H.B. 258 Insurance Coverage Amendments: transcript

Um, so the next bill, HB 2 58 is still in the insurance, uh, conversation, but this one is about private insurance, which is slightly different. So some private insurance companies has been at, as has been discuss, discussed in the last, um, Medical care. Just hold. Okay. So, um, anyway, some of the transgender procedures are covered by some insurance companies, but not all. Um, and so there isn't really a standard across the board. Um, but drans procedures are largely not acknowledged or covered at all. And there's, uh, kind of an invisibility actually of drans. There isn't ICD 10 CM codes to be able to even bill insurance companies for the deran procedures. And so those types of things need to be acknowledged, especially because the deran population is growing. If you'll just refer to the handout, um, that we handed out earlier, it says, studies estimate that up to 9.8% of patients experience detransition or regret the clinical reviews suggest combined transition and care disengagement rates may reach 32.3%. So care disengagements means they stop after doing it for a little bit. Daggett transits is, we go through and then try to do reverse the effects. Okay? So that's why there's a, a percentage difference there. You can see those numbers. Um, there, the, the studies on this stuff is, are emerging. So this is new area because there's suddenly this large drans population that's growing. Um, so another study here, it says, A UK review found that 6.9% of detransition within six months, 16 months, another 3.4% showed patterns consistent with detransition and 22% disengaged from care entirely, um, in that 16 month period. So, um, the Daggett trans community absolutely needs our support. They need people to care about them. What this bill does very simply is it says that if an insurance company, a private insurance company, is going to choose to pay for transgender procedures, then they also need to pay for drans procedures because it's the same conversation, really. And so we need to have parody there in the insurance world. Um, I, I do, I have invited, um, Dr. Kurt Elli to give a brief testimony for about one to two minutes, just really briefly about this issue that he knows quite a bit more about than I do actually.

Thank you for the opportunity chair members of the committee. Uh, my name is Kurt Elli, chief Medical Officer for Do No Harm Action. We unfortunately know the very low evidence of benefit and significant harms of medical transition, particularly for children. Based on systematic reviews of the data, the harmful impact of puberty blockers, cross-sex hormones and transition related surgeries has been well documented, including irreversible and lifelong adverse effects that require medical attention. A growing number of individuals are living with these consequences and deeply regret what the medical system has allowed to happen to them. Their desistence is real, as is their desire to detransition. We as a people, as a healthcare system must do better for these individuals for the detransition. While the true rate of detransition is not known, uncertainty does not mean that the rate is negligible. Some studies do suggest that it may be quite substantial, again, as referenced by representative, anywhere from 10 to 30%, but more so what is clear is that detransition have medical needs, often serious ones, such as lifelong hormone therapy. As just one example, given past transition related surgeries they may have endured, and yet they're frequently overlooked, dismissed, or left without appropriate clinical support. And as mentioned, their condition is not currently recognized among the 70,000 codes in the ICD 10 diagnostic code manner manual. And many, uh, find that their providers who facilitated their transition are unavailable when they seek to reverse it. This abandonment must end house bill 2 58 offers a responsible first step establishing a simple and fair principle that if a healthcare plan covers transition procedures, it must also cover the medical care required to reverse them. These treatments can be lifelong and financially burdensome, and no patients should be denied coverage because their needs fall outside a tragic one-way model of care. You don't need a study to see the need, just listen to detransition. Their medical needs are real and they deserve coverage. Now, HB 2 48, uh, 2 58 is prudent balanced and a compassionate measure that protects vulnerable patients. Thank you.

Thank you. Thank you. So in short, we're just trying to make sure that all people are represented by their private insurance companies and without, we're open to any questions.

Uh, thank you, uh, Madam Chair. So just help me understand what is required of who is it? Is it the case that if an insurance company covered even one transition related treatment, then they would have to cover all detransition related treatments?

Right. So basically what the bill says is if a private insurance company chooses to do transition treatments, which would include the hormones as well as any surgical procedures and such, then yes, they would need to also do the drans procedures and hormones that would be required for the patient.

Sure. I, I guess what I'm saying, so maybe If they wanted it, obviously not every patient's gonna want it. Sure. But if, um, let's say there were 20 different possible transition treatments out there. I mean, there's different treatments that might be used. Um, and maybe there was 20 different jury detransition procedures, and the insurance company felt that some of those were useful, but that some of them did not have a benefit or were harmful. Um, but if they covered even, even one of those 20 transition treatments, then would they be required to cover all of the detransition treatments, or if they felt, or would they have some ability to cover some, but not others of the detransition treatments? 'cause I, I'm not sure, so convince me otherwise, I guess, but it looks to me like if they cover even one from this side, then they have to cover all of them from the other side with how it's written. So it seems to me we're maybe getting a little bit into the theoretical, um, because we don't know, do we Exactly.

Every single treatment. And, and that hasn't been something that, you know, I've looked into either. Is there 20, is there five? Is there, does it depend? It could be that it's personalized and maybe the doctor could speak to that. Um, because you know, each person's effects, there's iatrogenic effects that can happen from any treatment that could occur, right? Mm-hmm. And so they might have to treat a, a myriad of things. But I think the point is, yes, if you're going to choose to cover, and this is just financial coverage, if you're choosing to financially cover transition treatments, so even any for the purpose of transition, not a woman who is, you know, going through menopause and needing something else, okay? But for the purpose of transition and you're, you're choosing to financially cover those treatments, then the only fair thing to do for parity would be to also cover any drans procedures, because those are all in the same category.

So if I cover, if a insurance company chose to cover hormones but not surgeries for transition, could they then choose to cover hormones but not surgeries for detransition? Or they would also have to cover surgeries for detransition?

