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Government & Politics Health Care

Bill on Transgender Health Equity Doesn’t Just Stall, It Sort of Vanishes

Del. Anne R. Kaiser (D-Montgomery) has sponsored a bill that would extend Medicaid benefits for gender-affirming surgery and treatment. Photo by Danielle E. Gaines.

Bills stall in the final days of the General Assembly session all the time and for all kinds of reasons. A committee chairperson’s drawer is a particularly dark hole in the legislative universe.

In this digital age, bills seldom vanish altogether, however. Yet one bill has become unusually difficult to track on the General Assembly’s website over the past few days.

A measure to extend Medicaid coverage in Maryland to individuals receiving gender-affirming surgery and treatment that’s now stalled in the House hasn’t quite vanished, but some of the developments in the bill’s legislative journey can no longer be found on the General Assembly’s website. And the chair of the House Health and Government Operations Committee, who supported the measure when her panel voted in favor of the bill last week, is not saying why she is bottling up the legislation now — though it appears likely that the bill did not have the votes to get through the House with a robust majority.

At issue is a bill sponsored by Del. Anne R. Kaiser (D-Montgomery) that would provide Medicaid coverage for gender-affirming treatment — any medically necessary treatment, including mental health services, prescribed by a licensed health care provider for the treatment of a condition related to the individual’s gender identity.

Many of these treatments are covered by private health insurers, and so the bill is designed to extend the same services to lower-income Marylanders who rely on Medicaid for their health coverage. According to state statistics, there are about 2,000 transgender Marylanders receiving Medicaid benefits, and about 100 a year seek the kind of gender-affirming treatments covered in the bill. Enacting the legislation would enable an additional 25 Medicaid residents a year to receive such services, legislative analysts estimate.

“The bill brings it up to date to what the commercial carriers are doing,” Del. Joseline Peña-Melnyk (D-Prince George’s), the Health and Government Operations vice chair said during a committee voting session on March 25.

Earlier that week, the Senate had passed an equivalent bill, sponsored by Sen. Mary L. Washington (D-Baltimore City), in a 31-15 party line vote. Dozens of witnesses testified in favor of the bill in the Senate Finance Committee, and the bill generated no controversy on the Senate floor.

After a 45-minute debate, the House committee on March 25 voted 14-8 to send both Kaiser’s and Washington’s bills along to the House floor. They were scheduled for debate on the House floor on March 29 and rescheduled for March 30. That day, the other bills that had originally been on the Health and Government Operations calendar for floor debate along with the transgender health equity legislation were passed.

Now, the measures aren’t just in limbo — a common enough fate for legislation this time of year. The General Assembly’s website no longer lists the committee votes of March 25 on the identical bills as having happened. There’s also no electronic record of the witnesses who testified in favor of the legislation during the House committee’s hearing of Kaiser’s bill on March 2, though the General Assembly website does list the witnesses who testified at the Senate hearing for Washington’s bill on Feb. 22.

Asked Friday why the committee vote on the health equity bills is no longer on the legislature’s website, Del. Shane E. Pendergrass (D-Howard), the Health and Government Operations chair, replied, “I have no idea what you’re talking about. That’s not something I have any knowledge of.”

And asked Friday why she had decided to hold the bill after her committee had passed it — an unusual move — Pendergrass refused to discuss the policy decision. She said a procedural vote that Health and Government Operations had taken early in the legislative session to address COVID-19 protocols gave her the discretion to hold on to a bill even if the committee had supported it.

But in the view of some advocates and Democratic lawmakers and strategists, debate over the bill had the potential to become heated on the House floor. Although the Senate version of the bill passed in the Finance Committee along party lines — just as it did on the Senate floor — two Black Democrats, Dels. Sheree Sample-Hughes of the Lower Shore and Cheryl S. Landis of Prince George’s County, voted against the measure in the Health and Government Operations Committee. A third Democrat on the committee, Del. Harry Bhandari of Baltimore County, had been present during the debate on the bill, but was absent during the virtual voting session.

The committee vote suggests that the legislation could be controversial with certain members of the Legislative Black Caucus, who have resisted some LGBTQ bills in the past, and with the half dozen or so House Democrats who, like Bhandari, represent purple districts. The House’s 42 Republicans could almost certainly be expected to oppose the measure in a floor vote.

What isn’t altogether clear is why a bill that got through the Senate fairly smoothly is now bogged down in the House.

Peña-Melnyk, who had been expected to defend the gender-affirming Medicaid legislation on the House floor, deferred questions about holding the bill to Pendergrass. But she held open the possibility that the bill could be revived in the last week of legislative session.

“Around here, anything can happen,” she said.

The likelier scenario, however, is that the bill is dead until at least next year.

Kaiser, the sponsor of the transgender equity legislation who was one of the first openly gay members of the General Assembly, said she accepted the bill’s fate.

“The advocates and I are certainly disappointed that the bill didn’t pass this year,” she said. “But we’re looking forward to next year and building a stronger majority for it.”

Kaiser said she and transgender activists were especially disappointed that the record of the committee’s vote in favor of the legislation has disappeared from the General Assembly’s website.

“It’s a shame that a community that feels erased now has to deal with this kind of erasure,” she said.