gas stations or convenience stores. The legality of the machines has been questioned for some time.As Malek explained on his own episode of Politically Speaking, he wanted to make sure the unclaimed property program was as widely advertised as possible. But he acknowledged it was a mistake to put the decals close to the machines and ultimately decided to remove them.Osmack said: “This doesn’t even pass the common sense sniff test of, ‘Hey, should I put state stickers claiming you might have a billion dollars on a gambling machine that is not registered with the state of Missouri?’ If we’re gonna give kudos for him acknowledging the wrong thing, it never should have been done in the first place.”Osmack’s platform includes supporting programs providing school meals using Missouri agriculture products and making child care more accessible for the working class.He said the fact that Missouri has such a large surplus shows that it’s possible to create programs to make child care within reach for parents.“It is quite audacious for [Republicans] to brag about $8 billion, with a B, dollars in state surplus, while we offer next to no social services to include pre-K, daycare, or child care,” Osmack said.Here’s are some other topics Osmack discussed on the show:How he would handle managing the state’s pension systems and approving low-income housing tax credits. The state treasurer’s office is on boards overseeing both of those programs.Malek’s decision to cut off investments from Chinese companies. Osmack said that Missouri needs to be cautious about abandoning China as a business partner, especially since they’re a major consumer of the state’s agriculture products. “There’s a way to make this work where we are not supporting communist nations to the detriment of the United States or our allies, while also maintaining strong economic ties that benefit Missouri farmers,” he said.What it was like to witness the skirmish at the Missouri State Fair between U.S. Sen. Josh Hawley and Democratic challenger Lucas Kunce.Whether Kunce can get the support of influential groups like the Democratic Senatorial Campaign Committee, which often channels money and staff to states with competitive Senate elections.

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As Illinois receives praise for its cannabis equity efforts, stakeholders work on system’s flaws

Published

3 months ago

August 29, 2024

Natural Bridge

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Medical marijuana patients can now purchase cannabis grown by small businesses as part of their allotment, Illinois’ top cannabis regulator said, but smaller, newly licensed cannabis growers are still seeking greater access to the state’s medical marijuana customers.Illinois legalized medicinal marijuana beginning in 2014, then legalized it for recreational use in 2020. While the 2020 law legalized cannabis use for any adult age 21 or older, it did not expand licensing for medical dispensaries.Patients can purchase marijuana as part of the medical cannabis program at dual-purpose dispensaries, which are licensed to serve both medical and recreational customers. But dual-purpose dispensaries are greatly outnumbered by dispensaries only licensed to sell recreationally, and there are no medical-only dispensaries in the state.As another part of the adult-use legalization law, lawmakers created a “craft grow” license category that was designed to give more opportunities to Illinoisans hoping to legally grow and sell marijuana. The smaller-scale grow operations were part of the 2020 law’s efforts to diversify the cannabis industry in Illinois.Prior to that, all cultivation centers in Illinois were large-scale operations dominated by large multi-state operators. The existing cultivators, mostly in operation since 2014, were allowed to grow recreational cannabis beginning in 2019.Until recently, dual-purpose dispensaries have been unsure as to whether craft-grown products, made by social equity licensees — those who have lived in a disproportionately impacted area or have been historically impacted by the war on drugs — can be sold medicinally as part of a patient’s medical allotment.Erin Johnson, the state’s cannabis regulation oversight officer, told Capitol News Illinois last month that her office has “been telling dispensaries, as they have been asking us” they can now sell craft-grown products to medical patients.“There was just a track and trace issue on our end, but never anything statutorily,” she said.

Dilpreet Raju

Capitol News IllinoisThe graphic shows how cannabis grown in Illinois gets from cultivation centers to customers.