I see what you mean. Um, those types of things aren't particularly specified in the bill as far as this one, then this one and this one, then this one, it just basically says if you cover transition procedures and hormones, then you must also do the same thing on the detransition side. So I guess the answer to your question would be yes.

Okay. Uh, alright. Well, we can talk later about what exactly it would require, but that's still a question I have.

And go ahead and state your name. One minute Goes so fast. Maryanne Christensen, the Utah Legislative Watch. I was introduced to a detransition named, um, Sidney Wright many years ago in a, in a, a child welfare coalition meeting. Um, I was heartbroken by her story because although when she was confused about who she was, when she was uncomfortable in her changing body, when she had body dysmorphia, there were plenty of people to get her involved in this, this LGBT group at school. There were plenty of people online that were telling her how to transition. Plenty of people convincing her that if she had these thoughts, that meant she was born in the wrong body. Plenty of psychologists that would just refer her to transition programs, plenty of doctors that wanted to transition her body, but when it came to Detransition, she was alone. And she disappeared for a long time because, because the whole community that took her in at first, they turned their backs on her when she wanted to. Detransition. I have sought out a lot of stories about these detransition. I have tried to send them money and to help them, it's super hard because they get so much blow back that they, they try and stay anonymous and thank you, Marianne. They need this assistance. So thank you

Thank you. Committee. My name is April Gardner. I'm a life lifelong Utah resident. I see both of the representatives bills, uh, HP 2 58 and, uh, 1 93 is inherently linked. I see them as a broad spectrum of ensuring that trans people have as little access to healthcare covering their, their healthcare needs as possible. As the legislature has control over public funds, they can say that my healthcare as a cis woman who needed, uh, to have HRT starting when I was in my thirties, to make sure I didn't go into premature menopause for my medical issues, that's fine, but my coworker can no longer have access to their, their hormones unless they get grandfathered in and don't move to another job. But of course, private insurance doesn't have that same series of levers and controls. I do not believe that there is a legitimate need for reversal because there's not a standard of care. However, this might be a very clear way to sh frighten private insurances due to liability concerns when there's not a standard of care to cease covering this healthcare. Please oppose both.

I'm Shaylee Millard. Um, for this bill, I'm representing the worldwide organization for women, and this bill ensures that when health insurance plans cover major medical procedures, like sex transition surgeries, they also cover procedures, treatment or therapy later needed to address or re or reverse those procedures. It's a matter of fairness and continuity of care, ensuring patients aren't left without coverage for care directly related to earlier interventions. I believe this strengthens our health system, protects families and promotes responsible coverage. For those reasons, we respectfully urge you to support HB 2 58.

last one, Gail, Gail Ika with Utah Eagle Farm. Uh, I just wanna take us a minute because we had, uh, Chloe here, Chloe Cole, and when she was here before, I talked with her a lot about what she had gone through when she decided that she wanted to, to do trans and, and, uh, in fact, she even showed me, uh, videos that she had of herself. And it was horrible to watch what she went through. She needed help. She didn't even know how to do it. She just went off the drugs, you know, cold Turkey without the doctor's help, uh, watching those videos of what she went through and then having her tell her story. I mean, this, this is dangerous when they, when they don't have medical help to, to reverse it. Just like it'd be dangerous to, to have medical help to begin with. So please, we if if they're, if they're gonna have, you know, gonna pay to, to transition, please help 'em if they change their mind because she could have lost her life through all that.

I I'm a mother of retention woman. I think the main, Can you introduce yourself first please? Sorry. And, and state where you live. Thank you. Yes. And I live in Ora, Utah. I'm a mother of a transgender woman who lives in Utah. Utah. Two things I think are not being mentioned. One being transgender is biologically found. As far as like a valid means ways of being, we can prove that that is a way that people are born. Okay? Um, my daughter was born transgender. She is who she is. You not offer them care or try to restrict their care based on any reason is discrimination. So I feel like you're not addressing that at all. Two. Yes, I agree. If there's transition, there should be these transitions. But I feel like the doctor gave you statistics that aren't correct, because if you look at every major organization that studied this, the greater percent of people who have transition surgery are happy and life better. There is a fair number of people det transition, and usually it's because of the people around them do not accept them as their transgender self. That is a great reason why. Now, other people may not, but that's just the way, it's life is fluid. So yes, detransition should be also covered, but transition should be covered too and respected as of valid means of healthcare. Because it's just healthcare. It's just healthcare.

Go ahead, Matt. Yes. My name is Matt Child, um, represent the Utah Independent Agents insurance agents. I reside currently in St. George with our offices in Salt Lake. Um, I don't wish to weigh in on the emotional component of this. This is, uh, significant. I have a family member who is transgender and we struggle with this as a family from an insurance perspective. However, I would like to suggest or or state the consequential cost of covering these significant, um, commitments and requiring the insurers extend the significant financial commitment. Um, the reality is insurance is not entirely born by one person. That's why they have insurance. The cost of that is gonna be spread across everyone. All of our insurance costs will go up as a result of this, um, whether you call it a necessary treatment or elective treatment. Either way, the cost will be significant in order to assist these people with their, their challenges. And, uh, so for that reason, we would oppose this bill.

Thank you Madam Chair. I'd like to move amendment one on the na uh, system in Representative Peck's name.

I mean, it just sets a future starting date so we know when it's starting it. I think it's a good clarification. Great. Yeah, so it, yeah, and that date change basically makes it so that the insurance companies can have, uh, a little bit of a time. So normally new insurance programs start at the beginning of the year, and that effective date was gonna make it very difficult for them. And so we moved it to the start of next year instead, just for convenience there.

I move that we, uh, pass with a favorable recommendation, HB 2 58 as amended.

