H.B. 193 Transgender Medical Procedures Amendments: transcript

Thank you. Madam Chair. Can I have permission for my intern to hand out a paper to everybody?

Thank you. All right. Thank you. Madam Chair and members of the committee. Um, this bill, HB 1 93 is, was brought to me by a constituent of mine who happened to be an insurance broker. And he, he called me concerned because he works with municipalities, school districts and fire stations and such, helping them get insurance, government insurance. And he said, we have a problem. There is a default in our system that when they are signing up for PEHP insurance, that the default is that it would pay for transgender procedures. And some of these municipalities don't want their pools and stuff to be paying for that. And if they were to opt out of it, then they would be potentially up for a legal problem. And so, and these municipalities and people that he was working with were very frustrated and concerned that their taxpayer dollars would have to go toward this. And so this bill is actually pretty simple. Really what it does is it just says that publicly funded insurance, so insurance that is funded by taxpayers cannot pay for elective transgender procedures. And there is a substitute on this bill as well. And I would like to speak to that substitute. There are two parts in the substitute that have been added to the bill. Um, the substitute says, the additions in there say that if a, a person, if a patient was on a, um, hormone for a transgender procedure, then that particular treatment, if they're currently on it before the effective date of the bill, will not be disrupted. If the doctors, if they, they visit with a doctor and a doctor deems that it's medically necessary for them to continue in that treatment. Of course, no new treatments would begin for people as far as far as coverage. Anyone can have any treatment they want. Um, you know, this isn't saying that people can't have the treatment. This is just talking about what taxpayer dollars will pay for. And then the second part in the substitute says that, um, if a publicly funded insurance, so thinking maybe, you know, PEHP, if they have funded a transgender procedure for someone in the past, and that that person now wants to have a reversal or detransition, which is becoming more and more common all the time, then um, then that same, uh, publicly funded insurance would need to fund it for that person that they had had done that original procedure for, to help them, um, if that was their insurance. And, uh, basically that is the gist of this, this bill. Um, our taxpayers shouldn't be paying for elective procedures. There are many, many elective procedures that are not, uh, paid for that people wish could get paid for. But in, when it comes to healthcare and insurance coverage and especially charging the people of the state of Utah, um, for that procedure, um, it's been the history always that things would be incredibly medically necessary. Um, we don't wanna put municipalities and others who are using government assurances, um, in legal trouble as well. And so with that, I'm open to any questions.

Uh, thank you Madam Chair. Um, these kinds of decisions are, are decisions that insurance companies make all the time, um, about what is, uh, elective, uh, versus medically necessary. What is considered cosmetic versus medically necessary for context in the lay of the land? Could other private insurance companies that are not governed by the state, do they generally cover these procedures now or generally not, or what? I think there's maybe a mix, you know, as far as Daggett trans procedures, no. Um, we'll talk about that probably a little bit more when it comes to the, the next bill. 'cause that does relate more to the private insurance sector. Um, but there, there's kind of a, an isolation. I mean, there's an invisibility in a way of people in the det trans world. And, and I love the addition in this substitute because it makes it so that we are making sure that there's parity between both of these bills too, that, um, the Deran communities can get, um, the help that they need if, if they've had, you know, a, a situation where they may regret as well, um, what their decision was to transition. If, if someone does, I mean, work for a government entity, they work such that their insurance is PEHP or they work for a municipality, so I guess they'd have PEHP. And if they as an adult felt like this care was helpful to them and their doctor felt like it was helpful to them, I mean, would they have another realistic way to get it? They, I mean the state pays some of that, but the person also pays some of that, um, out of their own pocket. Do they would then, what would their option be then? Well, I mean, you know, there's a lot of other things too, representatives. So, um, such as like tattoo removal or stem cell treatments or things like that, that are not covered by insurances. And so if people want stem cell treatments, they, they take their credit card, they take a loan, they do something else to happen to have it happen. I know, um, that there's a young person that lives near me who, you know, does a, has a GoFundMe because they're doing a transgender, you know, procedures that they want to do. And so I think, I think they would need to figure out those elective procedures just like stem cell or, or tattoo removal on their own instead of using the taxpayer dollars.

You. Oh, hi. Hello. Uh, my name is Claire Robinson. Uh, I'm running for mayor of West Valley in 2029, and I think you'll be seeing a lot more of me around here. Representatives. We know that gender affirming care saves lives. We know it reduces suicidality up to 73%. We know that gender affirming care is needed by both cisgender and transgender people alike. Make no mistake, today's vote is about whether people who already have the healthcare they need should be allowed to keep it. Article one, section one of the Utah State Constitution states all persons have inherent and inalienable right to enjoy and defend their lives and liberties. Representative Peck and her colleagues want to take away those vital God-given rights representatives. I implore you in the strongest possible language. Do not pass this bill. My healthcare and the healthcare of many thousands of Utahans should be between them and their doctor, not between them and the feelings of a government employee. If you pass this law, you lower your voice, people will die. It is not a what if it is a guarantee. And when those people die, their blood will be on your hands. And that is between you and your God. Please. Thank you.

Can you guys hear me okay? Yep. There we go. There we go. Um, Madam Chair and Committee, I want to thank you for at least hearing me speak today. Can You introduce Yourself, please? My name is Pastor Ron Williams. Uh, there's a lot of things that I could say spiritually on a spiritual level that uh, could go far past anything we could cover here, but in this room we talk about, you know, we kind of skate around talking about God, but I believe that true science and God truly do agree because science is just a discovery of what God created. And he created us as human beings. And with that being said, I think that this bill that, um, Representative Peck is putting out is very well, should be looked at in a way that, um, um, it should be passed. Because, because we have so many issues in our communities with, uh, healthcare, cancer, all sort of other, um, surgeries that are, that are taking place in healthcare, that if we don't have the money to take care of that, why should we take taxpayers money to pay for an elective surgery or elective surgeries or procedures that, uh, the, the people that are here in society or the common person really doesn't have the finances to cover, um, the impoverished families that we have to deal with. So please consider that and pass this bill. Thank you, pastor. Honor. God bless you guys.

How do y'all, my name is Zeke Kak. I am a Utah born and raised. Um, we, if you are all familiar with this, bill is a spiritual successor or spiritual copy of, um, what was it, HB 5 21 from last year, which had a similar limit. I am a person that benefits off of state funded medical care, and I sit before y'all four weeks post-op from top surgery. So I am currently still in recovery. I can barely reach above my head. Um, and I would not have been able to get this, uh, this operation without those funds. The cost of it was $16,000 and my insurance covered all but 4,000 of it, and I had to fundraise the rest. So that was brought up earlier that, um, the, uh, the sponsor knew somebody that was raising funds to cover it. I'm telling you here that both of those things are still necessary to even achieve this. And without that ban or with that ban in place from last year, I would not have been able to receive this care. I now have a higher quality of life and a new lease on my future when I wouldn't have been before. And if this bill comes through, it will stop my testosterone and I'll be forced to de transition, which will be in extreme impact on my health negatively. I urge you to not vote in favor of this bill. Thank you.

My name's David Becker. I'm a pediatrician. I spoke before. Um, this bill is not about what kind of care people get, it's about who pays for it. So actually the earliest systematic review of the literature that I know of was done in 2016 by the Obama administration when they had a request for a NCA national coverage analysis for Medicaid patients to pay for transgender treatments. And they did their due d diligence, did a systematic review. Here it is. And they declined to make a national coverage determination because they found that the evidence was inconclusive and there were a variety of problems with it. So, um, that's the earliest systematic review on gender affirming care. And they left it up to the states to decide who pays for it. And the state decided whatever. But today, you get to decide. Thank you.

Hello, committee members. My name is Caz Kani Howell. I'm a queer trans person of color that lives here in Salt Lake City. I've lived in Utah my whole life. In fact, Representative Peck, you and I used to be members of the same in Twila. I'm here today to strongly urge you to vote no on HB 1 93. Denying trans people access to life-saving medicine and healthcare will not make us less trans or cisgender. You would make living a joyful life extremely harder to access for me as a trans person of color. Um, as, as a trans utan, as an American, I feel that I have three unal unalienable rights, life, liberty, and the pursuit of happiness. Do you have any prescriptions or medications that are essential to your day-to-day life? Do you take antidepressants? Do you take supplements? Anything like that? Aside from being trans, I'm also a type one diabetic. I am insulin dependent for the rest of my life. Without access to insulin and an endocrinologist, I would be dead. My endocrinologist is also the person who manages my hormone replacement therapy. I've been on testosterone for about a year now, and it has greatly improved my life. So something that would make me happy is if I go to the pharmacy, I can actually pick up all my medications, not just my non-trans medications. Thank you. And I urge you vote, urge you to vote no for this bill. Thank you.

