Tonight, Democratic Senator Melanie Scheible (SD-9) announced that Republican Governor Joe Lombardo signed Senate Bill 163, a law which now mandates that all insurance companies, including Medicaid, provide coverage for gender affirming care for gender dysphoria and gender incongruence for minors and adults.

At the time of publishing, the Governor’s office had not released an announcement confirming the signing, but according to the Nevada Legislature’s website, the bill has been signed into law. To note, the bill passed out of the Senate and Assembly along party lines.

As reported by The Globe, SB163 requires health insurance companies and Medicaid to cover treatment, including sex-change surgery, relating to gender dysphoria and gender incongruence for adults and minors (less than 18 years of age). In amended an adopted language, it specifically prohibits “insurers from engaging in certain discrimination on the basis of gender identity or expression.”

According to SB163, the diagnosis and medical treatment of such conditions must be prescribed by “medical providers” such as speech-language pathologists and social workers, and a minor must provide a written expression of the desire to undergo the treatment after only six months of showing a “strong desire” to be, or be treated as, the opposite gender assigned by birth. 

According to initial estimates, the cost to Nevada taxpayers is just shy of $5 million, however increasing costs are likely as the costs associated with gender affirming care are expansive due to a double-digit increase in minors identifying as transgender, and the costs of treatment and surgery are continuous due to surgery-related complications.

Additionally, SB163 does not include a religious exemption for medical providers or small businesses that may have objections to providing treatment or insurance. Insurers must consider the most recent Standards of Care published by the World Professional Association for Transgender Health (WPATH).

At the time this legislation was in committee, The Globe learned that lawsuits protecting insurance companies who hold religious exemptions were anticipated.

Prior to the bill being signed into law, Emily Mimnaugh, Attorney at the Pacific Justice Institute in Reno, NV, told The Globe:

“SB163 will create a statewide mandate that requires insurers—including Medicaid and, with it, Nevadans—to fund surgical interventions for gender dysphoria, including gender affirmation surgery and genital transformation (“bottom surgeries”) for children.

There is no recognition for insurers who are affiliated with religious organizations in the Bill. There is no consideration for personal conscience in the Bill.

Previously, when Nevada state law has mandated insurance coverage for a specific procedure, such as abortion and contraception, state law has explicitly provided that an insurer affiliated with a religious organization is not required to provide such coverage in violation of its religious beliefs. There is no such parallel protection for religious organizations in SB163.”

For what it is worth, Jon Ralston of the pay-to-play Nevada Independent contends that Lombardo’s signing of the legislation is also a pay-to-play to whip Democrat votes for the taxpayer-funded A’s stadium.

The “know nothings” behind Lombardo in the NVGOP and the RNC, are also tied to donors, voters, and activists who provided the necessary resources to a former Clark County Sheriff to win the top executive position in Nevada. The Governor may get the Democrats to vote for a baseball stadium, but it is highly unlikely that these Democrats will support his reelection bid in 2024.

Considering this bill failed to get one Republican vote in the Senate or Assembly, it is also highly unlikely that his Republican colleagues, and their constituents, who will now be faced with higher insurance premiums (and taxes), are pleased with how the Governor “gets shit done.”

UPDATE: 8:52 PM:

Attorney Emily Mimnaugh provided this comment now that the legislation has been signed into law:

“This law can fund surgical interventions for a child of any age who suffers from gender dysphoria. This law provides no protection for a religious organization, affiliated with an insurer, who objects to these surgeries and its mandate. This law is pushing childhood surgeries forward and pushing people of faith to the side. The new mandate is inconsistent with current state law and contrary to our constitutional guarantee of religious liberty. Some of the most progressive nations in Europe are now stepping away from these surgical inventions for children; Nevada is saying we’ll pay for them.  Politicians should never pander to idealogues at the expense of a child’s physical well-being.” 

UPDATE 9:14 PM:

A person associated with the Nevada legislature, and who wished to remain anonymous, told The Globe:

“I would argue that this is much, much worse than what Sandoval did to Republicans and Nevadans in 2015 when he passed the largest tax increase in state history. Lombardo’s signing of SB163 hits us on the spiritual level, there is no spreadsheet to justify this. If the Governor’s team argues this was done in exchange for a baseball team, he will only add insult to the injury he dealt his supporters today.”