These Are Not My Thoughts On Banning GAC
These are more difficult thoughts, on a more difficult topic. No, really.
Wednesday evening, May 21st - last night if you’re reading promptly - House republicans voted in committee to amend their omnibus bill, implementing a large number of changes all at once. That large amendment package included a section forbidding federal dollars expended under Medicaid, the CHIP Act (the federal children’s health insurance subsidies), and ACA subsidized exchange plans from paying for trans persons’ gender affirming care. Trans persons of any age. It was previously known that the bill would ban GAC for minors, but at the last minute yet another amendment removed the words “for minors” and other language that might permit trans adults to receive care.
This is bad. It was bad when it applied only to minors; it’s worse now. As a result half the online trans people in the United States will be posting about it. Erin Reed of Erin In The Morning was, as she often is, one of the first out with a story on the topic. Written last night, it states that a vote might happen “as soon as” today, but the debate was held starting midnight-ish and the bill has already passed the house.
The GAC ban is not certain to make its way through to law. The senate has to pass its own version of this bill and then the two chambers negotiate a final version of the bill taking elements from each. This “in conference” procedure can sometimes change bills quite substantially, so nothing should be considered set in stone. But there’s also nothing to suggest that Senate Republicans are at all motivated advocate for trans care, so most people are (quite reasonably) treating this as a fixed part of a bill that is destined to pass.
Assuming passage and no veto, impacts will be immense with just trans persons on Medicaid totalling 152,000. That number comes from UCLA’s Williams Institute and is much lower than the number potentially affected since children covered under the CHIP act aren’t included, nor are trans persons who purchase (or whose families purchase) subsidized coverage on exchanges. As much as it might be helpful, I haven’t been able to make my own final tally of trans persons due to lose health care as I started by counting Medicaid-reliant trans persons living in my apartment and my brain froze when I reached one.
But as I have said, many, many people are writing about this attack on adult trans care even now. So I would like to use this time to write about a part of the same amendment that horrifies me even more. This will not be easy or gentle. I could yell my warning at you, but really I don’t have the energy for that. Instead, please believe me when I say quietly and politely that this is your content warning, and I mean it as seriously as anyone possibly could. If today is not your day for reading difficult things, you should skip the rest of this piece and come back another time.
Okay, you ready? You sure? Like I said, I won’t yell, but you don’t have to read. I can’t be more serious.
For those still here, the reason this is about to get heavy is because we have to talk about the abuse of intersex children. The House GOP excluded from the coverage ban any efforts to modify the sexed anatomy of children with differences in sexual development (DSD), commonly known as intersex kids. Here is the initial wording of the exception, from page 56 of the Health subtitle of the bill and covering Medicaid and CHIP expenditures:
This section reads:
‘‘(2) EXCEPTION.—Paragraph (1) shall not apply to the following when furnished to an indi- vidual by a health care provider with the consent of such individual’s parent or legal guardian:
‘‘(A) Puberty suppression or blocking pre- scription drugs for the purpose of normalizing puberty for an individual experiencing pre- cocious puberty.
‘‘(B) Medically necessary procedures or treatments to correct for—
‘‘(i) a medically verifiable disorder of sex development, including—
The last line there is the bit relevant to intersex kids. There is identical wording on page 111 to permit coverage for procedures banned when performed for trans persons through plans purchased on ACA exchanges. The exact procedures permitted to be performed on intersex children - including infants - is lengthy, and reading the names of some procedures (such as “vaginectomy”) can induce wincing or cringing even before one remembers that the law authorizes their use on literal infants. So instead of copying the list, let’s take it as read that it includes just about any surgical alteration of the genitals one can imagine.
Many people commenting on laws like this one that have been considered or passed at the state level have taken he position that while banning care for trans people is bad, permitting such care for intersex kids shows a level of mercy, humanity, and sympathy that partially redeems the effort. This language is common even on left wing sites, and you are guaranteed to something like it in coverage of this issue in mainstream media — at least if that coverage mentions intersex kids at all.
