PHOENIX — Gov. Katie Hobbs issued executive orders Tuesday to halt the use of public funds for “conversion therapy’’ for minors while mandating their use for “gender affirming health care’’ for adults. The first order affects AHCCCS patients as well as state government and university employees and retirees, while the second covers current and former state government and university workers.
In the first, the Democratic governor took aim at what the Associated Press defines as “the scientifically discredited practice of using therapy to ‘convert’ LGBTQ people to heterosexuality or traditional gender expectations.” Hobbs specifically prohibits the use of state or federal dollars to “promote, support, or enable’’ conversion therapy on minors.
Hobbs’ order includes the health insurance the state makes available for its own or university employees, which includes mental health services.
Also affected are any mental health services available to individuals and families enrolled in the Arizona Health Care Cost Containment System, the state’s Medicaid program. About 2.5 million state residents are enrolled in AHCCCS.
A separate law, however, prohibits AHCCCS from paying for gender-affirming care for those enrolled in the system.
Gov. Katie Hobbs
Hobbs wrote that “conversion” therapy is based on “the false premise that homosexuality and gender-diverse identities are pathological.’’
Separately, Hobbs directed the Department of Administration, the state’s personnel arm, to remove language exempting “gender reassignment surgery’’ from the health-care policies now available to state government and university employees and retirees. Hobbs specifically exempts coverage of minors which is prohibited by a state law.
This order will most immediately affect Russell Toomey, a transgender professor at the University of Arizona who filed suit four years ago after he was denied coverage for a long-sought hysterectomy.
Toomey said the state refused to pay for what he said is a “medically necessary’’ procedure for his gender dysphoria even though the insurance policy covers other medically necessary surgeries. That amounted to illegal discrimination based on sex as the insurance is supposed to cover all “medically necessary’’ surgical procedures, his attorneys said.
The executive order now will end the lawsuit.
The broader victory is that the governor’s action will clear the way for other transgender workers to get similar coverage.
Targeting ‘hate and discrimination’
At the heart of both orders, Hobbs said, is how the state treats some of its residents.
“Our LGBTQ+ community should never have to face hate and discrimination,’’ Hobbs said in a prepared statement.
“The state is leading by example on this issue,’’ she continued. “And we will continue working until Arizona is a place where every individual can participate equally in our economy and workforce without fear of discrimination or exclusion.’’
Both new orders are an extension of actions Hobbs took on her first day in office in January expanding existing rules against discrimination of current or prospective state government employees.
At the time the rules covered race, sex, religion, pregnancy and veteran status. She extended them to include other traits that cannot be considered in hiring, firing or pay, ranging from gender identity and marital status to culture, creed, social origin and political affiliation.
Hobbs’ expanded list also included sexual orientation, though that appears to already have been covered in a 2003 executive order issued by then-Gov. Janet Napolitano, a Democrat.
A threat by state Sen. Jake Hoffman, R-Queen Creek, to challenge the order never materialized.
Now, Hobbs is taking aim at other practices she considers discriminatory.
Pima County already bans the therapy
She cited the findings of various organizations that oppose the practice of conversion therapy on minors because of what they say are dangerous effects.
She wrote that those include the American Psychological Association, which said that being subject to conversion therapy in childhood contributes to increased risk of suicide, depression and substance use throughout an individual’s life.
She also said the federal Substance Abuse and Mental Health Service Administration has concluded conversion therapy is “coercive, can be harmful and should not be part of behavioral health treatment.’’
Hobbs has no unilateral power to outlaw the practice throughout Arizona.
That is a question for state lawmakers. And while more than 20 states have banned the practice, that is not the case here.
There is an exception. Conversion therapy conducted for a fee is illegal in Pima County, where the Board of Supervisors enacted a restriction in 2017. A bid by then state Sen. Vince Leach, R-Tucson, to have lawmakers overturn that ordinance failed.
What Hobbs said she can do, in her duty to taxpayers, is “ensure that decisions are fiscally sound, transparent, and evidence-based, and that public healthcare funds are not spent on discredited, ineffective, and unsafe practices.’’
‘Medically necessary’ care
Her second executive order Tuesday relates to the multi-year fight by Toomey to get the state to pay for his hysterectomy.
Hobbs pointed out that the state’s insurance plans already require payments for “medically necessary’’ care.
She said only the policy written for state government excludes gender reassignment surgery — an exclusion she said is “not consistent’’ with policies the state’s insurance carriers offer to other customers.
There have been successful challenges in other states to that exclusion, Hobbs said. So she ordered it removed “as soon as practicable,’’ with notice provided to state and university employees enrolled in the system.
They include Toomey, a professor of family studies and human development at the UA who conducts research on how “sexual and gender minority” youths thrive despite barriers and challenges they encounter.
In an interview with Capitol Media Services, Toomey said he knew he was “different’’ at a very early age.
“I thought I was a boy at that point but was being told by everything and everyone in my environment ‘No, suck it up, you’re a girl,’’’ he said.
It took until he was at least 19, read and book and worked with a counselor that he learned there was a phrase to describe what he was experiencing: gender dysphoria, a sense of mismatch between sex assigned at birth and gender identity.
Shortly after that he began taking hormones and, about a year later, had chest reduction surgery, all paid for out of his own pocket.
“The need to have a hysterectomy has always been there for as long as I can remember,’’ Toomey said. But he said he waited until he got the security of tenure at the UA to seek coverage for the hysterectomy, first by trying to change the policy and, when that didn’t work, by filing suit.
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