Either Way. Alright. In case I'm sitting in the wrong chair. Either way, I wanna say that, uh, I believe that each and every person in this room, each and every person in this stage. And can you introduce Yourself please? I'm sorry. I'm Chuck Bickle. Um, I represent myself and the conservative pastors of Utah and everybody that everybody in this state was fearfully and wonderfully made by Almighty God. And you have such value that Jesus Christ left heaven came to this earth and died on the cross of Calvary to pay for our sin debt. You're that valuable. And we need to find our identity in Christ. We need to trust that the sexy made us is the sexy meant us to be. These surgeries, these medical procedures do not change your gender. They don't change your DNA and, um, I'm a, I I just can't fathom the founders ever imagining that the state would pay for such surgeries. So I'm against the state paying for such surgeries. Thank you. Check, make sure you sign the paper

Perfect. Um, hi. Thank you. Members of the committee, marina Lowe, legislative Council with, um, equality Utah. Um, transgender Utahans have been the, the, the focus of this legislative body's attention for the past five years. We've seen five years of bills really focused on this small and vulnerable population. And I just wanna remind everyone that transgender Utahans exist. They deserve the same rights and dignity that all Americans deserve, and that extends to healthcare as well. We are troubled by this repeated interference by the legislature in the patient doctor relationship. We just got finished hearing a bill where we were discussing the grandfathered population of a moratorium that was passed three years ago. While I appreciate the substitute, which now grandfathers in patients, adult patients seeking gender affirming care, I do wonder are we gonna be back next year with an attempt to compromise that grandfathered group? Um, it's, it's hard to ignore that when that has been the pattern the past number of years. All Utahans, I think, should be worried when the legislature steps in between that sacred relationship between a doctor and a patient, and dictates what sort of medications and procedures, um, can, can be had by patients. I do wanna acknowledge, I'm very grateful that Jeff Bean sitting behind me as well as Representative Acton, both acknowledged the difference between adults seeking treatment that mature adults can decide for themselves and should be able to access treatment that, um, that they deem necessary for their care. And so I hope that that will come into play in the decisions that you make on this bill today. Thank you.

Hi, my name is Ariel Malin. Uh, I am representing myself today. I'm a healthcare administrator with over a decade of experience working with trans and gender diverse communities in both academic healthcare, uh, systems and nonprofit settings. I strongly urge you to vote no on this bill. Restricting public funding for evidence-based care that a licensed medical provider determines to be necessary is comparable to telling a patient already struggling to pay for their basic needs with diabetes that they have to pay for their insulin out of pocket. We know that patients will experience significant adverse health outcomes from not being able to access that treatment. This bill would increase healthcare costs and barriers for an already marginalized group that is disproportionately impacted by poverty and underinsured. When care becomes harder to access patients, avoid seeing their providers leading to poorer health outcomes and greater reliance on emergency services. Uh, these costs ultimately are carried by the healthcare system and taxpayers alike. There is cost effective analysis that shows us that there is a decrease in cost to insurance companies who provide healthcare for transgender people. These cost savings are then passed on to our health systems. So I respectfully ask you to vote no on this bill. Thank you for your time and commitment, uh, to the health and wellbeing of all utahns.

Hello. Testing. Can you hear Me? We can hear you. Thank you. All right. Hello, my name is Isaiah Asata. Thank you Madam Chair and Committee. Um, I'm a, I recognize third gender of my people that predates the life of the United States itself. I'm a, I'm a representative of nua collective, of grassroots organization dedicated to serving our queer trans and HPI and com and POC communities. I don't have any fancy sentiments or statistics, but I only want to urge you all to listen to the constituents that would be harmed because of this bill. And the ones that would be negative in negatively impacted are not those that have presented this legislation. This bill restricts access to affirming care, not just for our youth, but for all Utahans rather than focus on, than our focus being put on improving the lives and care and success of all your constituents, queer or trans or otherwise. Please oppose this bill. Thank you.

Perfect. Thank you. Hi, my name is Billy Klaus and I'm here to share some numbers of the committee today. Uh, according to your research by the Trevor Project, 46% of trans youth Utah have seriously considered suicide in the past year if passed. This bill is all but guaranteed to increase that rate for children of public employees because they'll have their access to necessary healthcare alone. But unfortunately not the full extent of the damage data from the Utah Department of Health and Human Services shows that between 2021 and 2023, the rates of suicide spike between, uh, those, between the ages of 35 and 55, meaning that this legislation will also affect state employees directly. Uh, this will actively harm the teachers, police officers, administrators, and all the other 200,000 plus public employees of our state if the health and safety of trans people isn't moving to you. I wanna point out the fiscal note attached to this bill. Research outta Murray State University show that the average cost of replacing employee is 150% of their annual salary. So if you have just six state employees making $50,000 a year leave, because of this legislation, the staff replacement costs a loan will cost more than the ongoing annual savings that this bill could provide. And I can tell you right now, there'll be much more than six employees who will leave public service because of this bill. Uh, as you consider whether or not you want to advance this bill, I urge you to consider the true cost of this bill, both financially and in the lives of those who will be irreparably harmed. If this passes, thank you for your time and please have the kind of day that you vote for it. Thank

Uh, thank you. It's, uh, I, I'll allow Billy to respond. It's, it's more of a comment. There's been a lot of discussion about, uh, suicide, uh, during the, this committee meeting. It's a very important topic that a legislature's been very focused on. It's extremely difficult to, uh, look at the, our rates of suicide and say definitively they've gone up or down because of one certain policy. For instance, I'm not going to say even though it's actual policy, that for the fact that for the past three years, our rate of youth suicide has gone down. That is per data from the Utah Medical Examiner. But we can't definitively say it's because of one reason or another reason. We know the legislature has poured millions of dollars in youth and adult, uh, suicide prevention. So I just wanna make, be very careful that we, uh, hopefully spend as much time talking about the resources such as 9 8 8 safe, ut the Warm Line Crisis Receiving Centers, and making sure people of all backgrounds are aware of those resources available from the legislature. Thank you. Thank

Yeah, I, I agree with you. I think we can't point to a single source to know what is causing suicide rates to go up or down. I do think taking away what trans people are telling us is necessary, healthcare is absolutely going to have an effect on those rates. I don't think we can assume that it wouldn't affect that. And while overall rates may be down, which is obviously commendable, and absolutely we need more resources and funding to help people, it's, I think, very naive to think this wouldn't have a direct effect on that.

Thank you, Madam Chair. I just wanted to make the observation that this bill does not seem to me to be about the transgender issue as much as it is about taxpayer dollars being spent on elective surgeries. As far as I can tell, Medicare does not cover breast augmentation. And I would, I would say that all elective procedures should be covered by the people who want to get them or by their own private insurance, which I don't know if they cover them or not, but I do not think that single mothers, the elderly and families who are trying to just keep food on the table should be forced to pay for anyone's elective surgery. Thank you. Thank

Oh, thank you. Uh, Madam Chair, I want to make a, a request if I could, there's some other, um, comment that I would value, which would be from Chet Loftus, who is with PEHP, just to help with context, if that's okay. That would be great. Thank you.

I, I would appreciate it if you could help us understand whatever it is that you understand about how PEHP does this currently versus how other insurance companies that are trying to provide good service to their people do it. Is it generally standard of care across the industry to provide these services? Or is it generally not the standard of care to provide the services?

Obviously all insurances if they deem a, a procedure elective, typically would say if we deem it a elective or cosmetic, then it's not covered. And how to does PEHP and other insurances, if you know that, think about that distinction,

That's helpful.

Um, I really can't speak so much on the private side, although I think it's becoming more, um, accepted in terms of paying for this more generally. On the PHP side, we've looked at it completely as a question for each individual employer group to decide. Um, um, there are some heightened potential legal issues that a public entity might look at on this issue. And we didn't, we don't see ourselves as kind of being part of that, making that decision one way or the other. Currently, the state does not cover this, and it never has covered this, uh, other, uh, public employers have, uh, maybe for that reason, maybe for other reasons, I'm not exactly sure. Uh, but for our, for, for our pos from our position, it's just been to say, if this is something you want to cover, we know how to cover it. If it's something you don't want to cover, we don't cover it. We really make it a group decision. And by group, meaning that Bountiful City's a group, Davis County is a group of ours. We have school districts that are clients of ours. What the build importantly does is to make sure that regardless of who the carrier is, when it comes to this issue of public funds being used for this purpose, it wouldn't matter if it's PHP or anybody else, that the bill makes sure that, that, um, you know, as a matter of public policy, uh, that, uh, that this wouldn't be be covered by a public entity. Oh, okay. So currently the state as its own organization does not cover them. And individual subdivisions of the state may, if they perceive that their group of people that they serve would want it covered. Some of them have chosen to cover it. Mm-hmm. Thank you.

Che Loftus. Thank you. Che Loftus with PHP.

Motion? I'm ready for a motion.

I'd like to move, uh, for substitute. And my name Motion is to move first substitute in Representative Lyon's name.

Um, briefly, the sponsor has, uh, uh, spoken has been speaking largely to the substitute, which, um, would provide an option for those that have gone through a procedure that, um, like, you know, one of our witnesses we heard from earlier has, uh, wishes to Detransition provides that as an optional covered benefit. Um, the second component is that for those who are currently, um, receiving, uh, HRT, that would be, uh, a grandfathered in based on the physician's, um, recommendations. So that's what the substitute does.

Yeah. Thank you. I welcome the sub and I feel like that's very friendly and I was happy to work with a representative on that.

I'll make a motion. We pass that with a favorable recommendation.