Thank you. So I'm not ready to support that motion today, but I did want to just kind of say, I, the thing that I would like to see in the bill is, is not have it not set that if you cover even one over here, you have to cover all of 'em over here. So, in my mind that something along the lines that if you cover hormones here, you cover hormones here, separate from if you cover surgeries here, here, you know, on, on the, on the two sides. So it really was more toward parity. But I'll work with you afterwards, and if we come to some agreement then, then maybe we'll come to an agreement, but at least we'll chat. Thank you. I I welcome that.

Yeah. Thank you. I appreciate all the discussion and all of the comments that were really thoughtful. Um, I think that Utah, um, is going to provide a lot of clarity, fairness, and dig dignity to a growing Daggett trans population and will be following after states like Texas, who've already navigated this and gone down this road. Okay. And I urge your support. Thank you.

Thank you. Um, I think that there is a flyer, a, a data sheet up there for people. We, we do. We'll have the staff ask that. Could you Pass? Okay. That would be fantastic. Thank you. Thanks. All right.

Well, um, I appreciate you hearing HB 2 58 today. The bill is actually a pretty simple bill. So what it does is it just brings into awareness that there is a certain population that is a growing population, which is the Daggett trans population that is not actually getting coverage from many insurance comp companies. In fact, I think most insurance companies, so this bill says that, um, that private insurance companies, so think, you know, IHC, uh, blue Cross Blue Shield, something like that in our state, if they pay for transgender procedures for a person that they would also need to pay for deran procedures if the person wanted those. Of course, that's their decision always. Anyway. Um, so on the data sheet there, I'd just like to bring your attention to a few things, which is, um, that studies estimate up to 9.8% of patients experience detransition, um, regret and or, um, which means that they, in the middle of the process, they decide not to continue to the process. It says that there's, um, 32.3% care disengagement rates, and that up to that 10% actually are going through with full detransition procedures after the fact. So, uh, probably the most common transition, and then detransition desire would be for some of that hormonal treatment that happens, um, because not everybody does surgical procedures. In a UK review, they found that 6.9% of patients Daggett transitioned within 16 months of going through their transition procedures. 3.4% showed patterns consistent with detransition and 22% disengaged from their care entirely. So there is a population of people who are getting procedures, hormone treatments for desired transition. And then when they are changing, their mind regretting those decisions, needing help going back the other way, their insurance companies aren't covering them. So this bill desires to bring parity to that so that we're not just serving one side of a conversation when it comes to helping the population. There's a, an invisibility that's actually happening to that det trans population. And like I said, it is growing rapidly, uh, all the time. I do have someone online, Dr. Kurt Elli, who's gonna say a few words in the presentation if we can promote him and if he's, oh, there he is. He's there. Thank you, Dr. Maselli for joining us.

Thank you, representative chair, members of the committee. Thank you for this opportunity. My name is Kurt Elli, and I'm Chief Medical Officer for Do No Harm Action. We, unfortunately know the very low evidence of benefit and significant harms of medical transition, particularly for children based on systematic reviews. The data and comprehensive reports like the CAS review and U-S-H-H-S review, the harmful impact of puberty blockers, cross-sex hormones and transition related surgeries has been well-documented, including irreversible and lifelong adverse effects that require medical attention. A growing number of individuals who are living with these consequences and deeply regret with the medical system has allowed to happen to them. Their desistence is real, as is their desire to detransition, they seek to return to life as their biological sex. We as a people and as a healthcare system, cannot and should not deny this reality. And although the true rate of detransition is unknown, this uncertainty does not mean those who detransition are rare or do not exist. In fact, some studies suggest the rate may be as high as 30%. Much like any patient, these individuals need care from the medical establishment. Certainly those who had undertaken life altering surgeries such as the removal of sex organs require lifelong hormonal therapy. And this is just one example of the medical need a detransition may experience. Yet unfortunately, these individuals, despite their significant needs, have often been overlooked, minimized, and dismissed by the healthcare system. Their condition currently cannot be found within the diagnostic classification system known as the ICD 10. And often the providers who supported their transition process have been unavailable to them in the course of their detransition. This abandonment must end, and one place to start is with this bill. First and foremost, we must ensure health insurance coverage allows those who detransition to do just that. These treatments are often lifelong and come at significant cost. In addition to the emotional toll these individuals are already going through due to the original transition itself. This bill establishes a simple and fair principle. If a health plan covers gender transition procedures, it must also cover medical care required to reverse those procedures. It would protect patients who later need medical services relating to detransition. This legislation is both necessary and responsible. Patients who experience medical complications, psychological distress, as well as a return to their natal sex, should not be left without coverage, simply because their needs fall outside a one-way model of care. Studies show that detransition occurs, and in fact, its occurrence is likely increasing, particularly given the rapid increase we've seen in pediatric medical transitions over the years. But you don't need a study to tell you that. Just listen to the detransition. They exist today. Their medical needs are real, and they deserve coverage. Now, this bill is prudent, balanced and compassionate, and will ensure that patients seeking detransition care are not left facing financial barriers or insurance denials. Thank you for this opportunity to testify.

Thank you, Dr. Ms. Hill. I really appreciate you joining us here this morning. I know you had to squeeze it into your schedule to make it happen. Um, just one other thing that I would like to add on this conversation before this presentation is done is just that with every medical procedure, there can be an iatrogenesis effect to any medication or, or procedure, which means that there can be a harm when you're trying to even do good. And this legislation would make it so that if there are certain harms or iatrogenesis effects that happen because of transition procedures, it would also make it so that those things would need to be covered under insurance, because they might be actually more on the Daggett trans side of things because maybe there was a harm that the patient didn't see what would be happening or coming to them. And with that, Mr. Chair, I'm open to any questions.

