Hobbs issues orders on “conversion therapy,” gender-affirming health care

PHOENIX Gov. Katie Hobbs issued executive orders Tuesday to stop the use of public funds for conversion therapy for minors, while mandating their use for gender-affirming health care for adults. The first tier is for AHCCCS patients as well as university and state government employees and retirees, while the second is for current and former university and state government workers.

In the first, the Democratic governor targeted what the Associated Press calls the scientifically discredited practice of using therapy to convert LGBTQ people to heterosexuality or traditional gender expectations. Hobbs specifically prohibits the use of federal or state dollars to promote, support, or permit conversion therapy on minors.

Hobbs’ order includes health insurance that the state makes available to its or university employees, which includes mental health services.

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All mental health services available to individuals and families enrolled in the Arizona Health Care Cost Containment System, the state’s Medicaid program, are also affected. Approximately 2.5 million state residents are enrolled in AHCCCS.

A separate law, however, prohibits AHCCCS from paying for gender-affirming care for those enrolled in the system.

Governor Katie Hobbs

Mark Peterman, Associated Press

Hobbs wrote that conversion therapy is based on the false premise that homosexuality and mixed gender identities are pathological.

Separately, Hobbs directed the Administration Department, the state’s personnel arm, to remove language-exempting gender reassignment surgery from health care policies now available to state government and university employees and retirees. Hobbs specifically exempts coverage of minors which is prohibited by state law.

This order will immediately strike Russell Toomey, a transgender University of Arizona professor who filed a lawsuit four years ago after being denied coverage for a long-sought hysterectomy.

Toomey said the state refused to pay for what she said was a medically necessary procedure for her gender dysphoria, even though the insurance policy covers other medically necessary surgeries. This amounted to unlawful discrimination based on sex since the insurance would have to cover all medically necessary surgical procedures, her lawyers said.

The executive order will now end the lawsuit.

The larger win is that the governor’s action will pave the way for other transgender workers to gain similar coverage.

Striking hate and discrimination

Central to both orders, Hobbs said, is how the state treats some of its residents.

Our LGBTQ+ community should never face hate and discrimination, Hobbs said in a prepared statement.

The state is leading by example on this issue, he continued. And we will continue to work until Arizona is a place where every individual can participate fairly in our economy and workforce without fear of discrimination or exclusion.

Both new orders are an extension of actions Hobbs took on his first day in office in January by expanding existing rules against discrimination against current or prospective state government employees.

At the time, the rules covered race, gender, religion, pregnancy, and veteran status. He extended them to include other traits that may not be considered in hiring, firing or compensation, ranging from gender identity and marital status to culture, creed, social origin and political affiliation.

Hobbs’ expanded list also included sexual orientation, though it appears that was already covered in a 2003 executive order issued by the then-governor. Janet Napolitano, a Democrat.

A threat by State Senator Jake Hoffman, R-Queen Creek, to contest the order never materialized.

Now, Hobbs is targeting other practices it considers discriminatory.

Pima County has already banned the therapy

He cited findings from various organizations that oppose the practice of conversion therapy on minors due to what they say are dangerous effects.

He wrote that those include the American Psychological Association, which has stated that being subjected to conversion therapy in childhood contributes to an individual’s increased risk of suicide, depression, and substance use during their lifetime.

He also said the federal Substance Abuse and Mental Health Service administration concluded that conversion therapy is coercive, can be harmful, and should not be part of behavioral health treatment.

Hobbs does not have the unilateral power to outlaw the practice throughout Arizona.

This is a question for state lawmakers. And while more than 20 states have banned the practice, this isn’t the case.

There is one exception. Paid conversion therapy is illegal in Pima County, where the Board of Supervisors enacted a restriction in 2017. A bid by then state Senator Vince Leach, R-Tucson, to have the ordinance overturned lawmakers failed.

What Hobbs said he can do, in his duty to taxpayers, is ensure that decisions are fiscally sound, transparent and evidence-based and that public health funds are not spent on discredited, ineffective and unsafe practices.

Medical care needed

His second executive order Tuesday refers to Toomey’s multiyear struggle to get the state to pay for his hysterectomy.

Hobbs pointed out that state insurance plans already require payments for medically necessary care.

She said only the policy written for the state government excludes gender reassignment surgery, an exclusion she says is inconsistent with policies state insurance companies offer other clients.

There have been successful challenges in other states to that exclusion, Hobbs said. So he ordered it removed as soon as practicable, with advance notice provided to government and university employees enrolled in the system.

They include Toomey, a professor of family studies and human development at the UA who conducts research on how sexual and gender-minority youth thrive despite the barriers and challenges they face.

In an interview with Capitol Media Services, Toomey said he knew he was different at an early age.

I thought I was a boy at that point, but was told by everything and everyone in my environment No, suck it, you’re a girl, she said.

It took until she was at least 19 years old, read, booked, and worked with a counselor who learned there was a phrase to describe what she was experiencing: gender dysphoria, a sense of discrepancy between her assigned sex birth and gender identity.

Soon after, she began taking hormones and, about a year later, underwent chest reduction surgery, all of which she paid for out of her own pocket.

The need to have a hysterectomy has been around for as long as I can remember, Toomey said. But he said he waited until he got the security warrant at the UA to seek coverage for the hysterectomy, first trying to change the policy and, when that didn’t work, filing a lawsuit.

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Howard Fischer is a veteran journalist who has written since 1970 and covered state politics and the legislature since 1982. Follow him on Twitter at @azcapmedia or email azcapmedia@gmail.com.

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