Sure. Uh, thank you, Madam Chair. Um, I do not support that motion yet. I mean, this is a, uh, difficult thing to think about. Um, I feel like, um, there are a, a fairly large number of other cisgender hormone treatments that are given that don't have clear cut medical recommendations for them really at all. And if you go to the, the medical recommendations, they, they say, well, you, there's not a reason to give these cisgender hormones, but people choose to use them for their own personal perceived benefit. And, uh, so we write the prescriptions for them for their perceived benefit. Um, so to me that that's still an important line that I would want to be treating people equally across that barrier. If there's a lot of other things that to me still could be considered, um, elective. So at least that's just my thought about the bill.

Thank you, Madam Chair. Um, Representative Ward comment just inspired me to, um, I just wanted to acknowledge something to the public that I am covered by PEHP and PEHP pays for my hormone therapy. So thank you.

Yeah. Thank you. Um, I think the distinction in this bill, uh, is, is really about if it's transgender procedure related as opposed to just, um, any type of hormone or or thing for any other reason. Um, the point of this bill really is about the use of taxpayer dollars and prioritizing that. I sit on Social Services committee and I listen to all of the needs that are out there, um, that are absolutely life threatening that we have to make decisions about. And, um, and, and this one is something that I feel like, um, is very obviously elective. And so we need to protect those taxpayer dollars. And really, that's all that this is about. So I encourage everyone's support of this Bill. Thank you.

Thank you, Mr. Chair. Is it okay if my intern, uh, pans out, hands out some, uh, literature for the

Okay. Thank you, Mr. Chair and members of the committee. I'm happy to be here today in Senate business again, so I appreciate you, uh, inviting me to come and present on HB 1 93. So, HB 1 93 was a bill that began with a constituent of mine that happens to be a broker for insurance for public entities, so for government organizations and helps them get their insurance. And he notified me that there were some concerns from municipalities, school districts, people that he was working with, that when they were trying to sign up for the public insurance for, uh, PEHP, that they didn't have any choice about whether their insurance coverage would pay for transgender procedures or not, that it was basically an automatic thing unless they pushed a certain BE button. And they were concerned about that as far as public monies, taxpayer dollars going for elective procedures, and feeling compelled to cover that when that might not be something that their entity or municipality feels like should be covered with their taxpayer dollars. And so basically what this bill is about is, and by the way, I'm seeking, uh, speaking to the third substitute. So if you'll look at the third substitute there, um, basically what this bill does is it makes it so that taxpayer dollars will not be used for elective transgender procedures and, um, makes it just so that it can be really clear for the municipalities that are using that PEHP insurance. And, um, it does have some great little additions into it so that people don't get stuck high and dry. So if there happens to be somebody who has PEHP insurance and they are currently receiving transgender treatments, then what will happen is it says in lines 41 to 46 that they can continue on that treatment. So long as their physician that's overseeing it, um, determines that it's medically necessary for them to do so. Because that can happen sometimes with, especially related to hormonal treatments and stuff like that, that people might have to do hormonal treatments for long periods of time. So it's not going to cut off anybody's treatments that they're currently in. So that's really important to note. Um, it also in the lower part of the bill specifies that, uh, we just added this part in the house committee to make sure that there was parity with the other bill that we also ran, uh, HB 2 58, which said that private insurances needed to pay for deran procedures if they paid for trans procedures. We realized that there could be a situation with the PHP insurance also, that if PEHP had paid for, um, trans transition procedures for someone, and then that person decided that they wanted to reverse those procedures and restore that themselves to their biological sex, then what they could do is they could still have, if they were still getting that same insurance, of course not if they had left the insurance long before, but if they were still getting that insurance, then, um, PEHP would at that point be able to cover for that, uh, detransition as well. So this is something that our state is not alone in. There are other states, multiple other states who have been facing this same question, which is when it comes to a lot of elective pro procedures, things like hair transplants, tattoo removals, stem cell, uh, things like that, that, you know, those things aren't covered and they're, and the transgender procedures are elective procedures. And so should we be covering for controversial elective procedures with taxpayer dollars? And so this bill would basically just make a statement that PEHP would not be covering those procedures. Um, I think that's pr Oh, actually, I do want you to know that we've spoken with PEHP multiple times about this and that this policy is made with the intent to work with PEHP, not to hurt PEHP in any way. And we will continue to have conversations as we move forward with this legislation with PEHP, you know, if there's any little changes that need to be made, those types of things, we are happy to work with them as well. So, um, with that, I am open to any questions.

Okay. I just, I ended up spending a lot more time on this than I expected, obviously. So what is your, the target population? Are you talking just about about youth or, uh, adults as well? Or what is the target population?

Right. So it's just anyone who is covered by a taxpayer funded state, PEHP insurance.

Okay. And I, I've also had conversations with PEHP. And on this particular version, do you, um, do you know how it would affect this version, this, you know, the current version where that, you're talking about sub three? Mm-hmm. How it would affect PEHP?

Yes. I've had conversations with them as well, and that's why I said I'm happy to have more conversations with them too, just to make sure we really landed in a good spot. Um, they have said that this will change the dynamic a little bit for maybe some people, but for them they're gonna be, you know, carrying on. It could make some changes in the, in some of their administrative procedures and costs and stuff, potentially, is what I was told.

Yeah. And I've had similar conversations. Uh, the short answer is it would negatively affect PHP simply because this version, and I know we talked about multiple version, but this version would put them at a disadvantage. 'cause if there was, um, a public employee group that was, they could simply go to another, another insurance company that was, you know, providing the coverage. So I just wanna make sure everybody knows that if, you know, she's recognized that, you know, this, this is a version she wants to continue to work on. But I, I do want you to know that, that this current version is, is very difficult for PHP to accept.

Yeah, you and I have talked earlier and I, I'm, I have some concerns about this version as well. Um, the version, this version, because you, you have PHP, then you have the state employee pool, then you have multiple pools within the PHP world, right? Like everything from municipalities to counties to universities. And each of those universities or, or municipalities are self-governed, as it were. Um, and they are in and of themselves their own risk pools. And as far as, it's one thing to say to the state risk pool, we, uh, you know, as a state, we want this policy, but then we're gonna be reaching down to the rest of those risk pools. And I, this will re reveal some of my ignorance. I, I don't know exactly how each of those risk pools, um, are funded. They're insured under the same risk pool as PHP, but they're funded through whatever mechanism they're funded through, whether it be collections, collection from dues from each of their employees assumably. Um, but now we're reaching down to those individual municipalities or political subdivisions or universities and dictating to them what they should do in their own risk pool. Um, that seems like a bridge too far, uh, because it, it gets, it's just way more complicated than it is on, its on its surface, I think. And, um, I'm not sure if it's would be appropriate for, for individuals that, that feel like that, that that is the improper use of government funds. Maybe they should be, um, appealing to those individuals at those municipalities, at those universities to change their policy instead of us dictating to everybody carte blanche in a blanket policy. That is a long question. I apologize, representative, but if you, if you might respond to that.

Do you want me to respond? Okay, sure. Um, so I think there's a little bit of a problem with just going to your, say your school district or something and saying, Hey, can you please not pay for transgender procedures? Or Could you not have my money pay for transgender procedures because of the way that the pools work? I think that that would be very difficult for people to do. And I think that they make these contracts with the insurance companies. And so really the only way to say, okay, taxpayer dollars aren't going to be used for that, because we all know that if it's a government like municipality or if it's here at the state, then it's, it's part of the benefits package, right? And which comes through taxpayer dollars to all of the people that would be getting those things. And so, and those pools are put together by the insurance company. So the only way is to say that the insurance companies that are providing for the actual public funded insurance programs would not be able to pay for those things. I don't think you could just dive in and say, I don't wanna pay for it. So I don't think that conversation could happen. And I, and I think they could maybe try to get them to not do it, but then I think it could open the door to litigation for them if we don't give them some sort of protection, which is what this is aiming to do. I mean, that was, you know, that was a big part of the original conversation, was to try to protect our municipalities and people from any types of litigation that would happen.

If I might, Mr. Chair, please go ahead. This may be even a question for the chair, given some of your knowledge of this, um, as well as the presenter, but in, in, in establishing the rate at a, let's say a, a pool that is a sub pool, I'm gonna call it a sub pool. We, I think we'd, let's say a university or a municipality, let's use a university. Do they, do they use private money as part of that pool funding in any way, shape, or form? Do you know the answer to that? Is it purely from collection of dues, or is there private money that's ever part of that? You understand why I'm going, what if the university uses private money that's donated money as part of the procedure, then now we're dictating to private.

Right. What I do know, and I probably won't like, nail it, nail it because I am not an insurance agent, so that I probably can't phrase it perfectly. However, I will say that, um, in conversations with the University of Utah and people who also have been working with the University of Utah based upon this bill and what we're trying to do here, we do know that in that particular case, there are some people within the University of Utah as employees that would, um, be able to get the publicly funded or the taxpayer funded. But then there might be other people that aren't necessarily public employees that then would get different insurances. So they offer multiple different insurances. This bill would only, well, actually, this bill would only apply to PEHP and actually the University of Utah, Utah does not use PEHP.

Well, I didn't say University of Utah. Yeah, but you said

So, or, but that's the one that I was specifically, uh, recently having conversations about. I see.

Okay. Yeah. Thank you Mr. Chair.

