Arizona bills would impact transgender procedures

PHOENIX – A state lawmaker from Surprise wants to require insurance companies to pay the medical costs for those who want to "detransition'' from their sex-change therapy and changes.

Sen. Janae Shamp said she believes at least some individuals, particularly children, are convinced that they need to change their gender. And Shamp, a registered operating room nurse, said that performed, at least in part, because there are medical codes that doctors can use to bill insurance companies.

What's missing, she said, are any codes for the medical procedures to reverse all that. And the result, she said, is there is no way for doctors to get reimbursed by the insurers.

Shamp brought California resident Chloe Cole to a press conference Thursday to detail how she believes both she and her parents were misled by doctors into approving not just hormonal treatments for her when she was just 13 but gave the go-ahead to have her breasts removed two years later. Only afterwards, Cole said, did she realize that was a mistake.

SB 1511, Shamp said, is designed to provide a path – and payment – to reverse the procedure on anyone in Arizona who wants to reverse the process.

"There are dozens of medical billing codes for gender-affirming care,'' the senator said. "But there's not one single for patients seeking to cease gender-transition therapies and reclaim their God-given gender.''

Separately, Sen. T.J. Shope, R-Coolidge, has introduced SB 1451 that would bar providing any hormone therapy without parental consent "if the practice is performed for the purpose of changing a minor's appearance or body to no longer correspond to the minor's biological sex.''

The measures are the latest in what have been a series of efforts by state lawmakers to wrestle with issues relating to transgender individuals and procedures.

Two years ago the Republican-controlled Legislature voted to outlaw gender-confirming surgery for minors, even with parental consent. A broader measure to also ban hormone therapy, however, failed to get Senate approval.

That same year Arizona enacted a statute that spells out school sports have to be designated as male, female or co-ed. More to the point, it specifically says that teams designated for women or girls "may not be open to students of the male sex,'' crafted in a way to deny that opportunity for those who identify as female.

More recently, GOP lawmakers have tried, unsuccessfully, to designate who can use which restroom and to forbid teachers from referring to a student by his or her preferred pronoun.

Shamp said her legislation is designed to deal with people like Cole, now 19, who told reporters of the ongoing problems she is having since undergoing transition.

"I'm experiencing joint pain from the puberty blockers,'' Cole said. And she said pain in her pelvic region "has been slowly getting worse over time'' that she said will affect any future marriage.

"And my breasts, I know I will never have them back,'' Cole said.

"I know those scars always will be there,'' she continued. "And even if I chose to get them reconstructed, implants or tissue, nothing could ever bring the function or shape or sensation back.''

"It will affect my marriage in the future,'' she said.

Shamp said that's what's behind her measure.

"This is about having access to care for detransitioning which they don't have at this point,'' the senator said of those like Cole. And the root cause, she said, is how doctors keep their records.

"If there aren't any diagnoses code, they can't bill,'' Shamp said.

"The doctors, even when they want to, they don't know how,'' she said. "There needs to be a focus on this population.''

That gap, Shamp said, is "unheard of in the medical world.''

"And that means we have political ideology directing it,'' she said. "And that has to stop.''

Her legislation spells out that if an insurance policy provides coverage for gender transition procedures it also must cover gender detransition.

But it's not just about having the proper billing codes. Another provision says that any doctor, health care institution or any other licensed health care provider that performs gender transition "must agree to provide for the performance of gender detransition procedures.''

Cole's appearance at Thursday's press conference in Phoenix is not unique. She has testified in other states on behalf of more far-reaching legislation to deny gender-affirming care for minors in the first place.

Shamp said her legislation is separate than that question of whether Arizona should allow sex-change procedures to be performed on minors, with or without parental consent.

"We're not addressing that today,'' she said.

And she said that, at least as far as this measure goes, her personal opinions about sex-change procedures are irrelevant.

"I'm here to represent all of the children that have gotten bad advice, have been pushed into procedures and pushed into situations based on a political ideology and the fact that we don't even have it set up in order to take care of their basic health care needs,'' Shamp said. "And that is repulsive to me and that is why we're here.''

But the senator does have an opinion.

"I believe that God makes no mistakes,'' she said when asked if it is possible that someone could be born into a body that doesn't match the gender with which they identify.

Shamp's proposal has yet to be assigned to a committee for a hearing.