(Tribune News Service) — Donald Trump had recently finished a familiar riff about banning gender transition surgery for children when the former president, speaking to an audience of Evangelical voters, moved on to something new: a policy that would affect transgender adults.

“I will ban all taxpayer funding for sex or gender transitions at any age,” said Trump, receiving thunderous applause at the Faith & Freedom Coalition conference in Washington last month. The Republican leader, who moments earlier had also pledged to reinstate a ban on transgender men and women serving in the military, paused for several seconds to soak in the crowd’s adulation.

It’s the kind of moment — and the type of policy — increasingly common on the GOP presidential campaign trail this year.

A Republican Party that in recent years has emphasized transgender issues related to children, teenagers and student-athletes is becoming more and more comfortable now also focusing on transgender adults, led by a field of GOP presidential candidates who, through rhetoric and policy proposal, have denounced elements of the transgender movement as a farce and sought to limit the ways in which these adults can have the medical procedures performed.

It’s a shift led by Trump, whose proposed federal funding ban is just one of an array of policies designed to position himself as the Republican candidate most fiercely opposed to transgender rights.

But the change isn’t confined to the former president’s candidacy, with many of Trump’s rivals also offering blunt assessments about the legitimacy of medical procedures that help people transition to their self-identified gender while adopting many of the former president’s own positions, including a ban on federal funds for gender transmission surgery that LGBTQ advocates call a dramatic new front for the party’s anti-transgender agenda.

In statements to McClatchyDC, the campaigns of many of the primary’s leading contenders — including former South Carolina Gov. Nikki Haley, Florida Gov. Ron DeSantis, entrepreneur Vivek Ramaswamy, and former Arkansas Gov. Asa Hutchinson — said they also support bans on the use of federal taxpayer money for gender transmission surgeries for all ages.

“Taxpayer money should not be used for transgender surgery,” said Hutchinson, who as a candidate has been generally more reluctant to embrace the sharp-elbowed culture-warrior persona of other GOP contenders. “It is an individual choice to undertake transgender surgery and it is objectionable to many taxpayers. Taxpayers should not foot the bill.”

Other candidates supportive of the ban offered an even broader condemnation of all gender-reassignment surgeries as a treatment option.

“It’s wrong to treat anorexia with a liposuction, just as it’s inhumane to treat a person who suffers from gender dysphoria with genital mutilation,” Tricia McLaughlin, a spokeswoman for Ramaswamy’s campaign, told McClatchyDC in a statement this week. “These are mental health illnesses and should be treated as such.”

Ramaswamy, little-known to the public before the start of the GOP primary, is receiving more support from GOP voters so far this primary than many more prominent elected officials, according to an average of polls of the 2024 race compiled by FiveThirtyEight.com.

Bud Light, Target boycotts

The GOP field’s renewed focus on the adult transgender community could have profound effects for those men and women, affecting whether the country continues to accept them into mainstream society and limiting some people’s access to gender-affirming medical procedures.

Courts across the country are now debating the validity of laws restricting access to puberty blockers and hormone therapy, arriving at different conclusions in places like Florida and Tennessee. Politicians in other states, like Kansas, are engaged in an ongoing fight over whether driver’s licenses can indicate someone has changed genders since birth.

Meanwhile, Republicans in the U.S. House voted this week to block the military’s health plan from covering gender-transition surgeries. (The bill is not expected to be approved by the U.S. Senate.)

Brandon Wolf, spokesman for the LGTBQ advocacy group Equality Florida, said GOP politicians had used children as a “political shield for their all-out assault on freedom for transgender people of all ages.”

“From the beginning, the anti-trans policies and rhetoric from politicians like Governor DeSantis have been animated by a desire to use government to legislate and harass transgender people out of society,” Wolf said in a statement. “That they are now shouting their intent into a bullhorn to score presidential primary points should come as no surprise. It is on all of us to see through their smokescreen and resist these shameless attempts to build political careers by waging war on freedom for transgender Americans.”

The embrace of policies restricting health care for transgender adults among GOP presidential candidates also reflects a deeper dynamic within the Republican Party and conservative movement, which has increasingly spoken out about the growing visibility of LGBTQ people and issues in mainstream society, including the designation of June as “Pride Month.”

Right-leaning activists have recently led high-profile boycotts against companies that they say are inappropriately promoting LGBTQ themes, including Bud Light and Target, and other leading conservative publications have questioned whether their movement is compatible with the emergence of the transgender community.

Many of these conservative activists say the transgender movement represents not just an irreversible danger to children but a broader threat to society itself, blurring the lines between men and women in a way they find both wrong and repugnant. That sentiment, though not universally held among GOP voters, is widespread enough to persuade some candidates to expand their own criticisms, conservatives say.

Although the shift has made some Republicans uncomfortable — and nervous about the political fallout — other longtime conservatives predict that the GOP field, encouraged by conservative voters eager for a more combative approach to the increased visibility of the transgender community, will only unveil harsher rhetoric and more far-reaching policies as the primary wears on.

“What I see with politicians is some of them are awakening to this issue, they’re taking a look at it, and maybe the first thing they’re willing to say is, ‘I’m against allowing children to transition because of the way they feel,’” said Mary Hasson, a senior fellow at the conservative Ethics and Public Policy Center. “But I think they’re going to be pushed to consider the question more deeply. Because what we are seeing across society has far deeper ramifications.”

Trump himself, in fact, has already been accused of being overly supportive of transgender rights: Last week, DeSantis called his Republican rival a “pioneer in injecting gender ideology into the mainstream.” The Florida governor’s campaign also promoted a controversial video highlighting the same criticism of Trump, an online spot widely criticized as homophobic.