Lemme turn my camera. I've, I've been thinking a lot about this and I, I'm struggling on the, I guess the use of taxpayer funds. I, I think that, um, university of Utah, other employers, they, they, they purchase, um, they contract with an insurance company and then they pay a portion of the premium. The employee pays a a portion of premium once a surgery is, uh, done. Normally the employer is not contributing to this cost of surgery. Usually, uh, the insurance company covers a cost. There's usually a write off because of a contract or preferred provider. And then the patient has their, their, their, um, their portion of the bill. So I, I'm, I'm really questioning whether this is the use of taxpayer funds, but let's, let's say for the sake of argument, I think the taxpayer funds are going to the employee's salary and to their benefits, and then specifically going to the insurance company, whether it's PDHP or another company, but more specifically, let's, let's say for the sake of our argument that it is taxpayer funds, uh, which I still think is a gray area, but let's, you know, if I was a Jehovah Wi Witness, and the majority of this committee, uh, were members of that faith, and I said, gosh, I I don't want my taxpayer funds going to, uh, anyone's blood transfusions. I tho those are against my religion. I, I'm uncomfortable with that. And so I'm gonna, I'm gonna pass a law that says, you know, none of the employers can, you know, can, can, can cover, uh, can have health insurance policies that, uh, cover blood transfusions. I, I don't know that I would be comfortable with that. I don't know that anybody would be comfortable with that. And I, I could also say, you know, for circumcisions of male babies, you know, maybe that is something that maybe I, maybe I'm the, I have an advocacy group saying, gosh, you know, we should be more like Europe and not circumcised our babies, and I don't want any of my taxpayer funds going to pay for a circumcision. And, and at some point, I'm just wondering, you know, what, you know, why would it be my right as a legislator, as a taxpayer, whatever, to decide what other, what, what health decisions that other adults are doing? Just because I don't like the procedure. Um, and so I, I'm really struggling, um, along those lines, Representative Peck, I'm wondering if you can, if you can say anything to assuage my concerns.

Thank you, Senator. I really do appreciate actually you being so candid and just expressing, you know, how complex of an issue this is, because it really is, I do think when we're talking about Jehovah Witnesses not wanting to pay for blood transfusions or maybe not wanting to pay for circumcisions, most of those things are done because of religious reasons. And I do think that when we're talking about, um, elective procedures for transitioning, we're not talking about a religion. So there is a little bit of a difference there. But I, but I will say also that, you know, we've got these municipalities and we've got school districts and, and people like that who are looking for insurance, and they don't want to be, be doing things that they feel like are controversial. They don't want to be doing what they feel like are in very elective procedures that aren't considered to be medically necessary. They want to make sure that they're, if they're telling so and so, you can't have a mammogram, or not a mammogram, but a, a, a breast augmentation, if you can't have a breast augmentation, then, then why are we paying for this over here, which would be a surgery that's comparable to somebody that's saying, I want this, I wanna look this way. I want a hair transplant. I wanna, you know, that kind of a thing. And, and I think that, that they really are conflicted and they're put in a really hard place. And I think the safest thing to do is say, this is elective. Anyone can get a hair transplant or a breast augmentation. Anybody can, you know, get those types of elective procedures. But that doesn't necessarily mean that a taxpayer funded insurance or employer should be forced to contribute to that with the money. That is also a whole bunch of people that aren't using those services with that insurance too. I think that's the ethical part. And, and where that comes in is why, why should those people get drawn in to those elective procedures?

Can I, can I ask a follow up, Mr. Chair? Please? Go Ahead. Yeah, so let's say you have two women, and they're both 35 years old, and one of them, um, her mother and her grandmother both died of breast cancer. And she says, you know what, um, I want a double MA mastectomy. I don't have breast cancer, but I don't, I I don't wanna worry about it. I don't wanna have to get checked every six months or whatever. And so I just want to double mastectomy because my mother and my grandmother died of breast cancer. But the, the other 30 5-year-old woman, let's say they're coworkers, she wants a double mastectomy because she's now identifying as a male. So why, why would the, why, why would the insurance cover for one of them, but not cover for the other one? Do you see what I'm saying here? Isn't that a bit of a, almost an equal protection type of issue?

Does it cover for the first situation? I've never heard of that situation

Covering. I'm pretty sure it would. And, and, and I, and I know it's unusual. It's, it's not frequent, but I know there are healthy women that do choose to have a mastectomy. And in fact, I heard, uh, Dr. Mike Kennedy talk about it when, you know, he was a senator that do choose that be because they just wanna eliminate that risk. So I'm just wondering why, why we would say to, you know, hypothetically to woman number one. Yeah, that's fine. Woman number two, no, we're not paying for that.

Well, it sounds like both of those things would be elective things. And so those, and they're very elective things. I mean, because one of them is based on fear, I guess, of what they perceive their possible medical future could be. And the other one would be based on another desire to look a different way. And so they're both very elective. And all I can say is I'm not sure that's an ac actual policy. It sounds like we might be going on what we, you know, we're remembering someone says, I'm not sure if it is. That's a very interesting question. And I, I, you know, I don't think that personally as a taxpayer, I would want to pay for elective procedures like that at all myself, actually. So I don't know. But this isn't really about what I want. It's really about what the people who are trying to make these decisions when they're picking insurance are concerned about

Yeah, he was really still there. I've never seen him be that completely still before, so I was very impressed. Um, you know, uh, what is the difference between, um, do you know the difference between costs, like at a, on a cash basis, how much it costs to, you know, uh, to, we talked about breast augmentation, right? What does it cost to do breast augmentation or an insurance plan versus, uh, you know, someone doing it on a cash basis? Is there a, do you know if there's a difference between those two? Wow, that's a really great question. I have not looked at how it's billed or those types of things. No, Luckily, I have done a little bit of homework in life while we're sitting here. I apologize now to my wife. I am not considering breast augmentation myself. Uh, so if you look through my browser history, I'll be very clear. Um, but don't ask, don't tell there, fair enough. Uh, not that there's anything wrong with that. So I, I'm just, I'm just trying to look at the, the difference here. And, uh, 'cause I look at this bill a little bit differently. It's not an expression of belief. It's not, uh, you know, one, you know, you, you can go through some of these things as a measure of control or something like that. For me, this is a, an insurance provider question and trying to scope costs, right? And we scope costs all the time, or, you know, insurance providers are constantly trying to cover the top end of what they're doing, because when they cover dramatic ends of, uh, of costs, what ends up happening is the, it gets really expensive really quick. And, uh, you know, you compare that to circumcision was brought up a minute ago. I will get to my, my breast augmentation here in a second. Circumcision was brought up a minute ago. Uh, a typical doctor's visit is about $250 for a, a baby boy in a hospital. Uh, uh, the insurance company is typically charged between 200 and $300 for a male circumcision. So if you're looking at extreme levels of coverage, you're, you're right in line with that two to $300 as like a normal doctor visit type of thing when you're talking about that kind of care for, for, uh, uh, for a, a baby, so to speak, right? But for, you know, but when the baby needs additional care, right? And you start looking at, you know, uh, copays, uh, and you know, if the, if the child needs to stay in a nicu, uh, you go through all those things, the parents' cost goes up dramatically. And insurance, literally, I've seen the bills they can get into the millions for, you know, for, for, for kids in that situation. And so, you know, believe it or not, insurance companies have, uh, protocols, care protocols when they're dealing with, you know, with nicu, uh, patients, uh, for, you know, for, for babies and that kind of thing. And they do it to control the top end of costs. Some point, you know, society is always trying to make a cost utility argument, benefit versus burden. If you add a lot of expensive surgery or expensive medical care to a cost and, and insurance providers cover it, what ends up doing is it raises the insurance rates for everyone, right? And makes it extremely unaffordable, right? Yeah. Utah, we just recently released, Utah is the fourth largest participant in the Affordable Care Act in the exchange. And why is that the case? Because we are so many small employers in this state, right? And if you took that exchange and you started adding a bunch of high level cost of surgery or those kinds, you would top those costs off. But right now we're talking between 25, $30,000 a family who are on that exchange trying to cover health insurance for their families. Right? Now, bring it back to state employees. Lemme talked about breast augmentation for a moment. Turns out, if you go to Mexico for breast augmentation, you're paying about $5,000. If you do it in the United States, it's between 12 $15,000, right? There's a difference in the standard of care, and there's a difference in the cost. I, I think about that. And what we see is that when procedures, and by the way, that cost has persistently gone down, um, look at other types of care as when the cash, when there's cash provided or when there's cash payers, the cost of those procedures persistently go down. But what happens as soon as insurance gets involved in providing that cost, those costs go up. And that is persistent throughout our, unfortunately poorly organized or poorly managed health and care system where we manage on, you know, sickness and not necessarily manage on wellness. Right? And we're not outcome determinative. We're trying to deal with how do we charge up a bill or whatever it may be. It's all about insurance codes. So, but if, if we look through this and we say, how do we cover ourselves against top end charges in insurance, and how do we control this from an insurance provider standpoint and protect ourselves? You've got to add some types of care that aren't going to be covered. And I could go through the list of the types of cares that aren't covered, right? There are a lot, believe it or not, in, in PHP, there are a lot of types of coverage that are not covered. You know, in all insurance plans, they all have exclusions, right? And, uh, including types of drugs that you can take, like all those ex exclusions are part of the, part of the precedent. So my frustration about adding, uh, you know, transgender medical procedures to insurance is, it is going to drive the cost up. And when I look at what is happening now when we see insurance, is we, we are seeing those costs balloon. And however, if you took the same thing, no, no kidding, I did the same analysis, Juab, I just looked through this, uh, you know, anybody can do it. It's all online. But if you look online and you go to Mexico for the same surgeries, cash payer, it is a third the cost. So, believe it or not, what we are seeing is this medical tourism take place where costs, and, and believe it or not, in some, in some cases, it's actually going to be cheaper for them to go to Mexico than it is even for someone to do it through their insurance company, through medical care, through multiple trips or through all those things. So I'm looking at this as a fiscally prudent standpoint and saying, okay, what is medically necessary? Let's cover those things. Right now, if we choose to cover transgender surgery procedures, but we don't cover extra days in the NICU for a, a baby who's fighting for their life, or, you know, we charge extra for ambulance coverage, uh, for people to be rescued from, you know, the other parts of the state or an insurance won't cover that. I start to think about these limitations that we have throughout code. And I'm looking for some consistency. And what I see when I see this is I see an opportunity to say at the top end, this is newer and these procedures are newer and we see cheaper cash alternatives. There should not be, at least as I look at it, there shouldn't necessarily be a public employer requirement to provide this throughout the system, right? Especially when there are cash alternatives that are going to be a, that are going to be a better alternative as far as cash price availability. So the, you know, some people want to drag it into a, a belief like one, you know, belief system versus another, or those types of things. For me, it's dollars and cents. How do we control what is becoming, you know, uh, I know this, uh, to be the case, but it, the state used to contribute much less per employee for the cost of healthcare. And since 2008, we have seen nothing but an increase our 2009 Affordable Care Act. We've seen significant increases in the cost to cover for our employees. And I think for me, from a dollars and cents standpoint, it just makes sense that we start looking at experimental procedures, things that aren't guaranteed to work or whatever it may be, and we not include them in the public health system, but that doesn't mean they're excluded. 'cause again, those where there are cash, where there is cash availability, there is a much better deal to be had for those procedures than they can get through the hospitals or even through, you know, through their insurance provider. So that's, that's how I look at this. Uh, and, and, and I look at all these things and I'm like, there's, there is a better way to do this than we're doing it by including it in our insurance program. The one thing we've guaranteed is that it's going to get more