Thank you, Mr. Chair. Are you concerned at all that this is a mandate for the insurance companies? That's unfair for them to bear?

I appreciate that, Senator Ipson, because I am definitely the type of person that does not like to get into private business at all. My husband owns a business. I own a business. I, I don't think government should get involved. But what we have here is a whole population of people, a growing population of people that don't have codes within the insurance network to be, even if they want to detransition, even if their insurance companies want to pay for that, because it's not something that's broadly done right now, the codes don't even exist. So they can't get care. And the insurance companies can totally decide. They can say, if I, if we wanna pay for hormonal treatments for people to transition, then we'll also pay for hormonal treatments to detransition. And it's the parody is there. They don't have to pay for detransition surgeries when they've only done hormonal treatments for the person. And if they're only covering hormonal treatments, we actually very delicately with a scalpel, made sure that it was as fair as possible to any insurance providers that are actually working in this space. And so it's not meant to be heavy handed at all, it's just meant to make sure that there's a percentage of the population that is also getting the care, especially because, um, it's a growing population and we don't want them to be overlooked.

Yeah, the, if the chair would allow me a little bit of latitude, this bill's on the same question that was just asked earlier, but I wanna bring additional clarity because I think it's a fair question and I'm mostly for my own framing. Um, but if you, you don't mind, maybe a couple questions, Mr. Chair. Is that okay? Looks like it's okay. Thank you.

Um, the, so, you know, traditionally speaking, we, as it pertains to insurance, we'll, we'll set guardrails and maybe do definitions, but we're, we're not too descriptive. But, um, and I voiced some of my concerns to you earlier. And so I, I looked and, uh, we have done so in the past we've dictated, uh, uh, mental health parody cover on autism mammograms. We've, we've done similar things in the past, so, but I, I do it with a great deal of hesitation because of the same concerns that we, we, um, there was expressed earlier, but there are self-funded plans. I'm trying to look and see. Um, I think they're, and I may need some help from the chair because the chair may not understand ERISA Plans. So you're think Eris Plans? Yeah. So Typically, um, when we do legislation here, at least in other areas that I've worked in, we can't have, we are, uh, disallowed from affecting federal plans like Medicare, Medicaid or erisa. Erisa. Still, there is some, there are a few challenges still in the court system going about this. Whether we can pass state law that would affect a ERISA plan. For the most part, you're just dealing with the commercial plans, which is about 20% of the market. Now I remember when I first came in the legislature, it was more like 50%, but now it's down to about 20. Um, I, I guess maybe I'm gonna ask the question, but maybe the chair can brief, brief some clarity as well. Are, are we risking, uh, is there potential lawsuits gonna arise from this as it pertains to erisa? Or, or, or, no. I mean, I suppose there's always potential lawsuits, but are we, are we treading an area that's really treacherous If it is moving into the ERISA area? And so I guess that's my question. Is it, is it dictating only to private or, or would it be erisa?

Are we dictating to self-funded as well here? If I May, um, the plan was not to go into erisa. The plan was just to go, I mean, for the record we can say it's just for the private Okay. Insurance company.

Okay. So the last part of my question is, is if I were inclined to vote for this, it would be that it is a light touch. So help me bring some clarity to this. 'cause right now I'm on kind of on the point where I think I'm, I don't know, I'm bouncing back and forth right now in my head trying to balance this. This isn't about the actual topic. I think what's fair, you know, what's fair, providing that avenue is fair, but Right. Right. So,

Um, the, the question is, is, alright, so you're doing it, you're only mandating if they've pro if they've offered the transition in the first place, right? If they've already done that side of the conversation and they've said, okay, we're going to do, let's say that they just do just hormonal parts of the transition. And that particular private insurer does not wanna do any surgical, like maybe they say we don't do surgical transition, but we will do hormonal transition, then if that person wants to detransition later, if they have regret, or if they decide, you know what, I want to go back to my biological sex, then they would need to pay for ho hormones for them. Okay. To do that, I think I understand, I just wanna understand Yeah, kind of the, maybe get you on record on the reasoning by that. So an individual, let's say they, they have a, they have, uh, just have, have a normal private coverage and they, they are in a circumstance where for whatever reason, medically, otherwise they want to detransition. Mm-hmm. But their medical coverage do, didn't cover the transition in the first place. Those individuals wouldn't be allowed that coverage. But is your purpose for doing that so that there is, you're only saying we we're reaching down only in only for reasons of equal equilibrium Yes. To bring parody, really, Because it's not necessarily about, quote unquote fairness or not fairness, but an opportunity to have your detransition paid for, but equilibrium. Is that fair?

That's exactly right. So the idea is not to make every private insurance company pay for detransition. That's not the idea. The idea is that if they're already, if they've already serviced in a transition way and that person wants to detransition, then they should be able to, with the same coverage that they had doing the transition, undo that transition.

Okay. Thank you, Mr. Chair. Mm-hmm. Yeah. Further clarification is, um, just reaching out to staff and the drafting attorney clarification was that the plan or the bill does not affect ERISA plans? Okay, Thank you. So it would be just that, uh, 20% commercial mark. Interesting. And I don't know if there's anyone from PHP here that can clarify, but it was my understanding that the PHP originally did not cover any kind of, uh, transgender care. And then there was a, a court case that basically forced them to, so they would kind of be in a situation where now they, they would be required to provide the, the, the de degender care as well. So anyway, I, that was just Mr. Chair. Interesting. Mr.

But, um, PEHP would not be part of this bill. So I do have another bill, um, HB 1 93 that actually was related to the PEHP issue. So this one is just for the private insurance, so it won't touch public insurance. This bill won't.

