Midwestern cities become transgender health sanctuaries amid GOP legislative threats

A growing number of Midwestern cities are declaring themselves safe havens for gender-affirming health care, often in direct defiance of laws passed by conservatives at the state level.

While state legislatures across the Midwest are controlled overwhelmingly by Republicans, cities and metropolitan areas tend to lean more Democratic, driving some local leaders to introduce resolutions that distinguish the policy priorities of liberal communities from those of the conservative states in which they are located.

Most recently, local officials in Lawrence, Kan., last month declared the city a “safe haven for all persons seeking shelter from the adversity of discrimination,” including those impacted by a new law that bars transgender women and girls from single-sex spaces. That law was originally vetoed by Democratic Gov. Laura Kelly, but the state’s majority-Republican Legislature voted to override it.

In the midst of the worst year on record for anti-LGBTQ state legislation — the bulk of which has been introduced by Republicans — sanctuary resolutions are likely to play a critical role in protecting access to gender-affirming health care for transgender Midwesterners, city leaders said.

“We want to be inclusive; we want to be a city that grows in a diverse way. We recognize that we are inside of a state that may not have those values, but as a city we have those values and we want to govern accordingly,” said Reggie Harris, a City Council member in Cincinnati.

In June, the City Council unanimously approved a resolution introduced by Harris, who formerly served as board chairman of the LGBTQ rights group Equality Ohio, to designate the city a safe haven for transgender minors seeking gender-affirming health care.

Simultaneously, some GOP legislators in Ohio are pushing for heavy restrictions on that same care.

The state’s majority-Republican House in June passed legislation that would prohibit physicians from administering puberty blockers, hormones or surgeries to transgender minors. The measure, which easily passed in a 64-28 vote, would also prevent providers from engaging in conduct that “aids or abets” in performing the procedures and would bar mental health professionals from either diagnosing or treating a minor with a “gender-related condition” such as gender dysphoria without their parents’ consent.

The bill, which was amended to also restrict transgender participation in school sports, has yet to be considered by the state Senate, which is also controlled by Republicans. And Ohio’s Republican Gov. Mike DeWine has so far declined to say whether he will sign the bill if it is passed by the Legislature.

It’s possible that the state’s proposal, if adopted, will invalidate Cincinnati’s resolution, which is not legally binding.

Still, “anything that we can do at the local level — even if it is mostly symbolic — to demonstrate our commitment to being an open and inclusive city, we will do,” Harris said.

State leaders have been slow to respond to Cincinnati’s sanctuary resolution, and Harris said he has yet to be contacted by a member of the Legislature. Ohio Rep. Bill Seitz, a Republican who represents parts of Cincinnati, told The Hill he has neither “read nor heard” about the resolution.

“I have no comment on that beyond saying that I normally pay little attention to resolutions coming from the City of Cincinnati anyway,” he said.

If the bill in its current form were to pass and become law, however, Seitz said he strongly suspects it “would preempt any efforts by local Ohio cities to permit what state law clearly forbids.”

Other transgender health care sanctuaries in Republican-led states may soon find themselves in similar positions.

Officials in Kansas City, Mo., in May approved a resolution to declare the city a sanctuary for people seeking or providing gender-affirming health care, defying state lawmakers who voted just a day earlier to ban such care for minors and certain adults. The ban, which will expire after four years, was signed into law by Missouri Gov. Mike Parson (R) in June and is set to take effect later this month.

Andrea Bough, a Kansas City Council member who co-sponsored the city’s sanctuary resolution with Mayor Quinton Lucas and Councilman Eric Bunch, said she expects some retaliation from the state government. 

But whatever the consequences may be, Bough said she believes Kansas City did the right thing.

“At some point we just have to say, ‘enough is enough,’” she said. “We’re going to stand up to those in [Jefferson] City, who are doing things that aren’t in the best interest of what Kansas Citians want for their lives.”

Parson’s office did not immediately return a request for comment, but the governor told Missourinet in May that individual cities do not get to pick and choose which state laws they enforce.

Similar to other statewide bans on gender-affirming health care, Missouri’s ban prohibits medical professionals from administering puberty blockers, hormones and surgeries to transgender minors, with an exception carved out for individuals who began treatment before the law’s effective date of Aug. 28.

The measure also restricts access to care for some transgender adults by prohibiting the state’s Medicaid program from covering transition-related procedures. Missouri prisons, jails and correctional centers under the new law are barred from providing gender-affirming care to transgender inmates of any age.

In April, Missouri Attorney General Andrew Bailey (R) similarly restricted adult access to care under an emergency order that was abruptly terminated in May. Bailey’s office did not respond when asked if the state intends to prevent Kansas City from enforcing its sanctuary resolution once Missouri’s gender-affirming health care ban takes effect.

Even in areas of the Midwest where proposed health care bans are likely to fail, communities are declaring themselves safe havens for transgender youths and their families.

In June, county supervisors in Dane County, Wis., voted 25-1 to adopt a resolution declaring the county a sanctuary for transgender health care, meaning if Wisconsin’s majority-Republican Legislature passes a law imposing “criminal or civil punishments, fines or professional sanctions” on individuals seeking or providing gender-affirming health care, the board will ask the county sheriff’s office to make enforcement its lowest priority.

The impetus for the resolution, according to its author, County Supervisor Rick Rose, was to “draw a circle of protection” around Dane County, which includes Wisconsin’s capital city of Madison.

“People in that circle then are protected from any laws that may pass,” Rose said, referring specifically to state laws intended to limit access to gender-affirming health care. “Whatever the state of Wisconsin decides or whatever any other bodies decide, we in Dane County are giving a safety to people.”

The Wisconsin Legislature this session has not introduced a stand-alone bill to restrict access to gender-affirming care this session, but state lawmakers have added language targeting transgender health care to other proposals. In July, Wisconsin’s Democratic Gov. Tony Evers vetoed a portion of the Legislature’s budget proposal that would have ended Medicaid coverage for certain gender-affirming services.

Evers, who in 2021 signed an executive order partially banning the practice of LGBTQ conversion therapy in Wisconsin, last month said he would veto any forthcoming legislation that targets transgender people, including a recently reintroduced bill that would bar transgender women and girls from competing on female sports teams.

“I’m always behind trans kids, trans adults — they’re part of our world,” Evers told The Capital Times. “And anytime you want to mess with [them], you’re going to get a veto. Pretty simple.”

With a veto from Evers imminent, it’s unlikely that any legislation threatening to restrict LGBTQ rights will become law in Wisconsin this year. While Republicans control both chambers of the state Legislature, they do not have veto-proof majorities.

Even still, Rose said Dane County’s resolution sends a critical message to its transgender community that there are people in government who are fighting to protect them. It also sends a message to the Legislature — which meets in Dane County — that its anti-LGBTQ policy priorities do not align with those of most Wisconsinites, he said.

The county’s resolution is also meant to signal to the rest of the nation that “change can happen” anywhere, Rose said. “I think the Midwest is the perfect example of that.”