expensive. Thanks. Do you want me To comment on that? Sure. Okay. Just maybe two comments. I don't wanna take too much time. I know that the committee has, there's a lot of people here that care about this bill. Um, but one thought is, you're absolutely right. I used to work for a dental office and I did their billing, and I also was a dental assistant. And I remember that there were certain insurances that once those insurances started chiming in on some of those elective procedures, the cost of those procedures with the dentists, they all went up. Mm-hmm. Everything always go up, goes up because they don't pay the full amount. So then they have to inflate the cost in order to get more of that money. Yeah. So you're absolutely right on that. And I think another thing that you hit on that's really important is there's always the unforeseen consequences, right? Just like the little baby that could have a procedure, and now suddenly they're in the, you know, the intensive care something. But that could happen, um, you know, with this, and if we're gonna have an elective procedure that can then lead to a lot of other unforeseen negative physical consequences that could hurt the physical health, even mental health of the person. I think that then we're really talking about a, a lot of, a lot of taxpayer dollars here. And, and really that's, that's the reason why I took this on, because I really do care about what happens to our taxpayer dollars.

Yeah. And I, I, I will say this also, I mean, there, uh, you know, this, we, we are having this debate right now on another, on another bill, uh, I think it sent a bill 2 29, if I remember right. But we're talking about employee benefits and how much it costs, and there's a real fiscal cost to all of those things. I guarantee that if we put how much we're putting, you know, towards each employee's healthcare program as part of the fiscal note, uh, you know, for some of these, it would be, uh, a significant issue as well. So anyway, I just, uh, you know, if this bill was written differently and said that we're not gonna provide employer healthcare anymore for employees, like that fiscal note would also be huge, right? Like the, the list goes on of those consequences. Nobody's proposing that. At the same time, trying to provide top end guidance of the, of the cost, you know, because I, I know people are gonna have strong feelings during public comment, and I, I want them to see for, for many, this is a dollars and cents conversation and not necessarily, you know, a, you know, about an ideology or whatever it may be. So thank you for representative

I do have one question. Um, have you assessed the potential litigation if the bill passes?

Yeah, I appreciate that question. We have, so there have been, like I said, multiple other states who've passed bills just like this. And there have been, uh, litigation, you know, suits that have happened, and there have been very successful outcomes for those states in those suits. I've had a lot of conversations with our attorney general and other risk management attorneys, and we have had a lot of time working on, okay, what do we make sure that we do to, to, um, keep the, the state safe if we make this law? And what are we prepared to, um, you know, who, who, what state are we willing to, to follow if we had to defend ourselves? And I think they know exactly what they would do if they had to.

Okay. Thank you, Mr. Chair. I'm Phyllis Kimmel. I'm representing myself. Um, I feel government money should not be, um, used for elective procedures and surgeries, and that would include transgender procedures and surgeries. I ask you to vote for this bill. Thank you.

I'll try. I'm Kim DelGrosso with Eagle Forum. I was very fascinated with the, um, questions and testimony of the different, um, participants. So I looked it up to see how much it really does cost top surgery and hormones. Rough. Total uninsured is 6,000 to $12,000. Vaginoplasty alone, 15,000 to 30,000. Fallow plasty alone, 50,000 to a hundred thousand. Multiple surgeries, 50,000 to 150,000. I also asked what it would cost when they, if they wanted to, um, reverse the gender surgery. And it went through a whole list of re estimated cost at 20 to 60,000. And I think your point is well made. I worked in the insurance company, I think that taxpayer dollars. I have a husband who's a purple heart, which means that he was shot in Vietnam, um, and has really suffered. And some of the things we're getting insured and some of the things that he needs, we have coming, but right now, not all of it. So I would, um, ask you to, to vote in favor of the bill.

Uh, thank you very much. Uh, how much time do we have, please?

You. My name is, um, Amalia. I come here with my two children on behalf of ua. I carry the water. I am a, um, proud member that lives on the west side here on the native and stolen lands of Ani. And I just want to comment on some things. First of all, um, that, uh, I, uh, happy Black History Month, Ramadan and Lunar New Year. I come here speaking to you and many of the comments that you have made do not reflect your, um, who, your bodies. And so there were many about, about women, about other things. And to say, um, don't ask, don't tell. This is the history here, and it reflects here. The artwork does not, I do not see my children here. I do not see any of us. And for you to see us, look at me, I'm talking to you. You are here to serve us. Um, Senator Vickers, please, please address us. We are here and it seems that most of you like to talk to yourselves, but we are here. I am a mother, and I'm saying to please don't,

The, on the history of black, uh, in the month of black history. This is the history of this country that, um, a controlling black and brown bodies, thank you and bodies that

Black and brown bodies, please do not control and give trans, ma'am And ma'am, youth ma'am, please, Youth are, youth are coming suicide, and there are bodies in ice, so, and ICE in Palestine. So please don't talk about young children that you care about. Ma'am, please are ice. Please don't. Please, please. Okay, free Palestine. Thank you. Thank you.

Thank you to the legislators for your service. I'm Harris Carmichael. I'm representing myself. I'm an internal medicine physician trained here at the University of Utah. In my residency, I also completed a Master's in public health and health policy at, uh, Stanford University, sorry, fellowship of Public Health and a master's in in Health Policy. Uh, ACP is the American College of Physicians, the largest specialty organization of physicians in the United States. Has explicit policy positions against the mechanisms of this bill. On the subject, if you wanna talk, financial, uh, issues around the subject. The NHS in, in, in Britain is about as stingy as it gets. And they cover both hormonal and transgender conversion therapies because we know that, uh, gender affirming care reduces depression, anxiety, and suicidality and costs from those are also quite high. So if you're trying to balance cost, this is not the way to do it. And I agree with, you know, concerns. If we suddenly decide that depression is, is something that we shouldn't be treating because, uh, our constituents or legislators believe that we shouldn't be caring for patients that can't care for themselves, do we have to stop treating those patients? Do we have to stop giving care to that we know has evidence-based just as gender affirming care does? So I'm asking that you vote against this legislation.

Thank you, Mr. Chair. And the, uh, committee here. My name is Paisley. My birth name is Peter. I'm a transgender woman that lives here in Utah. This bill affects me, all of my friends. It affects my livelihood, it affects my health. Uh, I will bullet point this. Um, most of these procedures that are claimed, uh, through paranoia or fear to be fully covered by public funding is just not true. They are elective procedures, hence they are elective. What is covered by these public funds, uh, is HRT. So estrogen or testosterone, right? When a woman born with a vagina goes through perimenopause, she takes estrogen to Helper. That is gender affirming care that is not being banned in this bill just for transgender people. Uh, I also wanted to say to the point of, well, why should we pay? Why should taxpayers pay for things that they don't necessarily agree with or they don't want to pay for? Because that's what community is. That's what being an American and being a taxpayer is, is you have to pay for things that you may not want to pay for to help other people who can't help themselves. That's really all I needed to say.