Okay. I would have to have some clarification on that, because if it's just the commercial market, PEHP is part of the commercial market, I feel like it says, let's look at the language here. Okay. Well, if it does, then that actually would be in total alignment with the other bill. Yeah.

We'll, uh, we'll reach Out. You maybe asked to the drafter, but the idea was that we'll reach Would Be separated, but, But we'll reach out to the drafting attorney and try to clarify that In the other bill. It specifies that anyway, so

Okay. Well that's good to know. Well, Mr. Chair, that brings a whole nother set of questions then. If it does, Go for it. Uh, man. Alright, because I was not thinking, um, that, that this was wrapping in PHP, that's a whole nother set of questions.

So is there, is there a fiscal note on this bill? I heard We don't have a fiscal note. Do we not, I don't know how there can, if it wraps in PHP, there has to be a,

I'm, I'm gonna, is are we in committee action?

Um, good morning. I represent myself. My name is Cameron Fair. I'm a 21-year-old transgender woman who's lived in Utah my whole life. I'd like to bring up a study posted on Fenway Health, which is a nationally recognized credible source that found that 13% of currently identified transgender people have detransition at some point in their life. But of that 13%, 82 attributed that to external factors such as an unsupportive social network and increased risk of violence. Um, to me it doesn't make sense that this bill is being proposed while an actual numerical rate of people who Detransition has been named. Um, so I would urge you as representatives of people of Utah to keep transgender people in mind. Thank you so much for your time.

is Charlie Fieros. I represent myself. Um, I first of all would like to start by saying I believe this bill is written to creatively discourage private insurance companies from covering gender affirming healthcare and making lifesaving care accessible to those who need it. In the beginning of 2022, my life, my life came to a distinct pause in front of my mirror. I made a choice between my two options ending my life with the tools in front of me, or socially and medically transitioning. I could no longer live. With the mental chaos of gender dysphoria inflicted on me and the havoc it wreaked on my life. If HRT was not an accessible option for me, I would not be in front of you here today. I turned 26 this year, which feels surreal because in my childhood, I couldn't even imagine myself as an adult being turning 26. This means that this discussion about insurance affects me very, um, directly because I will be losing my coverage and seeking other options. I, um, don't believe this discussion would be happening over other forms of life saving healthcare. Transgender people only ask and beg to be ourselves. All we want is to receive access to life-saving healthcare, and to make our lives livable. Thank you.

Hello, my name is Brooke Oligo, and I'm a representative and support supporter of the trans community. Um, Jesus Christ. Most famous command with simple love one another. Scripture teaches us to love our neighbor as ourselves. From the time we are children, we are told to treat others the way we wanna be treated. And I cannot reconcile those teachings which HB 2 58. Transgender people, regardless of anyone's beliefs, are human beings. They are our neighbors, our coworkers, and our family members. Laws that single out and target a vulnerable group do not reflect love. They do not reflect Christ. They reflect, they do not reflect our constitution. They reflect fear. If Utah truly stands for faith, family, and community sense, then we must act like it. Mm-hmm. Faith without compassion is empty. Family means protecting all of our family. Community means no one is cast aside. This bill does not strengthen Utah. It diminishes it. And I urge you to choose love and vote. No, thank you.

Good morning to the council today. I appreciate y'all, uh, meeting together to talk about this and listening to our comments. Uh, my name is z. I'm here to oppose HB 2 58. Could you give us your full name please? I apologize. My name is Ze Kack. I am a community member of the trans community and highly involved, um, us in the community are highly concerned about this Bill by Rec, just as representative Musselman was mentioning. Uh, we are worried that by requiring insurance to cover gender affirm care that it will or to cover detransition as well as transitioning that it will cause insurance companies to drop transitional care altogether, even though it is a minute portion of the trans experience. Um, the bill comes across as also not professionally understanding Daggett transitioning as there isn't a way to hormonally detransition. All you do is you lessen and quit taking hormones completely. There aren't like countering hormones that you have to take into transitioning Ally. Um, the, what we're experiencing here as a trans community is a systemic push to restrict our access to healthcare. Representative Peck has, as she mentioned, other concurrent bills that are eliminating our access. And this feels similar in that vein, even though it is not as direct of revoking it, it does feel as it is still pushing to lose our access to healthcare. So thank you for your time today.

Morning. My name is Crea RAAs. I represent myself and my beautiful trans community. Um, I am a 25-year-old veteran of the United States Army. You wouldn't have known that by my voice, my height, who I love or how I was raised. You know that by me sharing my life story with you, just like you don't know that I'm a transgender man without me telling you. You see, we are all human beings coexisting together on a rock and space existing at the same time, just experiencing different lives. My experience as a trans person here in Utah has been very difficult, but also very rewarding. Um, my access to healthcare has been very up and down. Um, but it has been the thing that has saved my life. I have not thought once about Daggett transitioning at all. Um, and I grew up Mormon. I grew up in all different environments due to foster care and being moved around homes to homes. Um, and I wouldn't see my life any other way. And those that have Daggett transitioned, most of them, it's has a lot to do with the trauma that they are based around or getting bullied at school. And so they're forced to be placed back in a closet. And that's what this is doing, is forcing people to go back into a closet because it's gonna put that fear on others. Um, that's, that's all.

There we go. Oh, here I am. Sorry. I'm trying to learn this. Um, thank you Mr. Chairman. This is, uh, Phyllis Kimmel. I'm representing myself. Um, I'm asking the committee members One more, one more thing. Do you, where do you live? Oh, sorry. I live in Erda, Utah. Thank you. Um, I'm asking the committee members to vote yes for this bill because it's only fair that the, um, insurance companies, if they are going to pay for, uh, transitioning of people that those who desire to detransition, it's only fair that that insurance companies also pay for this and or support this. Um, that's all I have to say. Thank you.

