Last month, Ohio became the latest state to pass a ban on gender-affirming care for minors—part of the wave of anti-trans legislation across the country. Then at the last minute, Republican Governor Mike DeWine seemed to offer relief, announcing on December 29 that he would veto the ban, formally known as House Bill 68. From Human Rights Campaign to GLAAD to Equality Ohio, LGBTQ rights groups praised DeWine, a Trump-endorsed Republican, for flipping the right’s “parental rights” script to argue against the ban: “Many parents have told me that their child would not have survived, would be dead today, if they had not received the treatment they received from one of Ohio’s children’s hospitals,” DeWine said when announcing his veto.
But DeWine’s veto wasn’t what it seemed. In the same press release that announced the veto, the governor said he was directing government agencies to adopt new “administrative rules” on gender-affirming care that would put care out of reach for many trans Ohioans—minors and adults. On January 5, he affirmed this plan via executive order: new mandates that providers submit detailed data on care provision to the state every six months, and new requirements that anyone seeking care get the approval of a team including a psychiatrist, an endocrinologist, and a bioethicist. While getting credit for vetoing one ban, DeWine is proposing another ban in all but name.
“All of the proposed rules are unnecessary, harmful, and cruel,” Dara Adkison, board secretary of TransOhio, told me this week, “They contradict current well-established medical guidelines backed by national and international standards. These rules stand to harm all trans, non-binary, intersex and gender nonconforming people in the state, but particularly those who are Black and/or in the rural portions of Ohio.”
The confusing, demoralizing about-face seemed designed to provide deniability to DeWine’s administration. Headlines did not acknowledge this when reporting the veto. “Ohio Governor Blocks Bill Banning Transition Care for Minors,” The New York Times reported. Fox News went with: “Ohio governor vetoes bill banning gender-reassignment treatment, trans participation in women’s sports.” DeWine’s executive order on January 5 did exactly what his veto press release promised: banned gender-affirming surgery for minors and initiated the administrative rule process for additional restrictions, emphasizing that these rules would “go well beyond what was in House Bill 68.” For example, as he continued, “I am concerned that there could be fly-by-night providers or clinics, that might be dispensing medication to adults with no counseling, no basic standards to ensure quality of care.” (He didn’t offer evidence that this is happening in the state—only his feeling that this “could” be happening.)
The attempt to “soften” or “compromise” on a ban on gender-affirming care by instead proposing strict guidelines that could make care impossible to access may seem familiar. It’s the same playbook conservatives followed with onerous administrative rules around abortion during the Roe years: If you cannot ban abortion outright, then you attempt to administrate clinics out of existence. Such regulations have little (if not nothing) to do with health, safety, and medical ethics, and everything to do with creating unnecessary risks for those providing health care. They also give those who oppose this care a way of couching their opposition in other terms: rather than a “ban,” they say they support gender-affirming care with more data collection and oversight, care that is more “comprehensive.” In other words, they say they want more control over the process. In this case, as the ACLU said in a recent statement, these restrictions “could amount to a de facto ban on care for transgender youth and adults.”
“In many ways, this outcome is even worse than the lack of a veto,” wrote Zinnia Jones, a researcher and writer of Gender Analysis, about DeWine’s new strategy. Jones has been analyzing and reporting on similar efforts at using administrative rules to limit access to gender-affirming care, as Florida Governor Ron DeSantis attempted in 2022. “While this was previously a question of whether gender-affirming medical care for youth would be banned or not, this veto has instead been used as an opportunity to target and restrict care for transgender adults, a vastly larger segment of the trans population than youth.”
Some of the rules proposed concern health care providers, such as requiring they report every “diagnosis of a gender-related condition” to the Ohio state Department of Health within thirty business days. The rules also mandate that providers track and report the age, “biological sex,” “specific information about the nature of any diagnosis,” their “treatment plan” (such as hormone replacement therapy, or HRT), and if those individuals cease treatment or “detransition.” The health department is directed to “share aggregate data collected pursuant to this rule” every six months with the state legislature and the public. Anything can be made public so long as it is “in summary, statistical, or aggregate form.” How, or if, this data is meant to improve health outcomes is not proposed or described. It’s also unclear why the state wants to publish a public summary of all the reasons expressed by individual adults about why they are seeking transition care. Other proposed rules could directly impede access to care by mandating treatment from multiple, costly, and already difficult-to-access specific medical professionals. These new policies would mandate that, to lawfully provide gender-affirming care to adults or minors, including even “diagnosis of a gender-related condition,” the patient must get in-person, direct services from a psychiatrist, an endocrinologist, and have a “written, comprehensive, multi-disciplinary care plan … which has been reviewed by a medical ethicist.” For many trans people in Ohio, this will be nearly impossible to obtain. It is a rule of exclusion.
