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Florida’s Board of Medicine considers restricting gender-affirming health care for transgender youth, adults

The Florida Board of Medicine on Friday will consider establishing a new standard of care for transgender youth that is in conflict with recommendations from major medical associations and inconsistent with mainstream science in what critics have called a political ploy led by Gov. Ron DeSantis’ (R) administration.

The meeting comes just under a week after Florida’s Health Department filed a petition to initiate rule-making on the issue, citing a lack of “quality evidence” regarding the effectiveness of treatments including puberty blockers and hormone therapy for gender dysphoria.

“Given the lack of quality evidence in support of gender transition treatments, the use of such treatments for gender dysphoria should be considered experimental and should require fully informed consent of the risks and limitations,” the petition states, adding that children younger than 18 years old do not possess the “cognitive or emotional maturity” to comprehend the consequences of receiving gender-affirming medical care.

The department in April issued new guidance suggesting that gender-affirming health care should not be accessible to minors at all and accused the federal government of “injecting political ideology into the health of our children” by publishing a fact sheet providing evidence to the contrary.

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Florida Health Department officials in the guidance said children should not be socially affirmed in their gender identity, citing a statistic from a 2015 study published in the International Review of Psychiatry that 80 percent of youth seeking gender-affirming clinical care “will lose their desire to identify with the nonbirth sex.”

That’s not entirely true, Michael Haller, chief of the division of pediatric endocrinology at the University of Florida, said Friday.

“The state’s implication that the majority of children resolve their gender dysphoria is a gross misrepresentation of the data,” Haller said during a press conference held by the group Equality Florida outside the Marriott Fort Lauderdale Airport Hotel, where the state Board of Medicine is scheduled to meet.

“Yes, 80 percent of prepubertal children who express transgender identities return to their original gender assignment,” Haller said, “but 90 percent of those with a transgender identity following puberty – which is when we treat children medically – persist with a trans identity indefinitely.”

According to guidelines from the World Professional Association for Transgender Health (WPATH) and the Endocrine Society, social transition – non-medical interventions including haircuts or changes to clothing, names or pronouns – is the only acceptable treatment for gender dysphoria in children that have not yet started puberty.

“What kind of world would we be living in if the Department of Health dictates what haircuts and clothes kids can have?,” Jeanette Jennings, a transgender rights advocate and the mother of Jazz Jennings, a transgender television personality, said Friday during the Equality Florida press conference.

Using the state Health Department’s guidance, Florida’s Agency for Health Care Administration (AHCA), which controls most of the state’s Medicaid program, in June published a notice for a proposed rule to eliminate coverage for gender-affirming health care.

The agency also released its own report on gender-affirming care that has been widely criticized as “unscientific” by doctors with clinical experience treating transgender youth. The AHCA report has also been accused of using research from doctors with anti-transgender biases, including Quentin Van Meter, the president of the American College of Pediatricians – an organization designated as a hate group by the Southern Poverty Law Center (the group has contested this designation).

Van Meter, also a pediatric endocrinologist, has advocated for the use of conversion therapy to treat gender dysphoria in children, a practice that has been discredited by most of the medical community. 

In emailed comments to Changing America, Van Meter argued that those pushing to protect gender-affirming medical interventions are the ones who are “actually trying to convert” youth assigned male or female at birth. That, according to Van Meter, is “a feat that is impossible and which causes documentable harm.”

Providers of gender-affirming clinical care have acknowledged that treatments for gender dysphoria come with a set of risks, but argue that those risks are no more dangerous than those associated with other forms of pediatric care.

“In pediatric care, there are gaps in our knowledge base, there are inherent risks, and the government is not trying to interfere in that,” Meredithe McNamara, an assistant professor of pediatrics at Yale University, told Changing America.

McNamara was part of a team of medical and legal experts at Yale that authored a June report accusing Florida’s attempts to heavily restrict access to gender-affirming health care of being part of a “political agenda.”

In June, DeSantis appointed four doctors to serve on the state Board of Medicine, including Patrick Hunter, who in a lawsuit challenging Alabama’s felony ban on gender-affirming care made a declaration that he believes gender-affirming medical care for transgender youth “cannot be ethically justified.”

Should Florida’s Board of Medicine on Friday choose to adopt the state Health Department’s standards of care, gender-affirming surgical or “any other procedure that alters primary or secondary sexual characteristics for the treatment of gender dysphoria” will be prohibited for patients younger than 18 years old.