Hello. Okay, go ahead, tens. Good morning. I didn't realize I had to have my camera on. I'm a little sick today, but this was very important for me to be here. Um, I Uintah a top three doctoral program for clinical Psychology 10. I need to have you ident give you've given us your name. Please identify where you live and who you represent, if anyone. Salt Lake City, myself. Thank you. Go ahead. Um, I Uintah top three doctoral program where I studied L-G-B-T-Q people. I was awarded a hundred thousand dollars grant by the National Science Foundation to study trans people. From that work, I published the first longitudinal study about trans youth receiving gender affirming hormones. Much like the legislature's study, I found that it is life-saving care. As it's been mentioned, the reason people transition detransition is typically due to stigma, to violence, to discrimination to the, the, uh, other bills that folks like Nick Peck brings up and promotes. And I urge this committee to vote. No. I mean, just this morning I woke up to a message from a teen child who called me a t****y and told me to kill myself. That is what these bills are doing. I urge you to vote. No, thank you.

Hello. Um, I'm Kayo Crosby. Um, I live in Orem, Utah, and I'm representing myself. Um, so I wanna speak to this bill a little bit specifically. I got the opportunity to talk to Nicoline Peck about it very, very briefly. Um, last year, uh, when a similar version of the bill was put up. Um, I'm, I was, and I'm still in opposition to this bill. Last year I was dating a transgender man who ended up fleeing the state because of worries surrounding bills like this. His access to testosterone is anything but, um, elective. It was keeping him alive. It was super, super important for his mental health. Super, super important for his physical health as a person. He was an EMT. Um, he worked for Blue, blue Cross Blue Shield here and was like, was helping people on the streets of Salt Lake City. And, um, we lost like, such an important part of our, of my life, but also just our life as a community, and we're losing so much amazing talent and also just amazing people to this state because we keep on scaring them off. Um, and so I guess my, my just thing for this committee is like that, like this does affect people's lives dearly. And of course, this is like around 1% of the population less than, but, um, that it really, really, really hurts people and hurts the families here. And also just that, like, just because you don't know a trans person or doesn't mean that like those people's lives aren't important and that they're not super, super integral and key to our communities. And so I wouldn't cut off people's medical care just because you don't maybe necessarily understand them. Thank you for your time.

Senator Musselman, Um, Mr. Chair, if I might, um, so the fiscal note is zero, which as I understand it, and as has been clarified, it appears that, um, that means that PHP doesn't anticipate the use of it, meaning there is, there is no one within the P system that is looking to detransition. Now that being said, it may not be that, it may be, it's just a very, very, very small number, so it doesn't land. Um, but none, nonetheless, that doesn't negate necessarily what you're, what you're doing here as far as parody and equilibrium. So, but I I, I, I always have a concern of we just looking for a problem that doesn't exist. So I want you to answer that really quick.

Thank you, Mr. Chair. If I may, I don't think this is a problem that doesn't exist. Um, there are other states who are going down this road as well, because they're also seeing the issue. Um, Texas already has passed legislation like this as well, and because they also have had people, um, detransition in their state who have not been able to get care and have spoken out. And I, I feel like that we know that there are high numbers between 10 and 30% of people who either detransition or who regret their transitioning and then wanna discontinue care, which means that they will potentially need, in some cases, a lifetime of hormonal treatments. I just don't think we can leave them high and dry like that.

Yes, please. It was, it was stated, um, earlier that, uh, in Detransition that there isn't hormonal therapy used in Detransition. Can you speak to that as I, as I'm scrubbing and I cross reference it five times up here, and it appears that there is drugs that are prescribed during detransition. So do you, are you aware?

Yeah, for sure. And I can't, I apologize, I can't give you all of the exact names of all of the drugs or hormones because that's not my field of expertise. But I will say that when a person takes hormones and in order to transition, in order to change aspects of their body and stuff like that, then if they are going to detransition back to their biological sex, then what they would have to do is then take the reverse hormones to bring them back the other direction. So that so appears there's three paths simply reducing and stopping hormones, which is probably the most common. Mm-hmm. But there is also the prescription of testosterone Dear Detest test if there wasn't testosterone before. Mm-hmm. And also there are also issues with ma managing endocrine suppression as well, which is just a side effect of it all. So it, it does absolutely appear that there's pre grubs drugs prescribed.

Um, one last question, Mr. Chair. Um, no, that'll, that'll do. Thank you.

Thanks. I'll make a motion that we pass out House Bill 2 58, first substitute. Okay. The motion force is to favorably recommend House Bill 2 58, first substitute. Would you like to speak to that? Yeah, I think, you know, if, if a health system chooses to cover one way on this situation, uh, you know, in this, uh, medical, uh, world, then I think it's turnabout is also, you know, healthy to give a person the option to go the other way. And I feel like in that scenario, we're kind of acknowledging the choice of the individual in this process. And I feel like making that choice is something that is, uh, is clearly, you know, possible. The other thing I'll add, you know, to Senator Musselman's point, you know, point, you know, whether or not this happens now or happens later or, you know, or dealing with a, an issue that that's up and coming. What I'd say is when, when you look at, when you look at the balance of, of the harms, we do have a history and we've heard testimony in the past of people who are in the process of reversing the process. And so having that testimony, uh, you know, in the past in this committee does help us at least color the idea that this could be something that somebody might want. Uh, in that situation, preventing it from being available seems to be the least inclusive idea. But at the same time, I understand, uh, people are concerned and, uh, wanna make sure that we reach a respectful level with, you know, with the conversation. But I feel like this is a fair policy. Thanks.