No notice has been posted, but Johnson’s verbal guidance comes almost two years after the first craft grow business went online in Illinois.It allows roughly 150,000 medical patients, who dispensary owners say are the most consistent purchasers of marijuana, to buy products made by social equity businesses without paying recreational taxes. However — even as more dispensaries open — the number available to medical patients has not increased since 2018, something the Cannabis Regulation Oversight Office “desperately” wants to see changed. Johnson said Illinois is a limited license state, meaning “there are caps on everything” to help control the relatively new market.Berwyn Thompkins, who operates two cannabis businesses, said the rules limited options for patients and small businesses.“It’s about access,” Thompkins said. “Why wouldn’t we want all the patients — which the (adult-use) program was initially built around — why wouldn’t we want them to have access? They should have access to any dispensary.”Customers with a medical marijuana card pay a 1% tax on all marijuana products, whereas recreational customers pay retail taxes between roughly 20 and 40% on a given cannabis product, when accounting for local taxes.While Illinois has received praise for its equity-focused cannabis law, including through an independent study that showed more people of color own cannabis licenses than in any other state, some industry operators say they’ve experienced many unnecessary hurdles getting their businesses up and running.The state, in fact, announced last month that it had opened its 100th social equity dispensary.But Steve Olson, purchasing manager at a pair of dispensaries (including one dual-purpose dispensary) near Rockford, said small specialty license holders have been left in the lurch since the first craft grower opened in October 2022.“You would think that this would be something they’re (the government) trying to help out these social equity companies with, but they’re putting handcuffs on them in so many different spots,” he said. “One of them being this medical thing.”Olson said he contacted state agencies, including the Department of Financial and Professional Regulation, months ago about whether craft products can be sold to medical patients at their retail tax rate, but only heard one response: “They all say it was an oversight.”This potentially hurt social equity companies because they sell wholesale to dispensaries and may have been missing out on a consistent customer base through those medical dispensaries.Olson said the state’s attempts to provide licensees with a path to a successful business over the years, such as with corrective lotteries that granted more social equity licenses, have come up short.“It’s like they almost set up the social equity thing to fail so the big guys could come in and swoop up all these licenses,” Olson said. “I hate to feel like that but, if you look at it, it’s pretty black and white.”Olson said craft companies benefit from any type of retail sale.“If we sell it to medical patients or not, it’s a matter of, ‘Are we collecting the proper taxes?’ That’s all it is,” he said.State revenue from cannabis taxes, licensing costs and other fees goes into the Cannabis Regulation Fund, which is used to fund a host of programs, including cannabis offense expungement, the general revenue fund, and the R3 campaign aiming to uplift disinvested communities.For fiscal year 2024, nearly $256 million was paid out from Cannabis Regulation Fund for related initiatives, which includes almost $89 million transferred to the state’s general revenue fund and more than $20 million distributed to local governments, according to the Illinois Department of Revenue.Medical access still limitedThe state’s 55 medical dispensaries that predate the 2020 legalization law, mostly owned by publicly traded multistate operators that had been operating in Illinois since 2014 under the state’s medical marijuana program, were automatically granted a right to licenses to sell recreationally in January 2020. That gave them a dual-purpose license that no new entrants into the market can receive under current law.Since expanding their clientele in 2020, Illinois dispensaries have sold more than $6 billion worth of cannabis products through recreational transactions alone.Nearly two-thirds of dispensaries licensed to sell to medical patients are in the northeast counties of Cook, DuPage, Kane, Lake and Will. Dual-purpose dispensaries only represent about 20 percent of the state’s dispensaries.While the state began offering recreational dispensary licenses since the adult-use legalization law passed, it has not granted a new medical dispensary license since 2018. That has allowed the established players to continue to corner the market on the state’s nearly 150,000 medical marijuana patients.But social equity licensees and advocates say there are more ways to level the playing field, including expanding access to medical sales.Johnson, who became the state’s top cannabis regulator in late 2022, expressed hope for movement during the fall veto session on House Bill 2911, which would expand medical access to all Illinois dispensaries.“We would like every single dispensary in Illinois to be able to serve medical patients,” Johnson said. “It’s something that medical patients have been asking for, for years.”Johnson said the bill would benefit patients and small businesses.“It’s something we desperately want to happen as a state system, because we want to make sure that medical patients are able to easily access what they need,” she said. “We also think it’s good for our social equity dispensaries, as they’re opening, to be able to serve medical patients.”Rep. Bob Morgan, D-Deerfield, who was the first statewide project coordinator for Illinois’ medical cannabis program prior to joining the legislature, wrote in an email to Capitol News Illinois that the state needs to be doing more for its patients.“Illinois is failing the state’s 150,000 medical cannabis patients with debilitating conditions. Too many are still denied the patient protections they deserve, including access to their medicine,” Morgan wrote, adding he would continue to work with stakeholders on further legislation.Capitol News Illinois is a nonprofit, nonpartisan news service covering state government. It is distributed to hundreds of newspapers, radio and TV stations statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation, along with major contributions from the Illinois Broadcasters Foundation and Southern Illinois Editorial Association.

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