Good afternoon, members of the committee. My name is Michael Samantha Starks, a resident of Salt Lake City, a dedicated public servant of over 14 years. And I'm speaking, speaking strictly on my own behalf today to oppose HB 1 93. I start by turning to the February 12th meeting of this committee. When presenting HB 2 58, Representative Peck stated that the goal of that bill was parody of entrance comp coverage. She explicitly told this committee that HB 2 58 was, and I quote, in total alignment with HB 1 93. HB 2 58 establishes a linked framework. It legally ties detransition coverage to transition coverage, ensuring that if a plan covers the initial treatment, it must cover the reverse. HB 1 93 breaks that link and promise it explicitly prohibits a PHP from covering transition healthcare, yet simultaneously mandates coverage to, to reverse care provided prior to May of 2026. This creates a distinct statutory inconsistency. The state is mandating coverage for the reversal while prohibiting coverage for the initial treatment. It deems the reversal valid medicine, but the procedure itself invalid. That is not alignment. It is a double standard by placing the prohibition. Lastly, I want to reiterate that I'm a transgender person covered by PHP. This bill directly impacts my healthcare and my wellbeing. I urge you to hold the sponsor to their word regarding alignment and vote no on HP 1 93.

Um, y'all, hopefully Y'all are paying attention, please. Um, good morning, Tia as well. Um, my name is Madam Alyssa tle. I'm a transgender uan who's embraced being an elegant, hardworking, confident woman for eight glamorous years. In these eight years, whenever I stood in public, I have been named by strangers, the following, beautiful, a doll, a diva, an icon, a queen, all in the case of being my true authentic self. It the same eight years, I, along with others in this room, have been a target for hate from the government passing unnecessary laws that limit mine and others' freedom to live to the eyes of those who claim to be faithful and loving of all, only to prove otherwise by saying, I am destroying God's beautiful creation. When in truth, I am using the canvas that is provided by him only to make something beautiful. These daily attacks are rooted from normal humanly acts, everyone else does. Why are we the ones being villainized and neglected of help from the government? Representative Nicklin peak or perk, whatever her name is, I forgot, and Senator Daniel McKay. We share the same interest of preserving peace in all families of Utah, but where is peace? But where peace rises is where fear in the people dies. And this bill, HB 1 93, which prevents low income beings, both adults and minors, the H-R-T-H-R-T treatment, that they research and desired for their own, on their own wellbeing with no pressure from others. Thank

Thank you chair and committee for listening to me. I am a transgender mother, mother to a transgender child.

My name is Billy Simi and I represent myself. Um, I wanted to take just a quick moment to point out a few things. First of all, the woman who was here today speaking, um, for the bill mentioned a lot of conversations she had and never listed any facts or even outcomes, often of those conversations. Um, no specific facts, um, along with, I appreciate the research, um, done from the members of the, of the committee, but they were missing a lot of points, um, specifically the costs of healthcare going up. And I'm not gonna lie, I was completely shocked at the mention of leaving the country to get healthcare. Not even talking, talking about that standard of healthcare or that additional cost for somebody who is already, um, somebody with less than let's say, um, when it comes to support from the government or even anyone in the state. Um, the other thing is, is my voice is not enough. Um, everyone who takes the time to come here, I recognize you only have a certain amount of time, but these voices, this is their life. This means what happens to them tomorrow and the next day, and it means their livelihood for their kids, um, or themselves. And so listening to them would be really important. I'm not gonna lie, I got a little bit nervous, um, speaking to

But please remember that gender affirming care is healthcare. And when you are targeting a specific group, when it comes to how many people are getting elective surgeries, there are millions more, hundreds of millions more than those that are just transgender receiving gender affirming care. Please, please do not target one specific group. It is unfair unkind.

Thank you. My name is Il Tager. I live in Salt Lake City. I'm here to represent the testimony of a trans man in Davis County, as well as a board member for the Stonewall Democrats and the Utah L-G-B-T-Q Chamber of Commerce. So I'm gonna read the testimony from the trans man who couldn't be here because he's at work. I am a 26-year-old trans man, born and raised in Utah. Before transition, I was entirely reliant on government assistance, Medicaid, and Section eight housing. I could not hold a job down for longer than a couple months at a time. In 2022, Medicaid covered a hundred percent of my top surgery. Within six months, I secured a job that I've now been working at for three years. It has gotten me off all government assistance. I have never been more mentally stable in my life. My story is proof that Medicaid paying for gender affirming care is more cost effective than not, because people like myself get off Medicaid and other assistance programs when we're stable enough to be an engaged, contributing member of society. Again, now this is as, uh, board members and, and for myself and my community. This bill is designed to restrict our rights, erase our identities, limit healthcare access, silence expression, and codify discrimination into law. If passed, they will cause real harm. They will make L-G-B-T-Q people less safe, and they will send a clear message that queer and trans people are not welcome here. When our community is targeted, businesses suffer. Talent leaves entrepreneurs, entrepreneurs relocate national partners, reconsider investment employees disengage in growth stalls. Please,

Um, hi. Hi, can you hear me?

Hi, I am Dr. Sally Tran. I'm a board certified family medicine physician practicing in Utah. And I'm a UFP board member. I'm here to express opposition to this bill, which prohibits the use of public funds for hormonal sex, um, or surgical treatment for trans transition in care. As a primary care doctor, I care for transgender and gender diverse patients across the lifespan. Gender affirming care, including hormonal therapy, is not experimental or elective cosmetic treatment. This is evidence-based care recognized by major medical organization and used to treat gender dysphoria, diagnosable medical conditions that associated with increased risk of depression, anxiety, and sociality when untreated. So this would be more costly if we had to treat that. Um, treat worsening cases of depression and anxiety. This bill raises several significant concerns. First, it, um, substitute legislative judgment for individualized, uh, medical decision making determines, um, nations of medical necessities that are best made within the physi, uh, physician patient relationship guided by clinical standards of care, not by statutory prohibition. Secondly, it restricts public funding creates unequal access to medical indicated treatments. Patients with private financial means will continue to obtain care while lower income patients often already medical medically vulnerable will be denied access. This creates two tiered system of base solely on income. Third, it disrupts

No problem. Basically, it really restricts, uh, um, access to recognize medical treatment interferes with professional standards and pleases physicians in ethically challenging positions.

Thank you so much for the opportunity. I would like to speak in favor of the bill. Um,

Maryanne Christensen, executive Director of Utah Legislative Watch. I live in Murray. Um, several years ago I attended a child welfare welfare conference where a presenter named Sidney Wright was telling us about her Detransition story. And it was a heartbreaking story because she told about how the treatments, the hormones that she'd taken, the cross-sex hormones and the puberty blocker blockers, along with, um, physical procedures, had completely ruined her health. She kept going to the doctors and doctors would tell her, you're, you don't have a disease, we can't treat you. You're, you're suffering the consequences of these procedures. It just isn't a prudent thing to do to, to spend public money on procedures that are going to be a detriment to a body. Female bodies don't do well with male treatments and vice versa. Um, also, I think we do need to keep in mind the Utah taxpayers who they contribute with the tax dollars towards this program. Me and my husband, we had a small business and we, we would pay for our own health insurance program. And then when Obamacare took over, we were completely priced out and we tried to keep a medical savings account because we couldn't afford health insurance and we didn't have anyone paying for our health insurance. It's just not fair to ask taxpayers in those kinds of situations to be contributing towards, towards, um, treatments that they don't believe in and that are not in the long run, not physically, emotionally, and mentally beneficially. Thank You. Beneficial to the patients.

Thanks, uh, appreciate all the public comment. Uh, it is, uh, always helpful to hear public comment. I'll just, um, you know, that being said, for the the cost perspective, uh, I'd like to make a motion that we recommend the bill favorably.

Yeah. Why don't I withdraw that motion to make the motion to delete title and body, uh, first substitute house bill 1 93 and replace it with third substitute house bill 1 93.

Um, I, I'm gonna, I'm, I'm, I'm hesitant because I, there's, there's various stakeholders in this, involved in this, this substitute significantly does damage to PEHP that I'm concerned about. Um, there's others that like it, but there's other versions that are the same thing. You know, you benefit one, you don't benefit the other. So I'm hesitant to even to vote for the sub. I, I know that that's the one that the good sponsor would like. Um, and I, but I, I did wanna mention that.

No. I was thinking we were on the sub. No. Just to adopt the sub. We're still on the motion to sub?

That's welcome. Thank you. He's

Sorry, I just got back online. Um, the motion to substitute,

Thank you. So the sub that has been posted sub one takes in all public funds. And when we said that that language was recommended, and then we didn't realize that it would make it so that the University of Utah would not be able to do the procedures at their, uh, hospital, and we didn't. That wasn't the purpose of this bill. The purpose was just for public insurance. So sub three just says that PEHP public insurance cannot pay for transgender procedures.

Thanks. I'll make a motion that we, uh, pass out third substitute House Bill 1 93, and I'll speak to that if that's all right. Okay. Uh, I appreciate the sponsor's work and I actually appreciate the chair's work on this. Um, you know, trying to meet and find a balance, I do think sub three is better than sub one. And so I'm really glad that we, you know, adopted sub three. Sub three may not be perfect yet. Sounds like there may be some concerns. And so, uh, you know, we may have to continue working, but I think, you know, from a policy standpoint is a good way to protect us on the upper end with experimental surgeries, uh, and experimental merit medical procedures. And with that, uh, I'll, I'll conclude.