But this piece here is to tell you that this is wrong. No one should consider this exception an act of generosity or humanity or care. While denying care to trans folks is nearly unconscionable, the historic attacks on children with DSDs have inflicted injuries just as terrible and sometimes worse, while also poisoning relationships between parents and children, doctors and patients. You might wonder why such surgeries are performed on pre-verbal children in the first place, but the rationale for these procedures is perhaps the very worst thing about all of this.
“Very worst” seems an exaggeration when comparing mere thoughts, motivations to the physical injuries of genital-altering surgeries. It seems that way, but very worst is no exaggeration at all. So let me tell you a story, one to help you understand precisely how monstrous this rationale can be. The story is from memory, but it's a valid memory that made an impression and somewhere in my boxes of archives I do have the proof. Or if you doubt you could go looking through the Proceedings of the Society for the Scientific Study of Sex. Trust me or not, your call.
The story begins at a conference in the 80s or possibly earliest 90s where SSSS held a session discussing the ethics of surgically altering the genitals of children to make them less visually distinct.
To be clear, we're not talking about medically necessary surgeries. Some DSDs carry greatly increased risks of cancer or pose other safety and health risks. The discussion excluded those because the ethical case for those procedures was clear. Instead the session focussed on those procedures that, at the time, were justified by calling the existence of intersex people a “psychosocial emergency.”
Yes, “psychosocial” because even the worst, ovoviviparous, quasi-crystalline coat hangers knew that the infants weren't having the emergency. The phrase itself is laden with victim blaming and twisted rationale, because intersexuality isn’t inherently psychologically damaging. A difference in sexual development is neither a sickness nor a deficit. The entire emergency was "social.” Doctors stuck the "psycho" on there merely to medicalize healthy genitals that parents thought were unfuckable — and unfuckable not because they were infant genitals, but because the parents hated intersex existence.
Returning to the conference session — and this is where it gets truly horrifying folks, look away now if you need to — one doctor defending carving up intersex kids told the story of a father who tried to rip his young child's large clitoris off her body using a pair of pliers and his brute strength, claiming it made him crazy to look at a large clit.
He squeezed his daughter’s clitoris in a pair of pliers and ripped her flesh in his partially-successful effort to tear this sensitive, sacred part of her flesh from her body.
And he called himself her father.
The doctor telling this story was called in on the case. Yet instead of informing the people attending this conference session that he testified against the dad and successfully put him in prison for 10 years, he told the attendees that the threat of parents’ violence towards their own intersex children is why surgery is necessary.
It was presented as a choice: either doctors humanely cut intersex infants’ genitals and resew them into shapes that don't get them attacked by their parents or bullied in high school gym showers, or doctors must allow parents and peers to attack intersex kids without civilized measures such as anesthetic.
That's it. That's the justification.
Go through other papers, find the records of other debates and you may not find as traumatizing an example to read, but the logic remains the same: intersex children are unloveable, unfuckable monstrosities whose grotesque genitalia will inevitably provoke someone close to them into a mutilating attack. The best defense of the child, in the opinion of these doctors, is the excision of their offensive body parts.
But think for just one minute. I know how difficult it is the first time one reads this story, but walk yourself through the logic. People want to attack infants and children who are different, evil people want to utterly destroy the private, personal body parts of some of the most vulnerable members of society, and the doctors sided with evil. Dad attacks daughter? Don’t heal the damage. Certainly don’t report the dad to authorities. No, the surgeons had decided the proper response was to complete the assault, to deliver up to the father the severed clitoris in his victory. The surgeons decided that dad and daughter would both be happier and healthier if every time he looked at her he knew he had won his war against her individuality.
The role these doctors chose for themselves was not to prevent sexualized assaults on babies, but to consummate them. And in so doing, they guaranteed that they would never be able to tell the child even why the surgery was performed without informing that their body made them so unlovable that even their parents were at risk of attacking them (or perhaps already had). How, precisely, can a child learn that no one can trust her parents not to hate her, attack her, even kill her and grow up happy, healthy, loved?.