Return to bathroom bills?

The GOP’s focus on transgender adults isn’t entirely new, at least over the last 10 years. In the middle of the last decade, the party coalesced around opposition to transgender men and women using bathrooms that didn’t match their sex at birth. So-called “bathroom bills” receded from the political spotlight, however, when the issue was widely credited with in 2016 helping defeat incumbent North Carolina GOP Gov. Pat McCrory, who lost his reelection campaign after embracing the issue.

In more recent years, the party has instead focused on transgender issues related to children under 18 and collegiate student-athletes, championing laws that would ban children from having gender transition surgery and protesting transgender women competing in women’s sports. Critics have derided these laws as a thinly veiled attempt to attack a minority group disliked by social conservatives, arguing the GOP is putting the lives of transgender youths at risk by denying them necessary medical care.

That emphasis on kids has led to an array of new laws in GOP-controlled states that outright ban gender transition surgery for minors. And on the campaign trail, when Republicans talk about transgender-related issues, they still spend the vast majority of their time talking about the transgender movement and children.

“I still think the bulk of the energy and the policy focus is going to be on minors and protecting children from radical ideology, and from children being encouraged or persuaded to engage in gender transition without parental permission and involvement,” said Ralph Reed, founder and chairman of the Faith & Freedom Coalition, in an interview.

Reed noted that when his group hosted its event in Washington last month, all of the candidates except for Trump almost entirely avoided any discussion of adult transgender issues, a list of speakers that included Haley, DeSantis, Hutchinson, former Vice President Mike Pence and U.S. Sen. Tim Scott of South Carolina

But when asked if his group backed Trump’s call to ban use of taxpayer funding, the Evangelical leader said it did.

“We would clearly support it,” he said. “I think it’s a taxpayer funding issue.”

Reed offered that a ban on federal money could possibly be shaped like the Hyde Amendment, a legislative provision that prohibits the use of federal tax dollars for abortion but does include some exceptions, such as when the mother’s life is in danger.

But even a law designed that way would have far-reaching effects. Banning the use of federal money to pay for gender transition surgeries could effectively prevent members of the U.S. military from gender transition surgery, and Medicare beneficiaries would also have to find alternate means of funding for the procedure.

The situation is more complicated with Medicaid, a health insurance program for low-income Americans that receives federal money but is administered by individual states. Nine states, including Texas and Florida, already ban the use of Medicaid money for all transgender-related health care, according to the non-profit group Movement Advancement Project. (Florida’s ban was overturned last month by a federal judge, although the state is appealing.)

A national ban on federal money, however, could still force states that do include the surgery to find new ways to fund it.

Health care experts described the proposed funding ban as the first of its kind.

“That isn’t something that has been on the table before,” said Lindsey Dawson, associate director of HIV Policy and director of LGBTQ Health Policy at KFF, a health policy research and polling organization.

Dawson warned the loss of coverage could have severe consequences.

“The loss of coverage means someone is being denied access to a service that is medically necessary, and that can have really adverse consequences for individuals, including worsening mental health,” she said.

It was not immediately clear how many people, on average, would be affected by the loss of coverage. Not all people who identify as transgender seek or receive gender-affirming surgery.

The Pence and Scott presidential campaigns did not respond to requests for comment about the funding ban by time of publication.

Dylan Mulvaney criticism

Even before Trump’s proposed funding ban, however, Republican candidates were showing an increased willingness to criticize prominent transgender adults and question their decisions to receive gender transition surgery.

In May, Haley lambasted transgender social media influencer Dylan Mulvaney — the woman at the center of conservative protest against Bud Light — during a campaign stopover in New Hampshire.

“Make no mistake,” the former governor said. “That is a guy dressed up like a girl, making fun of women. Women don’t act like that.”

(Haley, in an interview this week with The Dispatch, did say she supported letting transgender members of the armed services serve openly and that members of that community “should have every freedom and every equality as anybody else.”

DeSantis, meanwhile, has mocked the notion that transgender men can become pregnant, recently making the line a regular part of his stump speech on the campaign trail.

“Don’t tell me that a man can get pregnant and expect me to accept that,” said DeSantis, speaking in June at a campaign event in South Carolina. “I will not. It is not true, and we’re not going to delude ourselves to think otherwise.”

In a statement, DeSantis spokesman Bryan Griffin affirmed the governor’s support for a ban on federal taxpayer funding for gender transition surgeries but highlighted his record on transgender-related issues for children.

“As governor of Florida, he has done more to protect children from radical gender ideological indoctrination than any other leader in the nation by ensuring it is a criminal act to surgically mutilate children or subject them to experimental puberty blockers and preventing schools from pushing this trend on kids in the classroom,” Griffin said.

DeSantis’ own transgender-related record as governor does go beyond focusing on kids, however, including limiting the use of pronouns for employees in public schools and signing legislation that requires every public school to have a policy that says it is “false” to ascribe to a person a pronoun that does not correspond to their assigned sex.

Many doctors and transgender men and women themselves describe gender-affirming health care as life-saving, an essential procedure that often lifts affected people out of depression — including suicidal states — and lets them live happier, fuller lives. The procedure is endorsed by nearly every major medical association around the world.

Trump, however, has led the way on specific policy proposals: In addition to saying he would reinstate a ban on transgender troops servinging in the military, the former president, speaking at the NRA’s annual convention in April, said he would order the Food and Drug Administration to “convene an independent outside panel” to investigate whether transgender-realted hormone treatments were responsible for an increase in violence in the country.

“President Trump has led on this issue long before any of them spoke publicly about it,” Trump campaign spokesman Steven Cheung said in a statement. “The question is: why did it take them so long to follow President Trump’s lead?”

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