I probably will make absolutely no fans in the room, but I'm gonna be a no, I don't believe state DAX dollars should be used for fund elective transition surgeries. But however, PHP is not just state employees. It's a collection of independently funded risk pools included university, cities, counties, and school districts. Those entities are funded funding their own coverage. They're their own actual actuary actuarial pools. I'm not convinced the legislator should mandate their benefits. So again, I'm, I know I'm not making any fans on either side. That's, that's where I'm at, of which I've communicated that to you earlier.

Thank you. Um, as was mentioned, um, I am very adaptable on this bill. We wanna make sure that we get it exactly right and I am happy to work with anyone. In fact, I really wanna express my thanks to all of the members of the committee who have been involved in the process of trying to fine tune things and get us to where we are on sub number three, especially the chair who's worked tirelessly with me to do this. Um, and I'm not above making other changes that need to be made because that's how these things go sometimes in this process. My dad used to say, um, that he hated when he was stuck between a rock and a hard place. And I think maybe for some people, uh, the bill feels a little bit like a rock in a hard place, which is kind of hard. But, but the thing that I'm trying to do with this bill is to get our public insurances like PEHP out of the rock in the hard place that they are in. So they are promoting an insurance that essentially can put municipalities and school districts in a legal path that would be detrimental to them in two ways. Because on one side, they could get sued if they say we're not going to be paying for transgender procedures. On the other side, there are people now that have gone through transgender procedures who are now starting to sue the medical industry and professionals who have done those procedures to them because of the detriment and harm that have been caused by those procedures. And so now we have two ways that it puts our insurance companies and our public funds in the middle, which could end up meaning because the state has the deepest pockets in all of that, that we could get sued if we don't just say, we're not in this game, we're out of this. And I think that's very important. We have tried to maintain as much parody as possible. I know in public Confi con comment, it was mentioned that there wasn't parody. But there is, because in HB 2 58, which we already voted on in this committee, it says, if a private insurance pays for transgender procedures, then they need to pay for the deran procedures. This bill specifically is don't pay. So if you don't pay for transgender procedures, then you don't have to pay for the deran procedures unless you did for a person at one point, then you would be held to the same criteria as those private insurance. So, so it does have that exact parody there. We've tried everything we can to be as thoughtful as possible as we've been working through this process as a, a team of, of legislators, drafters and, and just stakeholders who've been at the table on this. And so I hope that you will see this going forward could actually help our state in the future, um, not be stuck in a rock in a hard place. Thank you.

I'm gonna explain my vote. Um, and I applaud the, the, the good representative because, and I've kinda watched as I've, I've followed this bill for a while, but as it came to our committee and we start, I started spending more time on it. I think she's really landed on a policy discussion that needs to be had. In fact, it started out something a little smaller. And then, and then in the last, even just in the last two days, I think we've talked about three or four different iterations and versions. It could be and directions you could be going. So I think this policy discussion still needs to be had, but I just do not feel like uncomfortable in, in moving forward. So my vote is no.

Madam Clerk, Per substitute house Bill 1 93, transgender medical procedures, amendments by Representative Peck, this bill was heard in Health and Human Services with a vote of 9 4 1.

Thank you Mr. Speaker. This bill is a pretty simple concept. It was brought to be by a constituent who was concerned about municipalities having to make a decision that could potentially put them into legal problems. And had been hearing from the, his clients and people that he works with to, um, help them get health insurance in the public sector, that they felt that there was a problem with having to choose to cover certain elective procedures that, um, their tax base may not agree with. So anyway, this bill basically just says the publicly funded insurance cannot pay for transition procedures. And it also says that if a publicly funded insurance already did pay for a transitional procedure for somebody, then it would also have to pay for a drans procedure for that person if they wanted it, of course. And with that, I'm open to any questions.

Thank you, uh, Mr. Speaker, I'd like to move a second substitute on the system in my name.

Um, yes, I would. Thank you. Um, colleagues in this bill, there are are two parts that to me i I would like to consider separately. Uh, for me, this is important to what I would like to be able to support this. There are two broad categories of treatments that we're talking about here. One is hormonal treatments, uh, that can be given and one, and the other category is surgical, uh, treatments that can be given. If the reason for the bill, which is a very valid reason to consider, is that taxpayers in general should not pay more for a given insurance plan. The extra cost that comes from covering these treatments comes exclusively from the surgical procedures that are covered. That when you look in the little fiscal note on the bill, and it explains why the small extra amount that the plans have to cover that estimate comes entirely from their covering of the surgical procedures. So what is in the substitute really is to still keep the surgical portion in where this exact same policy would be in place. Plans that went of were governmental in nature would never have this extra higher cost. They would not cover the surgical procedures, but it would still allow those plans to cover the hormonal treatments. And there's a couple of reasons why I think the hormonal treatments still should be treated equally. The the first is that there's not a, a higher cost, uh, to cover them. These treatments are at times, are used the, the exact same medicine at the exact same dose by a patient who may wish to use it for a transgender related reason or a cisgender related reason. So as an example, there are some biologic females. There are women who wish to take a dose of testosterone that is as high as is typical for males because they wish to be able to build muscle mass easier. They perceive that it gives them more energy and they want to have the higher libido that comes with that dose. They have no intention of trans of transitioning to be a biological male may even be willing to take treatments to so that they don't grow a beard, but they perceive enough benefit that they want to take that medicine at that dose, and that is currently allowed to them. Another biologic female has a different motivation. Who wishes to transition to become a male may take that same dose of testosterone at that same dose. And if that portion remains in the bill, then we would say, well, this same medicine at this same dose, you can have it and this same medicine at this same dose, it won't be covered. Um, another example would be a male who is using spironalactone. They may be using that just because it reduces acne at the same dose. A different patient may wish to take it for the reason of transition that it reduces their facial hair so they don't visually appear to be a male. If the, if the bill passes and still retains this hormonal portion in it, it, it will be possible for insurances to parse that out. But it will be an extra step. Treatments that currently are inexpensive, these, these treatments in general are not expensive ones are medicines that mostly are generic. The insurance will then have to start prior authing those treatments for all patients who wish them to try and parse out the reason, uh, why they're using it, um, before they allow, are allowed to cover it. So for the, the larger group of patients who are using it for some cisgender reason with no intention to transition, that, that would be an extra hurdle for them also to be able to get this medication. So for those reasons, um, I hope you'll consider this substitute that still keeps surgical procedures in which give the greater costs. Uh, but that for hormonal treatments, which are used without additional cost and for the same reasons, um, I hope that you would support this substitute. Thank you.

Thank you. I appreciate the representative's attention to this matter and all of the research that he's done and his expertise in the area. However, I reject the substitution because as he even mentioned, if a person who is not undergoing a, a transition, a gender transition treatment wants to take medication for acne, this is not going to alter that this is not going to make any difference there. They still can go to their doctor. Basically what this bill does for the public insurances is it says that transgender procedures, including the hormones, would be considered elective procedures that are happening. And so long as the doctor doesn't say this is for an elective transgender procedure, then the doctor can describe whatever he needs to for his patient. So I would encourage my colleagues to not vote in favor of the substitution.

Thank you Mr. Speaker with the sponsor of the substitute yield to a question.

Representative Ward, will you yield? Yes.

Thank you Mr. Speaker. My understanding is the original, uh, first substitute has a fair, uh, quite a high, uh, fiscal note for taxpayers. Could you, I don't see a fiscal note on the substitute. Could you estimate the cost savings to taxpayers for the substitute policy versus the original, uh, uh, policy?

Sure. So my estimate is that it will look identical. And the reason that is my estimate is from speaking, um, with our CEO of PEHP and asking him why did you know, where did this fiscal note come from? And, and what he told me was that the fiscal note came entirely from the surgical procedures, that none of it came from the hormones so that it wouldn't change if you took that portion out. I expect it to look identical.

Thank you. Um, a line that was said right here on the floor just a few minutes ago was, as an adult they can do what they want. Um, to me, if that is really how we're thinking about it and if it really is the case that this can be done for equal costs that we don't estimate that there are any other co additional costs that we can measure put on anyone else, then I hope that we would be in a position to really honestly say that's a, a choice that we might not agree with, but a choice that they as an adult can make and we would not try and take away, uh, a portion of their insurance coverage over that issue.

We are in division. Yeah.

Thank you Mr. Speaker. Um, I wanna clarify, if this was just about keeping public dollars out of elective procedures, then it wouldn't be called transgender medical procedures and it would probably include things like breast augmentations and reductions in hormone replacement therapy and things like that. This bill is singling people out. And I also wanna say that this bill focuses on adults, not minors. We have had years of discussion about transgender youth and I I don't always agree with my peers. I usually don't, but I cannot at least see where they're coming from. But as, uh, the good representative who just presented, said, when they become adults, they can do what they want. A lot of the discussion revolves around the concept that people are too young to make permanent choices. And we are not talking about people who are young. We are talking about fully formed human beings who can make all sorts of permanent decisions. They can marry, they can join the army, they can rent a car, they can do a lot of things that we make sure that youth can't. These are different concepts. One person's elective is somebody else's, medically necessary. And that is the distinction that should be made between the patient and their doctor. Not 104 legislators in the exam room with them. It Is not our job to tell adults what they should be doing with our their own bodies. It is our job to be making our constituents lives better and to be removing barriers to success for them. And this bill does the opposite. We all have constituents. Every single person in this room has a constituent that is going to be hurt by this legislation if it passes. And so I urge my colleagues to please join me in voting no today. Thank you.