Thank you. Just quickly, really, this whole piece of legislation is just a reach out to the insurance companies to say, Hey, let's not make this whole other group of people invisible. I really appreciate all of the testimony that was shared today, and I think we see how personal the decision is to transition and, and I respect people's decisions to do whatever they feel like that they need to do for themselves. But on the, on the same vein, I also know that it's a very personal decision to detransition or to discontinue care. And I think we have to care about that population of people as well. So thank you for your consideration.

I, I'm, I'm gonna vote yes, but, uh, I'm, I'm hesitant. And I, and I'm not guarantee that that's where, where I'll land as it sits on the floor. I have to think through this a little further, but nevertheless, I'm voting yes because e even if there is a concern that some that detent and may due to social pressure, there's a possibility and we at least have to recognize there's a possibility that some, some within that realm want to detransition because they want to detransition because it wasn't the right decision. That is possible. Perfectly reasonable, uh, possibility. And, and to the, in that vein, I think we, I think this is light enough touch, reaching down and allowing for this kind of equilibrium is a, is a fair spot, but I do it from with an extreme amount of hesitancy. Yes.

Oh, great. Um, I, I'm, I'm very hesitant, similar to Senator Musselman. Um, it's interesting to listen to the public testimony when it, it appears that this would help somebody if they chose to, to, uh, detransition. Um, I guess I can see why the community would, would oppose the bill because they don't want anything that looks like it is, um, in opposition to transitioning to, I I can get that. I also, um, am sensitive to the mandate on insurance, but I'm like Senator Musselman. I'm, I think I'm doing, I'm very hesitant, but I'll, I'll, I'll say I, I think Senator Cullimore was absent. Is that correct? Okay.

Thank you Mr. Speaker. This bill is along the same lines of what we've just been talking about. Um, it's just a simple bill to help private insurances have parody in their coverage. So in the private insurance world, some private insurance companies are paying for transgender procedures but are not paying for deran procedures. And the deran population is growing all of the time. And we just wanna make sure that if we're covering one population of people, that we also cover the other population of people. And since it's a private insurance, they of course have complete say over what they're gonna cover. We're just saying that we need to make those codes so that drans can also be covered from private insurance.

Thank you. Uh, Mr. Speaker, um, motion to move first substitute on the system in my name.

Yes, I would. Perhaps I'm a slow learner, but I'm gonna try again here. Um, and I do think it'll become apparent. I think my, I agree with the intended outcome of this bill and the substitute that I have on here, I, I hope meets also with the sponsor's intention. Um, and it just simply, again, it splints out the two treatments just to be thought about separately. But it says if you're covering hormonal treatments for the region of making a transgender, uh, a transition, then you need to cover hormonal treatments for a detransition. And if sep then it puts as a separate line. If you are covering trans surgeries for the purpose of transition, then you need to cover surgeries for detransition. Um, I think to me the original wording of the bill reads such that if you cover any, uh, of the transition procedures, then you have to cover all of the detransition procedures and this language is meant to just keep them in parallel. Thank you.

Um, I consider that a friendly, um, substitution and so I accept that. I think it makes sense that if an insurance company was only paying for one thing before that they should only have to pay for one thing afterward.

Thank you Mr. Speaker, will the sponsor yield

Yes.

Is there a circumstance when an individual would be under hormone treatment and the effects of that hormone treatment would require surgery to fix?

Not that I can easily think of. Uh, I mean most, many of the effects of hormone treatments reverse just when you stop taking the hormone treatments. Some of them do not. Um, but the ones that I can think of that, that don't easily reverse such as a, a biological female's voice becoming lower when she takes testosterone to my knowledge, are not able to be reversed with a surgical procedure.

So, uh, would the sponsor continue to yield? Yes. Represe. Thank you Mr. Speaker. So if an, a young individual was receiving hormone treatment, let's say in another state because I can't receive it in this state and it slows the growth of their genitalia, um, and, and results in let's say a micro penis or something of that nature, um, would we not want insurance to pay for that to be, um, or for something to be done for that individual surgically?

My understanding, Mr. Speaker, is that many of the, those types of procedures, um, for those unfortunate enough to find themselves in the position where they want that surgery done are still not well defined at all with a much lower successful surgical rate and just very unclear if that's gonna be helpful or, or injure the person, um, to go through that procedure. So I guess to me, I would prefer to just have if you do the one, you do the other.

Thank you Mr. Speaker.

Yes. What

Uh, lines 32 through 33. Remove that health benefit plans considered necessary. And the same wording on 35 and 36.

Okay. Re remove the, uh, language that says the health benefit plan. That the health benefit plan considers necessary.

So the, the, the language that will be struck is that health, the benefit plan considers necessary. Was there another line? Yes. Line 35 and 36. Same language.

Representative Peck on that motion. Uh, this is a friendly motion. I think it's good because basically that would suggest that it wasn't an elective procedure. And these are elective procedures

Thank. Thank you Mr. Speaker. I just wonder if we could clarify the num word count that's allowed for a floor amendment. I believe it's 15, but 1715.

Shelley? I waive. Aye. We're gonna place the motion.

I think a lot of it's been said about this and I just really feel like this is a good step forward in really caring about our growing Daggett trans population. So I encourage everyone to vote for this bill. Thank you.

