New MAP “Under Fire” Report:

Recent Political Attacks on Transgender Youth Are the Tip of the Iceberg in Broader Effort to Eliminate Transgender People from Public Life 

MEDIA CONTACT:   
Rebecca Farmer, Movement Advancement Project
rebecca@mapresearch.org  | 303-578-4600 ext 122

September 14, 2023

Political and legal attacks on transgender people have dramatically escalated in recent years. While these attacks have primarily focused on transgender youth, these attacks are only the tip of the iceberg of a broader, coordinated effort to eliminate transgender people of all ages from public life, according to a report released today by the Movement Advancement Project (MAP). The report, Banning Medical Care and Legal Recognition for Transgender People, is the fifth in MAP’s report series, Under Fire: The War on LGBTQ People in America. 

The volume and speed of these attacks are unprecedented. This year alone, state legislatures introduced more than 725 anti-LGBTQ bills—shattering previous records—and the majority of these bills specifically targeted transgender people, including their access to health care, bathrooms, accurate identity documents, and much more. 

For example, in 2023, more states enacted bans on transgender youth’s medical care than passed bans on marriage equality in 2004, one of the worst years in the fight for marriage equality. This year alone, 19 states have enacted bans on medical care for transgender youth, compared to 13 states that banned marriage for same-sex couples in 2004. 

“While most of the public focus has been on recent efforts to ban medical care for transgender youth, these attacks are part of a much larger, coordinated effort to try to erase transgender people from public life entirely,” said Logan Casey, Senior Policy Researcher & Advisor at MAP.  “Anti-LGBTQ extremists want to make it impossible for transgender people to be ourselves and to be legally recognized according to our gender identity.”  

This latest report in the Under Fire series from MAP identifies five core tactics opponents are using in their attempts to erase transgender people from public life: 

Tactic 1: Banning health care for transgender youth 
The medically necessary health care for transgender youth that is targeted by anti-LGBTQ politicians is endorsed as best practice, evidence-based care by all major medical associations including the American Academy of Pediatrics and the American Medical Association. Despite this, the pace at which states are banning access to this care is remarkable. For example, prior to 2021, no states banned medical care for transgender youth. Today, 22 states have enacted this kind of ban – 19 of them during this year alone. 

• Currently more than 1 in 3 transgender youth live in a state than bans or severely restricts health care for them.  
• These kinds of laws have been enacted in all but two states in the U.S. South, leaving transgender youth in nearly an entire region without access to medically necessary care. 
   

Tactic 2: Banning health care or severely restricting health care for transgender adults 
While much of the political rhetoric–and the legislation passed this year–has focused on banning access to lifesaving care for transgender youth, the broader goal is to ban all transgender-related healthcare, regardless of age. This is increasingly evident in the legislation and other political attacks across the country, which are more and more explicitly targeting transgender adults’ access to care. For example:

• Nearly one-third of youth-focused medical care ban bills introduced in 2023 would also limit health care for at least some transgender adults.
• Some legislation seeks to ban healthcare for transgender adults by redefining a minor to include adults up to age 26, or through provisions explicitly restricting adults’ access to care.
• At least nine states explicitly exclude transgender-related healthcare from Medicaid coverage for adults as well as youth. Some states also ban coverage transgender-related care in state health insurance plans.
• Prior MAP analysis found that, from 2020 to April 2023, roughly one in seven bills attacking transgender health care included provisions to ban or restrict coverage in private health insurance.

Tactic 3: Limiting transgender people’s ability to live openly and participate in daily life
Anti-LGBTQ forces are increasingly targeting the ability of transgender people to live openly and safely as themselves throughout their daily lives. This includes making it impossible or extremely difficult to obtain accurate ID, banning the use of bathrooms, restricting social transition, and forced outing of transgender students.  

• Four states ban people from updating the gender marker on their birth certificates and another 12 states impose invasive and overly burdensome medical requirements. Having an identity document that matches a person’s gender identity reduces the risk of harassment, discrimination, and even violence. Birth certificates are often a necessary first step to obtaining other forms of ID that are more commonly used on a day-to-day basis, such as a driver’s license. 
• Nine states now ban transgender people from using bathrooms and other facilities that match their gender identity. Seven of those state bans focus on schools, banning transgender students but also transgender staff and parents from bathrooms. New bans, especially in Florida, are expanding their scope to apply not only to schools but also to other government owned buildings and spaces; Florida’s ban includes major airports, sports arenas, and much more.  
• At least 10 states have enacted new restrictions that effectively make it illegal for schools to use a transgender student’s name and pronouns. Five states now require schools to out transgender students to their families, often regardless of whether this might put the child at risk of harm.  
• More than a third of transgender students live in the 23 states that have enacted a law to ban them from participating in sports according to their gender identity.  

Tactic 4: Rolling back legal recognition and protections
Opponents are also working to overturn the limited protections from discrimination that do exist for transgender people while also working to enact new ways to remove opportunities for legal recognition.   

• Just in 2023, four states have enacted a new kind of law that defines “sex” throughout state law to allow discrimination against transgender and nonbinary people. Two additional states’ governors issued executive orders to the same effect.  
• Fewer than half of states have explicit nondiscrimination protections for transgender people. Some states are working to undermine those existing protections with religious exemptions. 

Tactic 5: Criminalizing and harassing supporters of transgender people 
Even supporters of transgender equality are being targeted to make it more difficult or even impossible for them to continuing doing so. The result is that transgender people are further isolated and, with fewer support systems, may be pushed out of public life. 

• Health care providers for transgender people are facing loss of their licenses or even criminal penalties for providing medically necessary care that is endorsed by major medical associations. In five states, it is now a felony to provide best practice medical care to transgender youth.  
• Dozens of hospitals have reported receiving bomb threats and other serious harassment for providing medically necessary care to transgender youth.  
• Many bills in recent years also target parents who support their transgender children. Florida legislation introduced in 2023 would have allowed the state to remove children from their families if the parents were even suspected of supporting them in receiving best practice medical care. 

“Make no mistake – this swift and coordinated attack on transgender people in the U.S. is part of a larger war on LGBTQ people,” said Casey. “It’s essential that we see beyond one bill or policy to understand the broader scope of what is occurring. This is a coordinated and organized effort to try to erase not just transgender people, but LGBTQ people overall, from being able to publicly live our lives.” 
 
The entire Under Fire series is available here.