Puberty blockers and hormone therapy will also be off-limits for minors, and gender-affirming medical interventions for transgender adults will be administered only after a mandatory 24-hour waiting period – a nod to a debunked hypothesis that youth and adults may experience “rapid onset gender dysphoria.”

Doctors in the state who continue to provide gender-affirming care could face lawsuits and potentially have their medical licenses revoked. On Thursday, Andrew Warren, the elected state attorney of Hillsborough County, Fla., was suspended by DeSantis for refusing to enforce the state’s ban on abortion and gender-affirming care.

“I’m not personally afraid,” Haller, the pediatric endocrinologist from the University of Florida, told Changing America, adding that he believes the courts will side with him and other doctors whose medical licenses may be taken by the state.

“I’m scared for my patients,” he said. “I’m terrified for them.”

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Watch live: Harris speaks to Latina state lawmakers on protecting reproductive rights

Vice President Harris will meet Friday afternoon with Latina members of state legislatures who are working to codify abortion rights at the state level.

The roundtable is scheduled for 3 p.m. ET.

Watch the live video above.

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RNC officially picks Milwaukee for 2024 convention

The GOP will host its 2024 national convention in Milwaukee, the party announced Friday following a unanimous vote by the Republican National Committee.

“Milwaukee is a world-class city, and we are eager to see it shine in the spotlight come 2024,” RNC Chairwoman Ronna McDaniel tweeted after the vote.

The announcement makes Milwaukee a convention host for the second straight presidential election cycle. Democrats planned to host their convention there in 2020 but ultimately decided to hold much of the event virtually because of the coronavirus pandemic.

The convention will feature speeches from major party figures and will culminate in the formal nomination of the Republican Party’s ticket for the 2024 presidential election.

Wisconsin is typically a key swing state and will likely be one again in 2024. 

Former President Trump has continued to pressure Wisconsin officials over the results of the 2020 election there, where President Biden defeated Trump by nearly 21,000 votes.

Nashville, Tenn., was the other city in contention to host the Republican convention in 2024.

Democrats have yet to announce where they will hold their 2024 convention. The party is still mulling a shake up to its primary calendar that would replace Iowa and New Hampshire as the first states in the nominating process.

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Republicans vow 'hell' for Democrats over economic bill

Republicans are sharpening their knives while the Senate prepares to hunker in for a long weekend as Democrats deploy a special process to pass the party’s sprawling health care, tax and climate plan without buy-in from across the aisle.

Republican leaders fumed over the Democratic effort at a press conference on Friday, one day before the Senate is prepared to begin consideration of the plan, while taking aim at Sens. Joe Manchin (D-W.Va.) and Kyrsten Sinema (D-Ariz.), two key centrist holdouts, for backing the effort. 

“So, what will vote-a-rama be like?” Sen. Lindsey Graham (R-S.C) told reporters on Friday, referring to the voting marathon senators are set to be subjected to in the next few days as part of the process Democrats are using to pass the bill. “It’d be like hell.”

“They deserve this. As much as I admire Joe Manchin and Sinema for standing up to the radical left at times, they’re empowering legislation that will make the average person’s life more difficult,” Graham said.

Graham, along with Sen. Roger Marshall (R-Kan.), also threatened not to vote for a critical funding measure ahead of a September deadline, when government funding is set to lapse, over the effort.

Democrats are using a complicated procedure known as budget reconciliation to try to pass the party’s Inflation Reduction Act, a massive package that would advance key pieces of President Biden’s legislative agenda.

The procedure, which Republicans used to pass former President Trump’s signature tax law in 2017, will allow Democrats to pass a bill in the 50-50 Senate with a simple majority, bypassing the usual 60-vote threshold.

But to pass the bill using the maneuver, Democrats have to jump through a series of hoops before they bring the bill to the floor for a vote. That includes what’s known as vote-a-rama — an often lengthy and messy voting marathon in which senators can offer a series of amendments for a chance to influence legislation before a final vote on the overall bill.

Republicans have been strategizing in recent days on how to make Democrats feel as much pain as possible during the coming voting session, promising to line up tough votes for the party that could be used as ammunition for the coming campaign season.

During the recent press conference, Sen. John Barrasso (Wyo.), a member of Republican leadership, said the GOP will be focusing specifically on areas like “energy, inflation, border and crime.”

Many Republicans have been keeping their cards close to the vest on what amendments they plan to bring up during the voting marathon.

Pressed by The Hill on Thursday about which ones he’ll offer, Sen. John Kennedy (R-La.) declined to divulge, saying he wants “it to be a surprise.”