“The rules as written seem tailor-made to eliminate care from smaller clinics, and leave standing larger hospital networks,” Cam Ogden, a member of Trans Allies of Ohio, told me this week. If these rules went into effect, Ogden said, “the clinic that I get my HRT from would not be able to meet these demands and would likely have to shut down their gender-affirming care provision.” While a number of pediatric hospitals in the state provide care involving the multidisciplinary teams the new rules would now require of adults, as Ogden explained, there are only so many. “If every single transgender person in the state is mandated to be a part of one of those teams, then we’re going to have to go out of state for care.”
On Wednesday, the Ohio House of Representatives voted to override DeWine’s veto of their initial bill banning gender-affirming care for minors, with a senate vote expected later this month. But there is no indication that, if the veto override makes it through the legislature, DeWine would withdraw his proposed additional rules. These rules are, after all, mostly in excess and outside the scope of the ban. Meanwhile, the Ohio Department of Public Health and Department of Mental Health and Addiction Services are accepting public comment on these proposed rules. Typically, there would be hearings after public comment, said Dara Adkison of TransOhio, but these agency rules were introduced under an “emergency” clause. “There is no timeline,” she said. “We are not operating as normal.”
As debate and adoption of these new restrictions on care will transpire outside the state legislature now, DeWine has also made the process even less accessible. “The rules being proposed are the most stringent rules currently under consideration anywhere in the United States, and would restrict gender-affirming care providers to a handful of university hospitals,” wrote Jess Kant, a social worker and trans health researcher, in a blog post detailing the rules process. “Is it disappointing to have to essentially fight this battle on multiple fronts? Yes,” Siobhan Boyd-Nelson, co-interim executive director of Equality Ohio, told me this week. “Is it draining for our movement, our organization, and our community? Absolutely. Do I think that’s an accident? I do not.”
Still, as both Boyd-Nelson and Adkison emphasized, their organizations are ready for that fight. These proposed rules governing gender-affirming care must be understood, like restrictions on providing abortion, as an attempt to narrow the conditions under which care can be lawfully provided. In abortion care, the direct parallel would be TRAP laws—or targeted regulation of abortion providers—which typically far exceed what is needed to safely provide care, by specifying the width of corridors or procedure rooms, or requiring clinics to be within a set distance from a hospital. Some mandate that providers have qualifications or affiliations that are not medically necessary. All of this has the effect of limiting who can provide and who can get an abortion.
Such restrictions on abortion and on gender-affirming care often originate with lawmakers who lack expertise on health care, who were prompted by Christian right groups who oppose such heath care as part of their effort to roll back rights for queer people, trans people, women, and all of the above. Ohio State Representative Gary Click, who first introduced the ban that became HB 68 and dubbed it the “Save Adolescents from Experimentation” bill, was approached in 2021 by the Christian right group Center for Christian Virtue. Founded in an Ohio church the 1980s, the Center for Christian Virtue has fought anti-discrimination protections for LGBTQ people at the city level, and headed the campaign for a constitutional amendment banning same-sex marriage in the state.
In line with the broader post-Obergefell strategy from the Christian right, CCV have stepped up attacks on trans rights and trans people generally. The group’s policy director, in a 2021 sermon at an Ohio megachurch, claimed that adults were coercing children into gender-affirming care. Representative Click has himself claimed that young people are “groomed in school and other places” into being trans. He has also spread misinformation about gender-affirming care and suicide risk, which he said he learned from CCV. “Representative Click actively chose to put forth legislation that will forcibly detransition all transgender minors in the state without talking to a single one,” said Cam Ogden, who is also one of his constituents. Ogden asked Click directly whether he had talked to any trans individuals when proposing this legislation. Click confirmed that he had not.
What has been made to look like a debate over health care provision to trans people is—and arguably was from the start—an attempt to make the rights of trans people debatable. “This is how they begin to roll back the progress that we’ve made,” said Boyd-Nelson from Equality Ohio. “And let’s be clear: we didn’t make all that much progress.”
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