A year ago, Florida Republicans added hurdles to transgender health care and restrictions on public bathrooms. Now, they’ve moved on to a new issue: driver’s licenses and health insurance.
On Monday, the Florida House Select Committee on Health Innovation OK’d legislation (HB 1639) on a 11-4 vote that would require driver’s licenses to display the carrier’s sex at birth rather than their gender identity.
It would also require all insurances, health benefit plans and health maintenance contracts in the state that cover trans-related health care to also cover detransition care, defined as discontinuing or seeking to reverse gender-affirming medical or surgical interventions.
The legislation also requires all health plans to cover therapies to “treat a person’s perception that his or her sex …. is inconsistent with such person’s sex at birth.”
The House bill was filed by Rep. Doug Bankson, R-Apopka, and Rep. Dean Black, R-Jacksonville. A similar bill (HB 1233) also was filed by Black.
In Florida, about 1.32% of teens identify as transgender, according to a 2022 publication from the Williams Institute at UCLA. That number was even smaller for adults, with 0.55% of Floridians age 18 and older identifying as trans.
Democrats voiced concerns about legality of measure
Bankson presented the bill on Monday, along with an amendment that added a definition of biological sex. “(We’re trying to) give the option for individuals in their pre-rights to find the peace in their life,” he said.
“This gives the opportunity for those who have said, ‘You know what, (transitioning) didn’t solve what was going on in my core,’ the opportunity to be medically responded to in a way that does help them find their path of health.”
Rep. Johanna Lopez, D-Orlando, said changing “gender” to “sex” on Florida licenses and IDs would potentially put Florida out of compliance with the Federal Real ID Act, which requires a person’s gender on ID and licenses.
Bankson said there were still some aspects of the bill that would need to be worked out, but his goal was to create a “state standard” for government documents related to references of sex and gender.
Rep. Anna Eskamani, D-Orlando, said the bill might not abide by the Affordable Care Act in terms of creating discriminatory premiums. She also raised concerns about the bill creating an administrative burden on the private insurance sector and that it would result in trans people losing access to insurance coverage.
Bankson disputed this: “I don’t think that any insurance company would turn down new business,” he said.
Despite Bankson repeatedly saying the bill was coming from a place of compassion for both trans people and those looking to detransition, former state Rep. Carlos Guillermo Smith, now with Equality Florida, called the bill a “sweeping new assault on the freedoms of transgender Floridians.”
“This will raise already soaring insurance costs on all Floridians, LGBTQ or not,” he said. “It’s time for Florida lawmakers to divorce themselves from DeSantis’ extreme agenda, stop the culture war attacks against LGBTQ Floridians and get to work solving real problems rather than creating new ones.”
Licenses: ‘I followed the law to the letter’
Now, transgender people can change their gender on a driver’s license or identification card by presenting credentials from another state, a certified court order or a signed statement from a physician or an advanced practice nurse that says the patient is transitioning.
The standards that the Florida Department of Highway Safety and Motor Vehicle follow were established by the World Professional Association for Transgender Health.
The legislation seeks to replace the term “gender” with the term “sex” on driver’s licenses and other forms of identification, adding that drivers licenses issued by DHSMV must include the holder’s sex instead of gender. Further, the bill would require DHSMV to amend its policies to require each applicant’s sex instead of gender.
During public comment, more than 17 members of the public spoke on the bill, with only one speaking in favor of it. Many were trans and and nonbinary Floridians who shared what it felt like to change the gender marker on their driver’s license and the potential danger they might face if required to revert the marker to their birth sex.
Jude Spiegel showed his Florida driver’s license and described the process of obtaining paperwork from multiple doctors, changing his gender marker at the social security office and then going to the DMV to get a new license.
“If you think it was something as simple as checking a box, you’d be incorrect,” he said. “I followed the law to the letter. Now we want to what, retroactively change this, revoke my right to an accurate ID that doesn’t out me to everyone under the sun?”
Insurance: ‘Gender affirming care works’
Nearly every major medical association in America backs the treatment of gender dysphoria, or the discomfort with one’s sex assigned at birth, through gender-affirming care such as puberty blockers, hormone-replacement therapy and surgery.
Florida banned that care from all minors except those already receiving care during last year’s legislative session. Adults can now access care only through an in-person visit with an M.D. or D.O., where they must sign a state-approved informed consent document.
WPATH’s standards, the most recent version of which was published in 2022, assert that psychotherapy might be helpful for transgender people, but should not be a requirement to access gender-affirming care. They oppose conversion therapy — or the attempt to correct one’s transgender identity — and say it should not be offered.
The bill would require insurance to pay for conversion therapy, though Bankson repeatedly said other therapy options would also be covered. Smith criticized the bill for this requirement: “(Conversion therapy is) a dangerous and debunked practice that falsely claims to turn gay people straight and trans people cis,” he said.
Some speakers questioned why the bill addressed care for people seeking to detransition when Florida put up barriers to accessing gender-affirming care last year. Spike Poma, an intersex trans man, described losing access to hormone replacement therapy that corrected medical issues he had from uneven levels.
“You don’t even give fair access to receiving our health care for those of us diagnosed with gender dysphoria, so to want to provide the opposite equally is hypocrisy,” he said.
And Lilith Black, who previously identified as a trans woman but has since detransitioned or “re-transitioned,” spoke on the bill being unnecessary. “The services that I required were the same ones that are covered by gender-affirming care,” they said. “Gender affirming care works, no matter whether it’s forward, backwards, side to side.”
