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Trans Missourians are ‘terrified’ by gender-affirming care ban

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With Missouri on the brink of becoming the first state to implement sweeping restrictions on gender-affirming care for adults, transgender people and doctors in the state are warning that discarding years of established health care practices will put patients’ lives at risk.“At this point, I’m terrified,” said Axel Pollack, 24, who began his own gender-affirming care in September through Washington University’s gender clinic at St. Louis Children’s Hospital.Like other trans people in Missouri, the future of Pollack’s healthcare was thrown into question April 13, when Attorney General Andrew Bailey issued a temporary emergency order that would place new restrictions on gender-affirming care beginning Thursday.The restrictions apply to people of all ages — which surprised health providers and patients because Bailey’s office last month framed the move as a tool to “protect children.” Although numerous states have sought to restrict transgender health care for minors, Missouri appears poised to be the first state to enact restrictions on such care for adults.“The clinic is telling me that, at the moment, they don’t know how this is going to affect their program,” Pollack said. “They said that I still have my appointment scheduled, but it might be best to prepare to get a new doctor in Illinois.”To be eligible for treatment under the new emergency rules, trans people have to demonstrate multiple years of medical and mental health care history, including experiencing gender dysphoria for three consecutive years. Patients have criticized other provisions in the rules, saying they’re confusing or downright impossible to follow. Another part of the rules mandates that trans people prove that their gender identity is not being influenced by other people or a “social contagion.”Those requirements are leading to widespread confusion for people like AJ Hackworth. A Springfield resident and father of two, Hackworth, 34, received an email on April 14 from his doctor at CoxHealth, the very day after Bailey unveiled the new rules.The email from Hackworth’s doctor said that because of the new rules, Hackworth could no longer be prescribed gender-affirming hormones after April 27. Two days after that email, the doctor sent another. Hackworth’s care would not be interrupted, the doctor wrote — just as long as he complied with the attorney general’s rules.But Hackworth says he doesn’t know how to comply with those rules. What sort of evidence does he need to show his transition wasn’t influenced by a social contagion? Will he have to restart therapy, or find a new psychiatrist?His doctor has no answers.“The provider is saying that she will do everything she can to continue care, and that she is there for us, but it doesn’t feel like anything is really changing,” Hackworth said. “I don’t know what to anticipate. I don’t know what kind of paperwork she’s going to require. There’s just so much up in the air. I don’t know what my future looks like.”

Danny Wicentowski

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St. Louis Public RadioDemonstrators take to the streets of downtown St. Louis to protest statewide policies and rhetoric targeting transgender people on April 16, outside of City Hall.

The stakes are high for trans people waiting to find out whether Missouri will allow them to continue their treatments. But, at least right now, providers have little guidance to offer them.At Southampton Healthcare in St. Louis, Dr. Sam Tochtrop is trying to schedule as many patients as he can before the rules go into effect. He said he’s fielding calls from patients terrified that they will lose their healthcare.“I probably had four or five patients, and they said ‘Hey, how much of my prescription can I get at one time, because I need to keep a stock of that so I can move out of the state.’”Dr. Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri, said that the aftermath of Bailey’s announcement has confused and worried providers and patients “now scrambling to figure out how they are going to continue this basic lifesaving care.”In facilities in St. Louis and across Missouri, Planned Parenthood opened hundreds of appointments to meet the sudden flood of patients seeking to obtain longer prescriptions for their needed medications. Others are desperate to simply become patients before April 27.“Many of these patients have spent a lifetime overcoming barriers trying to access this health care in a way that helps them live healthy, fulfilling lives,” McNicholas said. “And many of them are asking now, first of all, why are they being targeted?”

Sarah Fentem

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St. Louis Public RadioMatty Manshack, a patient at Planned Parenthood, holds supplies for injecting testosterone he received from a walk-in clinic at the organization’s Central West End location. Manshack came to the clinic directly from his job as a welder.

One patient, Matty Manshack, came to Planned Parenthood’s walk-in clinic for transgender people earlier this month in the Central West End. Manshack has been in recovery for addiction and was finally considering taking testosterone when he heard about Missouri’s emergency rule. He knew he needed to get an appointment as fast as he could.“It’s a very powerless feeling to know that your health and your mental health is in someone else’s hands,” he said. “People are scared of what they don’t know, and what they don’t understand… And not only that, but they’re not willing to try and understand, which is even scarier.”The complications are deeper than just medical appointments or vague provisions in the rules. For a trans person, losing access to hormones and gender affirming care can be life-threatening.“This is life and death for many people,” said Michaela Joy Kraemer, the executive director of the Metro Trans Umbrella Group in St. Louis. “And to know very close friends and community members who have died by suicide recently as a result of lack of support, lack of access — it’s crushing.”On Monday, a coalition of civil rights groups, including the ACLU of Missouri and Lambda Legal, filed a legal challenge against the emergency rules. A judge in St. Louis County will preside over a hearing Wednesday about whether to issue a temporary restraining order before the rules go into effect this week. (Southampton Healthcare in St. Louis, which employs Dr. Sam Tochtrop, is a plaintiff in the suit.)Seeking to halt the rules from going into effect, the lawsuit argues that Bailey is overstepping his authority as attorney general to pass “unprecedented and unique restrictions so onerous that it effectively prohibits the provision of this necessary, safe, and effective care for many, if not most, transgender people in Missouri.”

Danny Wicentowski

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St. Louis Public RadioA demonstrator holds a transgender flag while atop a vehicle, during an April 16 protest in St. Louis against anti-trans policies and legislations in Missouri.

Along with the lawsuit, the impending rules have sparked multiple protests across the state. Earlier this month, Pollock, the college student who receives gender-affirming care from Washington University, joined hundreds of people marching through downtown St. Louis earlier this month to protest the new rules.“I’m more scared for myself, about the mental health aspect with my gender dysphoria,” he said. “If I have to stop taking my testosterone… my mental health is going to plummet really bad. And I’m gonna wind up in a constant depressed state, worrying about being suicidal all the time, because I can’t live with who I was.”Pollock said it was powerful to see the large turnout at the protest, and to join the crowds as they marched to St. Louis City Hall.“It reminded me that I am not alone in this battle,” he said. “We’re just a giant family who’ve got each other’s backs. And as long as one of us keeps fighting, there’s hope.”St. Louis Public Radio’s Sarah Fentem contributed to this report.

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Poll: Support for Missouri abortion rights amendment growing

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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

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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

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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

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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

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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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