Missouri may offer a prime example of a red state primed for plug-and-play laws restricting transgender rights.
A robust network of conservative advocacy groups stretching across the country has eagerly seized the chance to show the Show Me State just how to do that.
Last year, lawmakers passed a ban on access to gender-affirming care for minors and another law effectively shutting transgender athletes out of girls’ and women’s sports. Since then, more bills reining in a range of LGBTQ rights have been introduced by a Republican-dominated General Assembly eager to accommodate voters.
Polling shows that Missouri’s conservative electorate broadly agrees with the new Missouri law regarding transgender people, but that comes with a partisan split.
The Democratic Party has lost ground in what used to be a national bellwether state. That means Republican lawmakers increasingly find themselves without serious competition in general elections, instead in danger of challenges from the right in primary elections.
Now, with elections looming and a veto-proof supermajority, ambitious Republican politicians are homing in on the issue with what critics describe as a “firehose of anti-trans legislation.”
In some cases, the impact of the legislation looks concrete, like the proposed Missouri law shutting off transgender people from the bathrooms that match their gender identity. Others, like a ban on government diversity efforts, could throttle cultural changes in recent years and make transgender people feel increasingly threatened.
National groups lobby Missouri lawmakers
Last year, Reuters news agency counted 142 bills filed in 37 states that would outlaw or restrict gender-affirming care. At least 17 states have enacted laws restricting or banning gender-affirming care for minors. The trend has continued this spring.
A well-documented network of groups helps ghostwrite legislation, lobby for its passage and elect conservatives willing to back similar approaches. Groups across the country, from all political perspectives, write legislation and disperse it to lawmakers.
But an AP analysis found that 130 bills in 40 statehouses last year mimicked model legislation peddled to lawmakers by the conservative groups Do No Harm and the Family Research Council.
In March 2023, the World Professional Association for Transgender Health (WPATH) said in a statement it opposed the “broad and sweeping” legislation being introduced in states and said bills that would restrict access to care violate best-practice medical standards.
In 2022, lawmakers filed at least 19 bills regarding LGBTQ issues in the Missouri General Assembly, according to data from the ACLU. In 2023, the number jumped to 48. In 2024, at least 34 bills have been introduced.
Many LGBTQ people in Missouri say the bills exploit ideas popular among some people that create life-threatening damage to others.
“We’re seeing in Missouri an attempt to … erase trans people,” said Katy Erker-Lynch, the executive director of Missouri’s LGBTQ advocacy group PROMO. “It’s a very clear attempt that’s manifesting through book bans, censorship of curriculum, anti-woke investing and (diversity, equity and inclusion) bills.”
Last year, two Missouri laws regarding transgender people were passed by the General Assembly that were centerpieces in the national conversation.
They got help.
One, SB 49, was Missouri’s version of a law originally spearheaded by the Family Research Council, a group “dedicated to articulating and advancing a family-centered philosophy of public life.”
“Family Research Council has been actively recommending state (SAFE) Save Adolescents from Experimentation Act-style bills based on the model legislation we developed, which aims to protect children from harmful, irreversible gender transition procedures,” the group said in a fundraising email.
The Missouri law halted access to gender-affirming puberty blockers and other hormone treatment for transgender people under 18, with an exception for kids already receiving treatment in Missouri. That law will go away in 2027 unless lawmakers revisit it.
The conservative think tank Heritage Foundation and Do No Harm testified in support when the bill was introduced last year.
But when disputes among Republicans threatened its passage, politicians in other branches of government acted unilaterally to block gender-affirming care for minors in Missouri.
Attorney General Andrew Bailey, who has appeared numerous times in programming from the Family Research Council, issued an emergency rule last March that called gender transitions “experimental.” His action triggered a litany of requirements before a patient can receive forms of gender-affirming care in Missouri, essentially blocking patient access.
Just hours before, the Missouri Freedom Foundation PAC held a rally at the state Capitol, promoted by the Family Research Council, urging lawmakers to support the SAFE Act, which would later become the Missouri law cutting off gender-affirming care for transgender minors.
After two weeks of inaction on the legislation, the bill was finalized in the Senate that afternoon.
Since the Missouri laws went into effect, University of Missouri Health Care and the Washington University Transgender Center have stopped offering gender-affirming care to their minor patients, driving some families to move out of Missouri to get care.
Medical professionals widely see gender-affirming care as lifesaving. WPATH noted in its updated 2022 guidelines a “growing body of evidence” that providing care to gender-diverse youth leads to positive outcomes.
The group added there is still limited data on the “long-term physical, psychological and neurodevelopmental outcomes in youth” who get gender-affirming care and that further long-term studies are underway to examine the impact.
How conservative groups promote their views of transgender rights in Missouri
What’s driving the trend in Missouri to pass anti-transgender laws? Americans have broadly accepted the idea that sexuality ranges across a spectrum, said Scott McCoy, the deputy legal director for LGBTQ rights and special litigation at the Southern Poverty Law Center. That organization classifies some of the groups authoring model legislation as hate groups.
But when it comes to transgender people and the idea of a spectrum of gender identity, polls show that Americans have less familiarity and understanding. At the same time, the number of children diagnosed with gender dysphoria has surged. A Reuters report found that over 42,000 Americans aged 6-17 were diagnosed with gender dysphoria in 2021, compared to just over 15,000 in 2017.