“My colleagues will all have plenty of time to read my amendments,” Kennedy said. “But I don’t believe in leading with my chin.”

Republicans have expressed hopes at attaching some of their amendments to the overall bill, despite their overwhelming opposition to the package, in the event it could make the legislation tougher to pass in the House.

Still, there is concern among GOP members around the chances Democrats will introduce a “wraparound” amendment, which could allow for erasure of all amendments adopted during the session.

Sen. John Thune (S.D.), the No. 2 Senate Republican, acknowledged the issue during the press conference on Friday, questioning whether Manchin and Sinema would vote for such an amendment. 

“Because they both said that they won’t vote after they felt like, in the American Rescue Plan, they voted for a wraparound amendment and felt like they were misled by their leadership at the time that they would never vote for one of those again,” Thune said. 

The Hill has reached out to the offices of Manchin and Sinema for comment.

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Rural Americans with early-onset Alzheimer's less likely to see a specialist

Americans suffering from early-onset Alzheimer’s are less likely to receive specialized care if they live in rural parts of the country, a new study found. 

Ohio State University researchers found rural patients with the disease, which occurs between the ages of 30 and 65, were typically seen exclusively by a primary care physician and were less likely to undergo testing that would help doctors manage the condition.    

Researchers noted that patients with early-onset Alzheimer’s make up only 6 percent of Alzheimer’s diagnoses, but they said this form of the condition is usually more aggressive and leads to accelerated cognitive decline. 

“These people are young – in their 50s and early 60s – and many are still the major family caregivers to older family members and children. They’re still working, paying mortgages and living active lives,” lead author Wendy Yi Xu of Ohio State’s College of Public Health said in a media release. 

“If you’re able to diagnose it early enough, the patients and the family members can prepare, make financial arrangements, plan important events and seek the support they need, which can improve the quality of life for all involved,” Xu said. 

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Xu said testing required to diagnose and provide care for the disease is often unavailable to patients treated exclusively by a primary care provider.  

The team said treatments could also overburden rural health care systems that are already stretched too thin, adding “community health care leaders and policymakers must explore innovative solutions to deliver needed specialty care to early-onset patients,” 

Researchers examined disparities by reviewing health care claims from 8,430 patients who were newly diagnosed with early-onset Alzheimer’s or dementia related to the diagnosis.    

The study was published Aug. 5 in the Journal of the American Medical Association.  

The Centers for Disease Control and Prevention estimates as many as 5.8 million people were living with Alzheimer’s in 2020.

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Hate speech, privacy and the personal lives of public officials

The recent arrest of an armed, threatening, potentially murderous person outside the home of Rep. Pramila Jayapal (D-Wash.) has underscored two areas of continuing and tragic governmental neglect: the vulnerability of public officials to violence, even assassination, and the incessant drumbeat of hate speech on social media aimed at vulnerable individuals and populations. 

Congresswoman Jayapal, the first Indian American woman elected to Congress, had been the subject of hate speech on social media for months, described as, among other things, a “street-sh—ing mother of a trans child.” Nor were these isolated posts; some of the same sites have been engaged in an escalating social media barrage of hate speech directed at the Hindu-American population. In a manner similar to contemporary expressions of antisemitism and other forms of hate speech, the tropes of hatred are not new; terms like “street-sh—er” have been employed to slander Hindus for years.   

What is new is the delivery of such hate speech over social media platforms that also make readily available, to anyone who cares to look, potential targets’ home addresses, places of worship, even their Social Security numbers. Indeed, as The Wall Street Journal points out, your “home address and other personal info are a search away,” and even with extraordinary effort to hide your search results, “[e]xpecting to have every digital trace removed isn’t realistic.”  

Congresswoman Jayapal’s experience is a case in point. According to the charging documents filed against 49-year-old Brett Forsell, in the days and months preceding the incident outside her home, Ms. Jayapal “had been doxed — having her home address and other private information maliciously posted online,” and was concerned that someone might show up at her home. On July 9, Mr. Forsell did, carrying a .40-caliber pistol and allegedly threatening to kill her and shouting at her to go back to India.   

Congresswoman Jayapal’s experience is hardly unique. On June 8, an armed man was arrested near the residence of Supreme Court Justice Brett Kavanaugh; he had reportedly located the justice’s home address on social media. Three days earlier, a retired Wisconsin state court judge was murdered in his home.  

