Nevada Gov. Joe Lombardo has signed two bills expanding the ability of transgender adults to access gender-affirming health care.
The move is contrary to the positions being taken by most Republican elected officials.
Earlier this week, Lombardo signed a bill requiring health insurance providers, including Medicaid, to cover all gender-affirming surgeries designated as medically necessary by a person’s physician. A nearly identical law was recently signed into effect in Oregon by Democratic Gov. Tina Kotek last month.
Lombardo also signed a second bill requiring the state’s Department of Corrections to adopt evidence-based, up-to-date mental and medical health standards for transgender and gender-nonconforming people inside the state’s prisons. That bill also requires guards at state penitentiaries to undergo LGBTQ cultural competency training.
Both bills were passed on party-line votes in both chambers, with Democrats supporting the measures and Republicans opposed.
Lombardo’s decision to sign the bill into law comes as Democratic-controlled legislatures, like Nevada’s, have passed bills to protect transgender health care and civil rights, while Republican-led legislatures — aided by Republican governors — have sought to curtail those rights.
But Lombardo also occupies a rare status as one of only two Republican governors — the other being Vermont’s Phil Scott — to lead a state where Democrats control both chambers of the legislature. As such, Lombardo has to moderate his stances on “culture war” issues.
“Nevada has for a very long time been a live-and-let-live type of state,” Brooke Maylath, a transgender rights advocate who worked with legislators to craft the pro-transgender health care bills, told the Associated Press. “And I’m glad to see that this governor has not been hijacked by the divisiveness that we’ve see in other states.”
But Maylath criticized Lombardo for vetoing a bill earlier this month that would have protected medical professionals who provide gender-affirming treatments from losing their medical license.
The bill would also have prohibited executive branch agencies from assisting with investigations into medical staff or parents who enable minors to access gender-affirming care in states where the practice has been outlawed.
In his veto message, Lombardo said the bill would hinder his office’s ability to “be certain that all gender-affirming care related to minors comports with State law” and to ensure that providers are abiding by public health and safety standards.
Despite rejecting the bill dealing with bans on gender-affirming care for minors, Lombardo was still criticized by his fellow Republicans for signing the measures applying to transgender adults.
He angered his party members earlier this month when he signed another bill into law to ensure commissions overseeing medical licensing do not discipline or disqualify doctors who provide abortions.
Nevada’s Republican National Committeewoman, Sigal Chattah, criticized Lombardo’s support of gender-affirming care for adults, calling the governor a “laughingstock across the nation” in a tweet.
When asked by a reporter about his decision, Lombardo defended his actions, arguing that the bill simply codifies into law what is already a common policy among insurers with respect to providing coverage for transition-related health care.
“I implore people to read the bill in its entirety,” Lombardo said. “And you will see it’s not as draconian or detrimental or immoral as people are portraying it to be. It’s for the benefit of the whole, versus the few.”
The bill also complies with Nevada’s existing policy prohibiting the denial of medically necessary care based on a patient’s gender identity, as well as the state’s law prohibiting discrimination based on gender identity.
Most importantly, the measure ensures that transgender people can receive the same type of insurance coverage as their cisgender counterparts. For example, without the bill, a mastectomy for a cisgender female cancer patient might be covered, but a transition-related procedure for a transgender man might have been deemed “cosmetic” and thus ineligible for coverage — even if both procedures were deemed “medically necessary” by the respective patients’ doctors.
"I was really into politics at a very young age," says Tim Miller, host of The Bulwark Podcast and an MSNBC political analyst. "I can't remember what they were called, but you'd get those kid magazines about politics that would come to your school, and I remember always really being drawn to them, and reading them and wanting to know more. I always knew lots of weird facts about politics and geography as a little middle school nerd."
Raised in St. Louis until fourth grade, when his family relocated to Littleton, Colorado, Miller became enmeshed in conservative politics at a young age, taking various campaign jobs throughout his career as a former Republican strategist. He jokes that his success at handicapping political races dates back to the 1992 election, when he won a $1 wager after betting his grandmother that then-Arkansas Gov. Bill Clinton would unseat sitting president George H.W. Bush.
On Sept. 10, the U.S. Supreme Court denied South Carolina's emergency request to enforce its bathroom ban, allowing a transgender boy at a public high school to keep using the boys' restroom while his legal challenge to the law moves forward.
South Carolina pointed to several recent actions by the Trump administration to justify its request, including an executive order threatening to pull federal funding from schools that don't maintain sex-segregated facilities, enforcement actions by the U.S. Department of Education, and the Supreme Court's June ruling upholding Tennessee's ban on gender-affirming care for minors.
U.S. Rep. Nancy Mace (R-S.C.) lashed out at Rep. Sara Jacobs (D-Calif.), an LGBTQ ally whose brother is transgender, after Jacobs criticized Republicans for introducing a series of anti-transgender amendments to the annual National Defense Authorization Act.
Several of the amendments -- including some introduced by Mace herself -- target gender-affirming care for transgender service members. One Mace-backed measure would bar TRICARE, the military’s health insurance program, from covering gender-affirming treatments.
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