". . . and having done all . . . stand firm." Eph. 6:13


3 Bills to Protect Minors from Gender Transition Procedures Debated in 9-Hour Missouri House Hearing

January 27, 2023

Four separate bills aimed at protecting minors from harmful gender transition procedures have been introduced in the Missouri House of Representatives in 2023. The House Committee on General Laws held a marathon, nine-hour hearing on Tuesday to take public comment on three of the bills, as well as five other bills related to protecting children from drag shows and protecting women’s sports.

At the hearing, hundreds of lobbyists, activists, and citizens weighed in on both sides of bills including The “Missouri’s Children Deserve Help Not Harm Act” (HB 419), introduced by Rep. Brad Hudson (R), the “Missouri Save Adolescents from Experimentation (SAFE) Act” (HB 463), introduced by Rep. Mazzie Boyd (R), and another version of the “Missouri’s Children Deserve Help Not Harm Act” (HB 540), introduced by Rep. Justin Sparks (R). A fourth bill, the “Missouri Child and Adolescent Protection (MCAP) Act” (HB 916), introduced by Rep. Cyndi Buchheit-Courtway (R), was referred to the General Laws Committee the day after the hearing.

The hearing had its colorful moments, including testimony by drag queens in costume and when the father of an 11-year-old who identifies as transgender accused lawmakers of bullying his daughter.

Unsurprisingly, the vast majority of registered lobbyists registered their opposition to the bill. Garrett Webb, a lobbyist for the American Academy of Pediatricians, insisted surgeries “which impact the fertility or reproductive ability” are performed “at absolutely no point in time” for minors — a clause tacitly admitting that Missouri physicians do perform other gender transition surgeries on minors, such as double mastectomies. Detransitioners like Chloe Cole have been outspoken about the damage such procedures have caused them. Pro-abortion groups also joined the gender transition chorus; lobbyists for Pro Choice Missouri and Planned Parenthood Great Plains registered their opposition, as did a lobbyist for Advocates of Planned Parenthood of the St. Louis Region and Southwest Missouri, Vanessa Wellberry, who called the bills “dangerous, discriminatory, and unconscionable.”

The only registered lobbyist to speak in favor of the bills to protect children from harmful gender transition procedures was Joseph Kohm with Family Policy Alliance. “Politicized medical organizations have pushed referring children for invasive, harmful forms of ‘treatment’ that can include off-label use of puberty blockers, administration of cross-sex hormones far above naturally occurring levels, and even — sometimes — surgery. These organizations have adopted their ‘guidance’ without long-term, peer-reviewed studies,” he lamented. “This is especially alarming given the fact that 80 to 95% of children will outgrow gender dysphoria and embrace their biological sex if these experimental treatments are not used, but 100% of children go on to transition if these harmful treatments are used.”

Comparison of Bills

Missouri’s situation is notable because legislators have a menu of bills to protect children from gender transition procedures, whereas many state legislatures only see one such bill per session. Thus, it provides a useful comparison of the various policy proposals on offer.

Missouri’s Children Deserve Help Not Harm Act (HB 419) stipulates, “A physician or other health care professional shall not provide gender transition procedures to any individual under eighteen years of age.” Additionally, “A health care institution or entity shall not facilitate the provision of gender transition procedures to any individual under eighteen years of age.” “Gender transition procedure” is defined as “any medical or surgical service … for the purpose of assisting an individual with a physical gender transition,” including “puberty-blocking drugs, cross-sex hormones, or genital or non-genital gender reassignment surgery.” This would flatly bar both individuals and institutions from providing these services in Missouri.

It also bans “conduct that aids or abets the performance or inducement of gender transition procedures on any individual under eighteen years of age” by any person, including “employees of other state governments.” The language is clearly aimed at California, which passed legislation to take custody of children from other states for the purpose of a gender transition procedure in California.

HB 419 further prohibits the use of public funds for a minor gender transition procedure “directly or indirectly,” including the performance by state-employed personnel, performance in state-owned facilities, tax deductions, and reimbursements through the MO HealthNet program (Medicaid).

HB 419 carries multiple enforcement provisions. First, it deems any referral for or provision of gender transition procedures for a minor to be “unprofessional conduct” and “subject to discipline by the appropriate licensing entity or disciplinary review board.” This means physicians could, among other forms of discipline, lose their license for performing gender transition procedures. Second, any child “abused” by a gender transition procedure may sue for an array of damages. Their parents may sue on the child’s behalf, and the child can sue on his or her own behalf “until thirty years after reaching the age of majority.” Third, “the attorney general may bring an action to enforce compliance.” The state can prosecute anyone who provides gender transition procedures.

The other bill titled, “Missouri’s Children Deserve Help Not Harm Act” (HB 540) is nearly identical to HB 419. The main difference is two added paragraphs that anticipate a legal challenge. The first empowers the legislature to intervene to defend the bill in case an unfriendly attorney general refuses to. The second provides that, if one provision is found unconstitutional, the rest of the bill can remain in effect.