Speaker, um, motion to move first substitute on the system in my name. That motion is an order. Would you like to speak to it? Yes, I would. Perhaps I'm a slow learner, but I'm gonna try again here. Um, and I do think it'll become apparent. I think my, I agree with the intended outcome of this bill and the substitute that I have on here, I, I hope meets also with the sponsor's intention. Um, and it just simply, again, it splints out the two treatments just to be thought about separately. But it says if you're covering hormonal treatments for the region of making a transgender, uh, a transition, then you need to cover hormonal treatments for a detransition. And if sep then it puts as a separate line. If you are covering trans surgeries for the purpose of transition, then you need to cover surgeries for detransition. Um, I think to me the original wording of the bill reads such that if you cover any, uh, of the transition procedures, then you have to cover all of the detransition procedures and this language is meant to just keep them in parallel. Thank you.

Um, I consider that a friendly, um, substitution and so I accept that. I think it makes sense that if an insurance company was only paying for one thing before that they should only have to pay for one thing afterward.

Thank you Mr. Speaker, will the sponsor yield

Yes.

Is there a circumstance when an individual would be under hormone treatment and the effects of that hormone treatment would require surgery to fix?

Not that I can easily think of. Uh, I mean most, many of the effects of hormone treatments reverse just when you stop taking the hormone treatments. Some of them do not. Um, but the ones that I can think of that, that don't easily reverse such as a, a biological female's voice becoming lower when she takes testosterone to my knowledge, are not able to be reversed with a surgical procedure.

So, uh, would the sponsor continue to yield? Yes. Represe. Thank you Mr. Speaker. So if an, a young individual was receiving hormone treatment, let's say in another state because I can't receive it in this state and it slows the growth of their genitalia, um, and, and results in let's say a micro penis or something of that nature, um, would we not want insurance to pay for that to be, um, or for something to be done for that individual surgically?

My understanding, Mr. Speaker, is that many of the, those types of procedures, um, for those unfortunate enough to find themselves in the position where they want that surgery done are still not well defined at all with a much lower successful surgical rate and just very unclear if that's gonna be helpful or, or injure the person, um, to go through that procedure. So I guess to me, I would prefer to just have if you do the one, you do the other.

Thank you Mr. Speaker.

I'll waive. Thank you.

Yes. What

Uh, lines 32 through 33. Remove that health benefit plans considered necessary. And the same wording on 35 and 36.

Okay. Re remove the, uh, language that says the health benefit plan. That the health benefit plan considers necessary.

Is that correct? Yes. Okay. So the, the, the language that will be struck is that health, the benefit plan considers necessary. Was there another line? Yes. Line 35 and 36. Same language. Five. So that the health plan benefit the health benefit plan. Where does it stop at line 36? What was the last Considers medically necessary Considers medically necessary? Are these the only two? Yes. Okay.

Uh, this is a friendly motion. I think it's good because basically that would suggest that it wasn't an elective procedure. And these are elective procedures

Thank. Thank you Mr. Speaker. I just wonder if we could clarify the num word count that's allowed for a floor amendment. I believe it's 15, but 1715. And so there's 15 allowed and that's exactly 15. Thank you Mr.

Shelley? I waive. Aye. We're gonna place the motion.

I think a lot of it's been said about this and I just really feel like this is a good step forward in really caring about our growing Daggett trans population. So I encourage everyone to vote for this bill. Thank you.

Thank you Mr. President. This, uh, this is a very simple bill, uh, and language is not very long. Uh, what it does is it says that if a healthcare provider is going to provide a, uh, provide for transgender therapy, uh, um, as it relates to, you know, any, any insurance provider that provides for, uh, transgender treatments also has to provide coverage for an individual that wants to go back. Uh, it's a really, uh, freedom, uh, and enabling, uh, provision in their healthcare such that somebody who wants to, um, you know, make that change, make that change and change their mind, has the ability to go back. With that, Mr. President, I'm happy to yield to questions.

Thank you. Uh, yeah, I believe that sponsor yielded to questions. I'm wondering if you could, uh, explain the rationale as to why the fiscal note is zero. Senator McKay, you yield? Yes. I, I yielded And

Go ahead. Uh, the fiscal note is zero because it isn't anticipated that it will affect governmental entities any more than it already does. So by my understanding, that means we don't expect to actually see this provision get used at all. So thank you.

Yeah, I'm, I'm impressed that he understood that. Um, with that, uh, I'm gonna move that, uh, first substitute house bill 2 58 insurance coverage amendments pass or be read for a third time.

Senator Spery Lewin Brammer bus Colmore Aye. Escamia Fillmore Grover Harper Hankins Ipson Johnson. K Juab McKay Mikel Milner Aye. Musselman Owens Pitcher Slum Re Sandal Stevenson Stratton Vickers Weiler.

Thank you. I'd like to vote. Aye. And remind my colleagues that there's no disparagement allowed on the floor of the Senate. I vote. Aye.

Senator Vickers Wilson Winterton, president Adams Aye. First substitute house bill 2 58.

'cause I was off the floor negotiating on other issues. But basically, uh, the simplest, this bill is very simple, even though, uh, you know, it's just looking through, it just requires that if a healthcare benefit, uh, covers certain procedures to, uh, that they, that a health benefit plan covers certain procedures to reverse a sex transition. If the health benefit plan covers certain treatments or procedures to effect effectuate a sexual tra sex transmission, uh, transition. With that Mr. President, I'm happy to yield to questions. See no questions on this bill. We had quite a bit of discussion, uh, on one second, but I'm gonna go to you for summation and a motion. Thank you. I'll move the first substitute house bill 2 58 pass.

Vote. Senator Vickers Baldy Aye. Lewin Brammer bus. Aye. Comore. Ms. Camilla Fillmore Aye. Grover Aye. Harper Aye. Kins. Aye. Ipson Johnson Aye. Quan McKay? Aye. Mikel Milner Aye. Musselman a Owens Aye. Pitcher Plum Rebi Sandal Stevenson Strat Stratton pickers Weiler Aye. Wilson. Aye. Winterton President, uh, president Adams Aye.