JUNEAU — The Alaska House this week amended its draft budget to cut Medicaid funding for so-called optional treatments for gender dysphoria.
Multiple lawmakers expressed that if the proposed cut is ultimately approved by the Legislature, it is likely not to cut health care for transgender Alaskans, although the implications remain uncertain.
Additionally, the Legislature’s attorneys warned that the proposed cut to gender dysphoria care could be unconstitutional and unenforceable.
Rep. Sarah Vance, R-Homer, highlighted that the Alaska State Medical Board urged the Legislature in March to ban hormonal and surgical treatments for minors seeking to transition from one gender to another.
Vance stated the cut would ensure taxpayer-funded coverage for gender dysphoria treatments is limited to only what is “medically necessary” as required by the courts.
In 2021, the state settled a class-action lawsuit that challenged the legality of excluding transgender Alaskans from health coverage related to their gender transitions.
Consequently, that coverage through Medicaid is currently required.
Jennifer Martinez, a spokesperson for Planned Parenthood Great Northwest, mentioned that the organization believed the proposed cut would likely not result in reduced Medicaid coverage for transgender Alaskans.
However, if the cut is ultimately approved by the Legislature, Martinez noted that Alaska’s Medicaid office would determine which treatments to cover.
This decision could impact what she referred to as “edge” treatments, such as follow-up surgeries for transgender Alaskans, although the specifics remain unclear.
The amendment to cut gender dysphoria treatments was approved on a narrow 21-19 vote.
Two Republican members of the Democrat-dominated majority — Reps. Chuck Kopp and Louise Stutes — joined the 19-member, all-Republican minority in favor of the amendment.
All other members of the majority voted against the cut.
Kopp amended the bill to stipulate that optional psychiatric coverage would still be funded for children under the age of 18 experiencing gender dysphoria.
He remarked that these services could assist in “interdicting” a child before they make “a life-altering, permanent medical decision.”
Anchorage independent Rep. Alyse Galvin, a mother of a transgender daughter, characterized the vote as largely “political.”
Galvin expressed concerns that the cut would make transgender Alaskans feel “othered and hated.”
The amendment sparked passionate debate on the House floor.
Anchorage Democratic Rep. Andrew Gray, who is the first openly gay man to serve in the Alaska Legislature, vocally opposed cutting Medicaid funding for transgender Alaskans, whom he described as “one of the most marginalized, powerless minorities in our country.”
Gray recalled his own experiences as a 16-year-old whose mother told him that he was wrong and a mistake.
In response, Vance contended that the cut was aimed at reducing the deficit and was not intended to suggest that transgender children are “broken.”
“God doesn’t make mistakes,” Vance asserted on the House floor.
In 2021, the state estimated that extending Medicaid coverage in Alaska for gender dysphoria treatments would cost approximately $28,000 per year.
Vance claimed on the House floor that gender dysphoria coverage through Medicaid costs the state $338,000 per year.
However, she was not certain how much the state spends on treatments mandated by court order.
The figure of $338,000 was shared with Vance’s office by the Alaska Division of Health Care Services, representing Medicaid claims since July of last year with a primary diagnosis indicating gender dysphoria, according to Vance’s staff.
It was clarified that the $338,000 in Medicaid coverage included funding sourced from both federal and state levels.
Ruth Botstein, the ACLU of Alaska’s legal director, opposed the amendment, asserting that medical decisions should be made by doctors, patients, and parents in cases involving minor children — not the Alaska Legislature.
“The American Medical Association, together with all other major medical organizations in the United States, supports gender-affirming care because it is medically necessary, evidence-based health care that is crucial to the health and well-being of people suffering from gender dysphoria and gender incongruence,” she stated.
Rose O’Hara-Jolley, Alaska state director of Planned Parenthood Alliance Advocates, expressed deep disappointment that the House approved “a harmful, performative amendment attacking gender affirming health care.”
“This amendment is rooted in bad faith.
It aims to stir confusion, spread misinformation, and fuel fear within Alaska’s LGBTQ+ community,” O’Hara-Jolley said in a prepared statement.
“We urge lawmakers to reject this amendment in the final version of the budget.
All Alaskans — no matter their income or gender identity — deserve dignity, respect, and access to the care they need.”
Last year, the prior Republican-led majority dedicated significant time to debating a transgender sports ban bill, which was ultimately rejected by the Senate.
In 2023, the Alaska School Activities Association banned transgender girls from competing on girls’ teams in high school sports.
Minority House Republicans separately attempted to cut Medicaid funding in Alaska for abortions, but their proposal was rejected on a tied 20-20 vote.
Stutes joined her colleagues in the Democrat-dominated majority to block the proposed cut.
Monday’s vote represents the latest in a long series of attempts by Alaska legislators to eliminate public funding for abortion services.
Prior votes have had little effect on altering the status quo.
The Alaska Supreme Court has consistently ruled that the right to an abortion is protected by the state’s constitutional right to privacy.
Additionally, the court ruled in 2001 that denying Medicaid services for abortion would constitute a violation of the constitution’s equal protection clause, discriminating against poor women.
Debates regarding budget amendments continued in the House on Tuesday.
Once approved by the House, the operating budget will proceed to the Senate for further consideration.
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