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Gov. Kim Reynolds signs bill that cuts off Medicaid funds for gender confirmation procedures


Gov. Kim Reynolds delivers the 2019 Condition of the State address. — Office of the Governor of Iowa

Gov. Kim Reynolds signed a bill on Friday that contained a provision overturning a March ruling by the Iowa Supreme Court striking down the state’s ban on the use of Medicaid funds to pay for sex reassignment procedures deemed medically necessary by doctors. The justices ruled unanimously that the ban violated the Iowa Civil Rights Act’s prohibition of discrimination based on actual or perceived sexual orientation or gender identity.

The provision was a last-minute amendment to Iowa Department of Human Services (DHS) budget bill by Iowa Senate Republicans on April 26. The Republican-led chamber permitted only a very brief floor debate on the amendment. Sen. Jake Chapman, R-Adel, said he considered sex reassignment and gender confirmation procedures to be “an elective decision. If Iowans want to do that, that’s fine, but not with our taxpayer dollars.”

Sen. Joe Bolkcom of Iowa City pushed back against the amendment during the debate, “It’s ignorant. It’s discrimination of the worst kind.” Bolkcom, a Democrat, pointed out that the state doesn’t refuse to provide Medicaid funds for other procedures deemed medically necessary. “We don’t ask when someone has cancer: ‘Geez, what’s that going to cost?” he said. “Well, that’s too much.”

The LGBTQ Rights group One Iowa released a statement after the Senate passed the amendment.

Protecting transgender people from discrimination is settled law in Iowa, and has been since 2007. The Iowa Supreme Court made clear that the Iowa Civil Rights Act protects transgender Iowans against Medicaid discrimination in their unanimous ruling just over one month ago.

In response, a small group of legislators want to pick and choose who deserves protections under the law, and it’s clear they think of transgender Iowans as second-class citizens. This amendment is a harmful attempt to deny transgender Iowans medically necessary care, and it will not stand up to legal muster.

Gov. Kim Reynolds could have used her line item veto to remove the amendment from the funding bill. A group organized by the First Unitarian Church attempted unsuccessfully to meet with the governor on Monday to encourage her to veto it.

A Reynolds spokesperson did issue a statement on Monday in response to a question about the amendment: “The governor appreciates and will consider all feedback from Iowans on the various pieces of legislation that is now on her desk. In the coming weeks, she will review each bill with her policy team and then make a decision.”

Reynolds did not issue a statement when she signed the DHS bill. Instead, her office included the bill in press release with a list of 13 bills she signed on Friday. The description of the bill does not mention the amendment.

According to another provision in the bill, the amendment took effect as soon as the governor signed the bill into law.


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