This term’s Supreme Court decision that allows states to ban gender-affirming health care for adolescent transgender minors is causing fear, frustration, and resolve in the LGBTQ+ community in Bloomington-Normal.
Transgender children and their parents in Tennessee had claimed the state ban on hormone treatments and puberty blockers for transgender minors discriminated on the basis of sex. They argued they were being denied equal protection under the law because other minors with conditions such as endometriosis and unusual onset puberty can get the same medications banned for minors with gender dysphoria.
Jess Sturges is a trans man and the program manager of advocacy and campaigns for the Central Illinois region of Planned Parenthood of Illinois. He transitioned at age 19.
"I remember being a queer teenager. It wasn't that long ago, and it wasn't great. It makes my heart hurt to see like these bans passing in a lot of other states," said Sturges.
Roughly half the states ban gender-affirming medical care for trans minors.
Renee Mishler grew up in Central Illinois and transitioned two years ago at age 34. Even though Illinois protects transgender rights and gender-affirming care, Mishler said there remains harsh national rhetoric matters in this state, and in this community. In just the last two weeks, Mishler said she's been accosted twice for using a women's bathroom at businesses in Bloomington.
"Maybe people think that what happens in Washington, D.C., doesn't impact us in our day to day lives, but when people hear things like, oh, trans people are threatening your children, trans people are a threat to you in public restrooms, that fear comes back to us tenfold," said Mishler.
Mishler said it's frustrating to be a stand-in for larger cultural and political issues.
"It's Anita Bryant save our children from the 1970s repackaged against trans people. It's Joseph McCarthy's witch hunt, which was partly based on homophobia repackaged against trans people. It's the same ignorant, hateful song and dance that we've heard time and time again," said Mishler.
Legal basis
The language of the Supreme Court opinion used the lowest of three ways to evaluate whether state legislation violates the equal protection clause of the Constitution. It's called a "rational basis" for the law.
Illinois State University legal studies professor Thomas McClure said that usually applies to economic legislation. An intermediate test applies to sex. The highest tier is called "strict scrutiny" which applies to things like race and religion. Despite a strong dissent by Justice Sonia Sotomayor, McClure said what the court did was not a stretch. It's similar to the decision in an early sex discrimination case from the 1970s.
"Which had to do with treatment of pregnancy as a disability that wasn't covered by a state insurance plan. And the argument was made that this was discrimination on the basis of sex because only women get pregnant. And the court there concluded it was not a sex-based discrimination, because women can also be under the plan who are not pregnant. They used the same kind of reasoning here," said McClure.
Advocates for transgender people said unlike the Dobbs case, which threw decisions regarding abortion back on the states, this decision has broader implications than just an impact to state laws. Jess Sturges of Planned Parenthood said yes, it emboldens other states to perhaps set similar bans. But "legality" and "access" to care are different things. Sturges said the case complicates an already confusing health care environment because each state can determine what health coverage looks like.
"It's a lot to keep up with. Things are changing rapidly. If you are a parent of a trans youth, or have a trans person in your life that you're helping support, you might be like, where do I even go to help my loved one, even if you're supportive? So, it really just makes things so much more challenging for people," said Sturges.
Illinois as safe haven
Illinois is one of those places to go for help, though service availability is uneven. The Patient and Provider Protection Act became law in 2023, after the Supreme Court overturned Roe vs. Wade. It solidified access to abortion and gender-affirming care in Illinois and protects physicians who treat out-of-state youth.
In the two years since passage, Illinois has become a haven state for transgender youth. Dave Bentlin of the Prairie Pride Coalition said about five families with trans members have already moved into Bloomington-Normal since the law passed. Bentlin said more will follow, and Prairie Pride has to be ready to extend support.
"They're coming from states where it's not so safe for them to be transgender and nonbinary. We've had a few outreaches to our organization, and we've got a directory of gender-affirming support services here in the community," said Bentlin.
Planned Parenthood of Illinois said around 7% of its gender-affirming patients come from out of state. Demand increased when nearby states restricted treatment for gender dysphoria.
Some services offered in Illinois though are under attack at the federal level. In the big reconciliation bill sitting in the Senate, there is a proposed ban on gender-affirming care for Medicaid patients.
"As someone who is on Medicaid and receives gender-affirming care through Medicaid, it's pretty terrifying," said Renee Mishler.
Mishler said that care is never a frivolous thing. Body positivity was never something she felt she was allowed to have, and it lets her love the person she sees in the mirror.
"Gender-affirming care saved my life. I don't know if I would be sitting here talking to you right now without Planned Parenthood and medical services that they provided for me," said Mishler.
It's not just Medicaid services for trans people at risk, according to Planned Parenthood's Jess Sturges. Sturges said he sees the cuts in the big reconciliation bill as part of a larger pattern that could move beyond the LGBTQ community.
"The way it's all written now, if it makes it through, it also affects the Affordable Care Act plans. It emboldens the Affordable Care Act plans to be able to ban gender-affirming care, and it just opens this whole other can of worms, of like, what else are we excluding? We already have a lot of things that are pre-existing conditions. This is a whole other angle," said Sturges.
Sturges said many programs intersect in the trans population that are also up for federal cuts. He says trans people disproportionately live at the poverty line. It's not just healthcare. It's SNAP food aid too.
The Supreme Court decision ducked the issue whether people who are transgender as a class have special protection. ISU Professor Thomas McClure said a case coming up perhaps next year involving transgender people and the military may address that.
McClure said in concurring opinions in the recent case, Justices Barrett, Thomas, and Alito indicated they do not think transgender is a classification that should have special protection.
"We don't know the position that justices Gorsuch or Kavanaugh or the Chief Justice have taken on that issue, but I would wager to think that they would also say there's no special protection,” said McClure.
Dave Bentlin of the Prairie Price Coalition said the legislation and the climate in the courts does raise concern about the potential for a national ban on gender-affirming care for minors and other legislation that could affect Illinois.
"This Congress is going after specific subsets of people and are trying to enact legislation that would curtail rights to any number of variety of people," said Bentlin.
Bentlin noted some states are already trying to pass legislation to ban marriage equality, and those may eventually get to the Supreme Court too.
Renee Mishler said there is a systematic effort to cut trans people out of programs and services they need to not only survive but thrive.
“This is what wiping out transgender people looks like from American life, whether it's banning our medical care or erasing our history from government websites. It's not only a silencing of trans folks and our history, but destruction of our physical and mental health," said Mishler.
There are some things that offer comfort.
"It can get pretty scary, and I think that, for me, the trans community the LGBTQ community, that's where I find my hope, where I find real joy to keep up the fight," said Mishler.
And she said community is what people need right now.
