How Ohio Gov. Mike DeWine is making gender-affirming care inaccessible

Ohio Gov. Mike DeWine’s plan to restrict gender-affirming care for both youth and adults amounts to an outright ban, activists say.

The Republican governor said Friday that the state’s Department of Health and Department of Mental Health and Addiction Services had drafted rules that require extensive counseling with a variety of health care providers before even adults could undergo gender-affirming procedures. The rules will be finalized after a period of public comment that goes until February 5.

He announced this while also noting that he had signed an executive order immediately banning gender-affirming surgeries on minors. This came a week after he vetoed a bill that would ban all gender-affirming care for transgender minors in the state, including puberty blockers and hormone treatment; genital surgery is almost never performed on people under 18. He said he stands by his veto, which is likely to be overridden by legislators this week.

But the new rules, as drafted, are worse than the original bill, House Bill 68, says Alejandra Caraballo, a former staff attorney with the Transgender Legal Defense and Education Fund and now an instructor at Harvard Law School’s Cyberlaw Clinic.

It’s “essentially a de facto ban on gender-affirming care for all trans people in the state of Ohio,” she tells The Advocate.

The rules will require a written care plan signed by an endocrinologist, a psychiatrist, and a medical ethicist (the latter position not defined in licensing procedures). The problem, Caraballo says, is that most trans people receive their care at community clinics, which generally don’t have an endocrinologist or a psychiatrist on staff.

“They would have to immediately cease providing care,” she says. “I saw this happen in Florida,” where a state law, currently being challenged in court, restricts which health professionals can provide care to trans adults.

Gillian Branstetter, communications strategist for the American Civil Liberties Union's LGBTQ and HIV Project, seconds that. "We've seen the same death by a thousand cuts in Florida," she says.

Complying with this regulation would be difficult even for major hospitals, as they would have to reconfigure and reassign staff, Caraballo says. Most trans people in Ohio will suffer at least an interruption to their care, such as delays in refilling hormone prescriptions, she says.

There would additionally be a six-month waiting period for anyone under 21.

Branstetter points out that accessing gender-affirming care is challenging for trans people in any case, even without the "onerous and baseless requirements" DeWine wants to impose. It's hard finding a provider, finding insurance coverage, and paying out-of-pocket costs, and trans people have a high rate of poverty. "Gender-affirming care is not being handed out on every street corner," she tells The Advocate.

The reporting requirements are problematic too, Caraballo says. The state plans to require the completion of a consent form, but the form hasn’t been created yet, she notes.

Further, the Health Department will be required to gather “de-identified data” — with names redacted — on people who’ve received gender-affirming care and provide it to the state legislature and the public every six months. Even with the de-identification requirement, it will likely be very easy for members of the public to identify trans people, Caraballo says.

“It’s death by bureaucracy,” she says of the rules as a whole.

Branstetter adds, "The goal is clearly shutting down access to medical transition, period."

When DeWine vetoed HB 68, he said he was protecting human life, she says, but “those words ring extremely hollow” after his release of the draft rules. "As a transgender person whose life was saved by this care, I find [the proposal] abhorrent," she says.

DeWine's move is receiving criticism from others as well. “The regulations would essentially end most adult trans care in the state, instituting a defacto ban for many trans patients,” journalist Erin Reed wrote in her Erin in the Morning column on Substack. “Individual private practice doctors, fertility clinics, community health clinics, and potentially even Planned Parenthood would likely not be able to offer care. The results would be devastating in underserved communities. Meanwhile, the few places that could comply with the regulations will likely see a ballooning of demand, leading to extensive waitlists.”

The strategy is similar to one used against abortion clinics, Reed noted. To make it more difficult for these clinics to provide services, conservative lawmakers “would mandate things like ‘hospital admission privileges,’ specialist forms, and waiting periods in order to access care,” she wrote. “Even for the few clinics that were able to meet the new regulations, Republican legislators simply added more regulations until they were unable to provide care.”

Trans Allies of Ohio, a coalition of trans youth, their families, and other allies, issued a statement against the proposed rules. Compared to HB 68, they "would add even more restrictions to transgender healthcare, this time for all transgender people in Ohio," the group wrote. "The Governor made clear with his veto and in comments made during his press conference explaining that he values 'physician-patient decisions' over that of politicians. These rules, if adopted, will directly contradict this statement."

The rules are "supported by nothing more than conjecture from partisan politicians" and "an unnecessary intrusion into private medical decisions, creating untenable, discriminatory barriers to care for transgender individuals that is currently safe and effective," the organization continued.

Ohio is the third state to attempt to restrict care for trans adults. In addition to the Florida law, in Missouri, Attorney General Andrew Bailey issued an emergency rule last year that would have banned gender-affirming care for all trans youth and adults. He withdrew it after it was challenged in court and legislators passed a bill to ban the care for youth and for certain adults, including those who are incarcerated or on Medicaid. Gov. Mike Parson signed the bill into law.

The movement against trans care “has moved beyond the area of ‘we’re concerned about youth,’” Caraballo says.

Branstetter adds, "This was never just about kids."

DeWine’s executive order and proposed rules could be an attempt to stave off a veto override, but Caraballo says something else is likely motivating him: quelling criticism from within his party. Donald Trump denounced DeWine for his veto, writing on Truth Social that the governor “has fallen to the Radical Left.” Florida Gov. Ron DeSantis condemned DeWine’s move as well, along with numerous Ohio Republican politicians.

Another section of HB 68 would bar trans women and girls from competing in female sports in public schools and colleges. The override vote is set for Wednesday.