“What (these groups are) desperate to do is push back against these advances,” McCoy said. “They went to the place where they have great influence, and to some extent undue influence, and that’s the state legislatures.”
The Family Policy Alliance promotes a biblical view of governance — and lobbies for it, pushing in at least 20 states for bans on gender-affirming care for minors.
The group also runs what it calls Statesmen Academy, which convenes legislators for training on things like “Policy According to the Bible” and “Christian Statesmanship in Practice.” The group has cited Missouri as one of the states which have passed a law that it helped author barring gender-affirming care for minors.
The Alliance Defending Freedom, an Arizona-based conservative group, uses the courts to advance its positions and provides legal advice for lawmakers on religious freedom, marriage, family and parental rights.
“We’ve been happy to provide legal advice on the best way to craft those” bills, said Matt Sharp, senior counsel and the director of the Center for Legislative Advocacy at the ADF. “And to help make sure that lawmakers taking up this issue have solid legal advice.”
How public opinion has transformed amid focus on transgender Missourians
Polling from the Public Religion Research Institute shows that, since 2021, Americans believe with increasing certainty that there are only two gender identities, growing from 59% of Americans in 2021 to 65% in 2023. It found that 90% of Republicans think that way, while 44% of Democrats feel the same.
“It’s really a story of Republican prioritization of this issue,” said Melissa Deckman, a political scientist and the institute’s CEO. “A lot of Americans probably didn’t think about transgender issues four, five, six, years ago, to the extent that we’re talking about them now.”
LGBTQ topics, especially access to gender-affirming care, have been in the center of a conservative media frenzy since 2021.
“When political leaders begin to talk about these issues at length,” Deckman said, “that can often change the attitudes or priorities of partisans.”
A nationwide June 2021 poll from the Global Sport Institute at Arizona State University found 32% of respondents felt that transgender athletes should be limited to competition by their sex assigned at birth, while 30% said they should be able to compete against athletes with the same gender identity. Another 28% felt that transgender athletes should compete in a third category.
Compare that to an August 2023 poll from St. Louis University and YouGov, which found that 67% of Missourians (including 95% of Republicans) opposed allowing transgender students to play on teams that match their gender identity.
Still, a recent Pew Research Center poll found that roughly two-thirds of Americans support protecting transgender people from discrimination in jobs, housing and public spaces.
The SLU poll of Missouri also found that 63% of respondents opposed allowing minors to receive gender-affirming care.
Studies show that gender-affirming care was associated with lower rates of depression and suicidality over a 12-month period.
Since 2003, Republicans have controlled the state House and Senate. In 2022, the party gained control of all statewide elected offices.
In 2022, Republicans ran for 151 seats across the General Assembly. Of those seats, 73 had no opposing candidate from a major party. That meant that once a candidate won their primary, they were essentially guaranteed election.
“In primary elections, you can get the most committed partisans,” Deckman said. “On the Republican side, it’s folks who are far more conservative and are often more religious.”
And in an election year, lawmakers are motivated by their political aspirations to appeal to their base of voters, PROMO’s Erker-Lynch said.
“So many of these senators, in particular, are running for higher office,” Erker-Lynch said. “They think that if they can appear to be, in my opinion, the most hateful, that they will appeal to their base the most.”
And with a nationwide consensus, including in Missouri, that access to abortion should be legal, political experts see the topic of gender-affirming care as one that can activate base voters.
“When they didn’t have the pro-life position to motivate their base of voters to the polls,” SPLC’s McCoy said, “they needed another issue.”
What’s ahead for transgender laws in Missouri
Conservative groups want to renew the ban on gender-affirming care for minors.
One bill, sponsored by Rep. Brad Hudson, a Cape Fair Republican, would continue the ban and prohibit medical professionals from being required to perform sex reassignment surgery or gender identity transitioning if it goes against their moral, ethical or religious beliefs. The bill would also require public school locker rooms and bathrooms to be designated for and used by male or female students only.
Do No Harm testified in support of the bill on Jan. 17.
Hudson, a pastor, is running for the state’s 33rd Senate District, home to Lake of the Ozarks, for the seat currently held by Republican Sen. Karla Eslinger.
Rep. Adam Schnelting filed a bill that he said was vetted by the Heritage Foundation, called the “Defining SEX Act,” which would place definitions of female, male, girl, boy, woman, man, mother and father in state statute.
Schnelting, a St. Charles Republican, is a minister and Realtor who is running to represent outgoing Sen. Bill Eigel’s seat in the 23rd Senate District.
The General Assembly in 2024 is focused on issues like making it harder to pass constitutional amendments and passing what has become a controversial bill to fund Medicaid reimbursement in Missouri. Both topics are closely tied to abortion politics in Missouri.
The conservative group Freedom Principle of Missouri is using research from the Heritage Foundation in their legislative lobbying.
“We’re facing an uphill battle with this,” Byron Keelin, the group’s president, said of passing further legislation this year. “If the legislature doesn’t act — and depending on who the next governor is — they may take some action via executive order, too.”
Ultimately, Deckman said, the issue is driven by activists within the Republican Party.
“It’s certainly really being driven by conservative activists who feel very passionately about this issue,” she said. “That polarization has had the impact of affecting general public opinion.”
This story was originally published by The Kansas City Beacon, an online news outlet focused on local, in-depth journalism in the public interest.
