Senate Bill 163 requires health insurance companies and Medicaid to cover treatment, including sex-change surgery, relating to gender dysphoria and gender incongruence for minors less than 18 years of age.

According to SB163, the diagnosis and medical treatment of such conditions must be prescribed by “medical providers” such as voice therapists and social workers, and the 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. 

Additionally, SB163 does not include a religious exemption for medical providers or small businesses that may have religious objections to providing treatment or insurance for gender dysphoria treatment and sex change surgery to minors. 

Current Nevada law, NRS 129, requires parental/guardian consent of medical treatment and surgery for minors (abortion excluded). State law also mandates insurance coverage for a specific procedure, such as abortion and contraception, provided that an insurer affiliated with a religious organization is not required to provide such coverage in violation of its religious beliefs.

Senate Bill 163, sponsored by Democratic Senators Melanie Scheible, Dallas Harris and Pat Spearman, limits (if not excludes) parental consent, denies religious objections, and curiously defines cosmetic surgery.

Per the legislative text:

Cosmetic surgery means a surgical procedure that: (I) Does not meaningfully promote the proper function of the body; (II) Does not prevent or treat illness or disease; and (III) Is primarily directed at improving the appearance of a person. (2) Includes, without limitation, cosmetic surgery directed at preserving beauty.

If you are confused at how a double mastectomy, phalloplasty or vaginoplasty on children, prior to puberty/developmental maturity, can cure their clinically-diagnosed gender dysphoria, you are not alone.

A revealing article from the Heritage Foundation summarizes a New York Times editorial and the Obama administration’s findings which conclude that gender dysphoria is not often cured by surgery or hormones and the treatments could make one’s psychiatric condition worse.

“Medical evidence suggests that sex reassignment does not adequately address the psychosocial difficulties faced by people who identify as transgender. Even when the procedures are successful technically and cosmetically, and even in cultures that are relatively “trans-friendly,” transitioners still face poor outcomes.

Even the Obama administration admitted that the best studies do not report improvement after reassignment surgery. In August 2016, the Centers for Medicare and Medicaid wrote: “[t]he four best designed and conducted studies that assessed quality of life before and after surgery using validated (albeit non-specific) psychometric studies did not demonstrate clinically significant changes or differences in psychometric test results after [gender reassignment surgery]….

In a discussion of the largest and most robust study on sex-reassignment, the Centers for Medicare and Medicaid pointed out “The study identified increased mortality and psychiatric hospitalization compared to the matched controls. The mortality was primarily due to completed suicides (19.1-fold greater than in control Swedes).

Yet, Nevadans will be paying for these experiments cosmetic procedures on children should the Democratic majority pass SB163 and Governor Lombardo signs the legislation.

According to initial estimates, the cost to tax payers is just shy of $5 Million. To note, these invasive, risky surgeries often require additional surgeries due to complications and often coincide with cosmetic surgery to masculinize or feminize the patient’s appearance.

Although the initial tax-payer funded mandate is $5 Million, this legislation is likely to cost tax payers even more money should the State mount a defense for anticipated lawsuits if this legislation is 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.

To conform the Bill with existing state law, and to endeavor to comply with the federal constitution and state constitution, the following amendment is, at a minimum, necessary as a matter of law:

An insurer that offers or issues a policy of health insurance and which is affiliated with a religious organization is not required to provide the coverage required by [S.B. 163] if the insurer objects on religious grounds.

This amendment must be included in each of the following six chapters that may be amended by SB 163: NRS 689A, NRS 689B, NRS 689C; NRS 695A, NRS 695C and NRS 695G.

SB 163 will be heard by the Senate Finance Committee tomorrow at 8 AM and The Globe will continue to track this legislation.