Thank you Mr. Speaker. This bill is not about what people can do with their bodies. This is about whether cities can designate or not designate what they will cover. Um, and, and what is considered a, um, something right now that is just a default versus something where they would be protected legally if they chose not to cover something that doesn't preclude anybody from doing what they want with their bodies. So I urge my colleague support of this very important distinction in our code. Thank you.

Thank you. Um, what has already been said is, uh, good enough. I think, uh, any adult can do whatever they would like to do. The question is just who pays for it and we shouldn't be forcing municipalities to pay for elective procedures. There's a lot of elective procedures that we don't pay for, like stem cell research and tattoo removal and all kinds of things. And this falls in that same sort of a category. So I encourage you to vote for this bill.

Thank you, uh, Mr. Speaker, I'd like to move a second substitute on the system in my name.

Um, yes, I would. Thank you. Um, colleagues in this bill, there are are two parts that to me i I would like to consider separately. Uh, for me, this is important to what I would like to be able to support this. There are two broad categories of treatments that we're talking about here. One is hormonal treatments, uh, that can be given and one, and the other category is surgical, uh, treatments that can be given. If the reason for the bill, which is a very valid reason to consider, is that taxpayers in general should not pay more for a given insurance plan. The extra cost that comes from covering these treatments comes exclusively from the surgical procedures that are covered. That when you look in the little fiscal note on the bill, and it explains why the small extra amount that the plans have to cover that estimate comes entirely from their covering of the surgical procedures. So what is in the substitute really is to still keep the surgical portion in where this exact same policy would be in place. Plans that went of were governmental in nature would never have this extra higher cost. They would not cover the surgical procedures, but it would still allow those plans to cover the hormonal treatments. And there's a couple of reasons why I think the hormonal treatments still should be treated equally. The the first is that there's not a, a higher cost, uh, to cover them. These treatments are at times, are used the, the exact same medicine at the exact same dose by a patient who may wish to use it for a transgender related reason or a cisgender related reason. So as an example, there are some biologic females. There are women who wish to take a dose of testosterone that is as high as is typical for males because they wish to be able to build muscle mass easier. They perceive that it gives them more energy and they want to have the higher libido that comes with that dose. They have no intention of trans of transitioning to be a biological male may even be willing to take treatments to so that they don't grow a beard, but they perceive enough benefit that they want to take that medicine at that dose, and that is currently allowed to them. Another biologic female has a different motivation. Who wishes to transition to become a male may take that same dose of testosterone at that same dose. And if that portion remains in the bill, then we would say, well, this same medicine at this same dose, you can have it and this same medicine at this same dose, it won't be covered. Um, another example would be a male who is using spironalactone. They may be using that just because it reduces acne at the same dose. A different patient may wish to take it for the reason of transition that it reduces their facial hair so they don't visually appear to be a male. If the, if the bill passes and still retains this hormonal portion in it, it, it will be possible for insurances to parse that out. But it will be an extra step. Treatments that currently are inexpensive, these, these treatments in general are not expensive ones are medicines that mostly are generic. The insurance will then have to start prior authing those treatments for all patients who wish them to try and parse out the reason, uh, why they're using it, um, before they allow, are allowed to cover it. So for the, the larger group of patients who are using it for some cisgender reason with no intention to transition, that, that would be an extra hurdle for them also to be able to get this medication. So for those reasons, um, I hope you'll consider this substitute that still keeps surgical procedures in which give the greater costs. Uh, but that for hormonal treatments, which are used without additional cost and for the same reasons, um, I hope that you would support this substitute. Thank you.

Thank you. I appreciate the representative's attention to this matter and all of the research that he's done and his expertise in the area. However, I reject the substitution because as he even mentioned, if a person who is not undergoing a, a transition, a gender transition treatment wants to take medication for acne, this is not going to alter that this is not going to make any difference there. They still can go to their doctor. Basically what this bill does for the public insurances is it says that transgender procedures, including the hormones, would be considered elective procedures that are happening. And so long as the doctor doesn't say this is for an elective transgender procedure, then the doctor can describe whatever he needs to for his patient. So I would encourage my colleagues to not vote in favor of the substitution.

Thank you Mr. Speaker with the sponsor of the substitute yield to a question.

Thank you Mr. Speaker. My understanding is the original, uh, first substitute has a fair, uh, quite a high, uh, fiscal note for taxpayers. Could you, I don't see a fiscal note on the substitute. Could you estimate the cost savings to taxpayers for the substitute policy versus the original, uh, uh, policy?

Sure. So my estimate is that it will look identical. And the reason that is my estimate is from speaking, um, with our CEO of PEHP and asking him why did you know, where did this fiscal note come from? And, and what he told me was that the fiscal note came entirely from the surgical procedures, that none of it came from the hormones so that it wouldn't change if you took that portion out. I expect it to look identical.

Thank you. Um, a line that was said right here on the floor just a few minutes ago was, as an adult they can do what they want. Um, to me, if that is really how we're thinking about it and if it really is the case that this can be done for equal costs that we don't estimate that there are any other co additional costs that we can measure put on anyone else, then I hope that we would be in a position to really honestly say that's a, a choice that we might not agree with, but a choice that they as an adult can make and we would not try and take away, uh, a portion of their insurance coverage over that issue.

Thank you Mr. Speaker. Um, I wanna clarify, if this was just about keeping public dollars out of elective procedures, then it wouldn't be called transgender medical procedures and it would probably include things like breast augmentations and reductions in hormone replacement therapy and things like that. This bill is singling people out. And I also wanna say that this bill focuses on adults, not minors. We have had years of discussion about transgender youth and I I don't always agree with my peers. I usually don't, but I cannot at least see where they're coming from. But as, uh, the good representative who just presented, said, when they become adults, they can do what they want. A lot of the discussion revolves around the concept that people are too young to make permanent choices. And we are not talking about people who are young. We are talking about fully formed human beings who can make all sorts of permanent decisions. They can marry, they can join the army, they can rent a car, they can do a lot of things that we make sure that youth can't. These are different concepts. One person's elective is somebody else's, medically necessary. And that is the distinction that should be made between the patient and their doctor. Not 104 legislators in the exam room with them. It Is not our job to tell adults what they should be doing with our their own bodies. It is our job to be making our constituents lives better and to be removing barriers to success for them. And this bill does the opposite. We all have constituents. Every single person in this room has a constituent that is going to be hurt by this legislation if it passes. And so I urge my colleagues to please join me in voting no today. Thank you.

Thank you Mr. Speaker. This bill is not about what people can do with their bodies. This is about whether cities can designate or not designate what they will cover. Um, and, and what is considered a, um, something right now that is just a default versus something where they would be protected legally if they chose not to cover something that doesn't preclude anybody from doing what they want with their bodies. So I urge my colleague support of this very important distinction in our code. Thank you.

Thank you. Um, what has already been said is, uh, good enough. I think, uh, any adult can do whatever they would like to do. The question is just who pays for it and we shouldn't be forcing municipalities to pay for elective procedures. There's a lot of elective procedures that we don't pay for, like stem cell research and tattoo removal and all kinds of things. And this falls in that same sort of a category. So I encourage you to vote for this bill.

Thank you Mr. Speaker. Um, I wanna clarify, if this was just about keeping public dollars out of elective procedures, then it wouldn't be called transgender medical procedures and it would probably include things like breast augmentations and reductions in hormone replacement therapy and things like that. This bill is singling people out. And I also wanna say that this bill focuses on adults, not minors. We have had years of discussion about transgender youth and I I don't always agree with my peers. I usually don't, but I cannot at least see where they're coming from. But as, uh, the good representative who just presented, said, when they become adults, they can do what they want. A lot of the discussion revolves around the concept that people are too young to make permanent choices. And we are not talking about people who are young. We are talking about fully formed human beings who can make all sorts of permanent decisions. They can marry, they can join the army, they can rent a car, they can do a lot of things that we make sure that youth can't. These are different concepts. One person's elective is somebody else's, medically necessary. And that is the distinction that should be made between the patient and their doctor. Not 104 legislators in the exam room with them. It Is not our job to tell adults what they should be doing with our their own bodies. It is our job to be making our constituents lives better and to be removing barriers to success for them. And this bill does the opposite. We all have constituents. Every single person in this room has a constituent that is going to be hurt by this legislation if it passes. And so I urge my colleagues to please join me in voting no today. Thank you.

Thank you Mr. Speaker. This bill is not about what people can do with their bodies. This is about whether cities can designate or not designate what they will cover. Um, and, and what is considered a, um, something right now that is just a default versus something where they would be protected legally if they chose not to cover something that doesn't preclude anybody from doing what they want with their bodies. So I urge my colleague support of this very important distinction in our code. Thank you.

Thank you. Um, what has already been said is, uh, good enough. I think, uh, any adult can do whatever they would like to do. The question is just who pays for it and we shouldn't be forcing municipalities to pay for elective procedures. There's a lot of elective procedures that we don't pay for, like stem cell research and tattoo removal and all kinds of things. And this falls in that same sort of a category. So I encourage you to vote for this bill.