Yet this is the unspeakable rationale justifying so-called “normalizing” reconstructions of the genitals of kids with differences. It is taken for granted that different genitals make normal people crazy, that the different people must submit not merely to denial of care, as the current Trump bill threatens for trans people, but to the most savage enforcement of sex stereotyping it is possible to imagine. The peace of mind of the normals demands no less.
So when the GOP includes intersex exceptions to genital reconstruction laws that ban gender affirming care for trans kids, This is what they’re preserving. Not care. Not concern. Not empathy. They are preserving the right of parents to rip apart children’s bodies with pliers, and the right of doctors to support them in their demented, evil efforts.
I don't want to make comparisons to Pol Pot or Joseph Mengele or whomever. I mean, obviously I do or I wouldn’t bring it up. But I don't want to say that killing kids is literally less evil than the crimes of these infamous men. I believe in the value of life far too much to say that any human being is better off dead than mutilated.
But evil people who fail in their evil plans might not be considered less evil. One can consider evil of intent separate from totality of harm. And when I think of the evil one must have in one’s soul to first look upon a father who partially severed his daughter’s clitoris by using a pair of pliers to grip it as hard as he could and pull with all his strength until the flesh tore and blood flowed and second to then say that the right response, the just response, is to finish that father's work, whoo, boy.
All I can say to that is that whatever your impact on the world, however many lives you did or didn't ruin, I can't imagine a soul more evil than that. If you can justify assisting that father in his efforts, you can justify anything. And this bill, these amendments, this effort to ban care for trans people, went out of its way to make explicit that Republicans are fine with this, actually. The Republicans believe that the conference speaker has it right, that the doctors preaching “normalization” have it right, that the father who attacks his child has it right.
They could have been ignorant of intersex conditions. They could have left the exception out on accident or even on purpose, allowing kids with DSDs time to grow into their bodies and have a say in the most crucial and intimate decisions regarding their own lives.
Instead someone or some few within the GOP educated themselves on the medical issues affecting intersex kids and then went out of their way to let the entire nation know that Republicans are #TeamPliers.
I know that most people - even most people arguing in favour of surgically enforcing conformity - don't know the specific story told at that specific conference. But to figure out whether or not to create such an exception, someone, somewhere among the Republicans had to ask, “Why do these surgeries? What purpose do they serve?” And they were told the purpose was to eliminate monstrosities to protect the normals. They must have been. It’s the only rationale the pro-surgery crowd have ever had.
So do I mean to say that every Republican is going to be holding up a pair of pliers in knowing celebration when the bill passes? Of course not. But do I think that they’d vote any differently if they’d heard this story directly from a surgeon’s mouth? Not at all. They know they’re team conformity. They know they’re cutting away at bodies — someone else’s body, someone else’s child’s body — to achieve their celebrated conformity. To the extent that any one of them can claim ignorance, they can only plausibly claim the willful kind.
So in the next hours and days, when you hear someone say, “But at least they didn’t ban intersex care,” that sentiment will likely be followed by loud noises like you might hear when a person picks up a refrigerator and bashes it overhand against a concrete wall, noises that seem to be coming vaguely from the direction of the Pacific Northwest. When that happens, I want you to know that it was me. And I want you to say it with me, “This is not care. The exception redeems no one, not to the slightest degree. No, the determination to continue cutting intersex children damns them all the more.”
Don’t ever let anyone get away with saying anything different.
If you’ve made it this far, please take care of yourself. Talk in the comments if you need to. Run away and say nothing if you need that. I literally threw up and then cried for 20 or 30 minutes the first time I read this story. I thought about siding with the dad, siding with that doctor, and I could not imagine how the attendees didn't tie him up and throw him out the door. So I get it. I really do. And as much as I meant it when I gave you the content warning earlier, I mean it when I now ask you to make sure you get all the care you need.
Doesn't Viagra count as gender affirming care? What about postmenopausal hormones? Somebody didn't think this through.
Thank you for writing this incredibly difficult and enlightening piece - get some well-deserved rest yourself, friend.