The “Missouri Save Adolescents from Experimentation (SAFE) Act” (HB 463) is shorter than HB 419, but its main thrust is the same. It has a slightly punchier definition of “biological sex,” which it defines as, “the biological indication of the physical condition of being male or female, which is determined by an individual’s chromosomes, identified at birth by an individual’s anatomy, and indicated on the individual's birth certificate, without regard to an individual’s psychological, chosen, or subjective experience of gender” (italics added). Its main strength is its uncompromising clarity about the objective, unchanging nature of sex.

HB 463 stipulates, “A physician or other health care provider shall not provide gender transition procedures to any individual under eighteen years of age and shall not refer any individual under eighteen years of age to any health care provider for gender transition procedures,” it states. This provision covers only individuals, not institutions. This bill also defines coercing a child “to undergo any surgical or hormonal treatment for the purpose of gender transition” as child abuse or neglect.

HB 463 adopts the first two enforcement provisions of HB 419. The first enforcement method, discipline by a licensing board, is actually stronger, because it requires that anyone who “willfully and knowingly commits or assists” in a gender transition procedure on a minor shall have his or her license rejected or revoked; it rules out lesser forms of discipline. It also provides the child with a right to sue for damages. However, instead of spelling out the damages that can be sought in the bill itself, it simply ties them to Missouri’s standard tort law. It does not explicitly provide the attorney general with enforcement power.

The fourth bill, Missouri Child and Adolescent Protection (MCAP) Act (HB 916) appears to combine elements of the Help Not Harm Act (HB 419) with elements of the SAFE Act (HB 463).

HB 916 edits down the Help Not Harm Act prohibition of public funding, while keeping the main provision and the ban on MO HealthNet (Medicaid) funding. It adopts the SAFE Act definition of biological sex and prohibition on physicians performing or referring for gender transition procedures on minors. It keeps the Help Not Harm Act’s enforcement mechanisms for discipline by a state licensing board and prosecution by the attorney general. For an individual right of action, it modifies the Help Not Harm Act’s timeframe to “until twenty years after reaching the age of majority,” or four years from the discovery of the injury and clarifies that the normal tort rules “shall not apply.”

HB 916 distinguishes itself from the other bills by its “delayed effective date.” It would take effect on January 1, 2024, whereas HB 419 could take effect as soon as August 28, 2023. HB 916 also grandfathers-in (or do we have to say grandpersons now?) the provision of cross-sex hormones to any minors who were placed on cross-sex hormones before the bill’s effective date. While inserted with good intentions, this provision would likely motivate therapists to hurry and place minors on cross-sex hormone regimens months or even years before they would otherwise do so.

Prognosis for Protecting Minors

The biggest takeaway from the Missouri legislature’s buffet of options protecting minors from gender transition is that this issue has clearly captured the imagination of state legislators. They obviously see the need to oppose the Left’s latest culture war aggression, and they’re willing to try different strategies to stop it. This activity — modifying each other’s bills to try and improve them — is one of the best features of the state legislature’s de facto function as “laboratories of democracy.” It’s also encouraging to a new generation of legislators engaged on the issue. All four bills are introduced by state legislators who have served six years or less.

One (minor) downside of the ongoing edits is that it becomes more difficult to compare bills across state lines, based on their titles alone (very minor indeed). For instance, the first bill in the nation for protecting minors from gender transition procedures was the Save Adolescents from Experimentation (SAFE) Act, which passed in Missouri’s neighbor Arkansas in 2021 (over the veto of a Republican governor!). Yet the Arkansas SAFE Act shares nearly as much language with the Missouri Help Not Harm Act as with the Missouri SAFE Act. Meanwhile, the Missouri Help Not Harm Act has very little in common with a current South Dakota bill that is also nicknamed “Help Not Harm.” Whatever the name, what really matters is that state legislators provide minors the strongest protections possible against harmful, unscientific gender transition procedures, which are often pressed upon them in manipulative and underhanded ways.

Is a bill to protect minors from gender transition procedures likely to pass into law in Missouri? It’s possible. Republicans enjoy a 24-10 majority (70%) in the Senate and a 111-52 majority (68%) in the House. The Washington Post suggests that GOP leaders in the Missouri Senate are at least unified in favor of protecting women’s sports — an issue with broader support.

Yet recent experience warns that no state is a slam dunk. In South Dakota, the Senate Health Committee smothered a similar bill in a previous session, while Governor Kristi Noem (R) — who is trying to gain national recognition for conservative policies — vetoed a women’s sports bill. In Arkansas, the legislature’s veto override to pass the SAFE Act into law was a close call.

If Missouri does pass a bill, which one will it be? It’s too early to tell. HB 916 lags behind the others after it missed the committee hearing date (and who knows when the committee will want to hold another nine-hour hearing on transgender bills?). The other bills are about equal in terms of attention and cosponsors. HB 419 may have a slight lead because it was introduced first, its sponsor is the most senior legislator, and other bills were based on it. But a lot can happen between the committee stage and a bill’s final passage. Whatever happens, it must occur before the Missouri legislature adjourns sine die on May 12.

Joshua Arnold is a senior writer at The Washington Stand.