And two years ago, U.S. District Judge Esther Salas, the first Latina federal judge in the District of New Jersey, was targeted for assassination at her home by a disaffected lawyer who located her home address, place of worship, and other personal information on the internet. She was spared when her 20-year-old son Daniel and her husband Mark Anderl intercepted the assailant.  Her husband was seriously wounded and has made a painstaking recovery; they lost their precious son. 

Any one of these events should have prompted legislation to protect judges and other public officials; in the aftermath of the Justice Kavanaugh threat, Congress did pass and President Biden signed legislation extending around-the-clock protection to Supreme Court justices and their families — but not to Supreme Court employees or to other federal court judges. But that level of protection is not feasible on a nationwide scale, and the bill failed to address the common threads in the targeting of judges and other public officials: the amplification of hate messaging across social media platforms, and the ease of access to potential targets afforded by the monetization of private information as a cost of entry to the world of social media.   

The Daniel Anderl Judicial Security and Privacy Act has been pending for nearly two years now, stymied by the objection of Sen. Rand Paul (R-Ky.) that the bill fails to include members of Congress. By its terms, the bill would prohibit federal agencies and private businesses from posting certain personal information, such as home addresses, of federal judges and their immediate family members. It requires such information to be removed upon written request of the federal judge, prohibits data brokers from purchasing or selling such information, and establishes programs to protect such information at the state and local levels. 

Senator Paul’s objection seems pretextual; there is no reason his concern that members of Congress should be similarly protected cannot be enacted separately, and therefore no reason the protection of federal judges provided by the Anderl Act shouldn’t be enacted immediately.  Certainly, the example of Congresswoman Jayapal underscores the need for similar protections for members of Congress.    

At the end of the day, however, the issues raised are fundamental to the structure of the internet itself. Shouldn’t any vulnerable person — a member of a group targeted by hate speech, a victim of domestic violence, a citizen concerned about exposing her private information — be afforded an easy avenue to protect that information? And shouldn’t the social media platforms be monitored independently and called to account for their tolerance of hate speech?    

In the meantime, the escalating threats to the lives of public officials, from federal judges and members of Congress to local election officials, require urgent action to address the common threads underlying those threats: easy access to private information on platforms that do little to discourage the proliferation of hate messaging that leads to real world targeting.    

John Farmer Jr. is director of the Eagleton Institute of Politics at Rutgers University. He is a former assistant U.S. attorney, counsel to the governor of New Jersey, New Jersey attorney general, senior counsel to the 9/11 Commission, dean of Rutgers Law School, and executive vice president and general counsel of Rutgers University.

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Trump PAC pushing election fraud claims paid $60K to Melania Trump fashion designer

Former President Trump’s Save America PAC, which he launched after the 2020 presidential election to challenge the results and raise money for candidates he supports, paid $60,000 to a fashion designer known for styling former first lady Melania Trump, according to Federal Elections Commission (FEC) filings. 

The filings show the PAC made four payments to Herve Pierre Braillard for “strategy consulting,” paying him $6,000 on April 7 and $18,000 on May 4, June 3 and June 24. 

Braillard is a French American designer who styled Melania Trump while she served as first lady. He had also styled other first ladies including Hillary Clinton, Laura Bush and Michelle Obama, according to USA Today. 

Save America PAC did not immediately return a request from The Hill for comment about what the payments were for. 

The FEC forbids candidate PACs from spending money on personal items, but Save America is a leadership PAC, which has fewer restrictions. 

The House select committee investigating the Jan. 6, 2021, Capitol insurrection has criticized Save America PAC for raising millions of dollars for election fraud claims that it knew were false. People were encouraged to make donations for an election defense fund, but two former Trump aides testified before the committee that the fund did not exist and was a marketing tactic.

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How policies ‘protecting’ small restaurants from delivery apps are backfiring

Whether you’re a policy professional, restaurant owner, delivery driver or just someone who loves takeout, you may want to turn your attention to a few legal battles across the country.

During the pandemic, at least 78 cities, counties and states in the U.S. have introduced temporary price controls restricting delivery companies from charging high commission fees to local restaurants. Many of these once-temporary measures are now becoming permanent, leading to legal battles between companies and governments, such as in New York City and Chicago. Last week, San Francisco policymakers voted to amend their permanent fee cap if companies drop their lawsuit against the city.

The policy emerged because Uber Eats, DoorDash, Grubhub and Postmates have charged participating restaurants commission rates as high as 30 percent on orders through their platforms. High fees, some argue, raise concerns of “exploitative and predatory practices” that threaten the viability of small restaurants. These high commission rates are also featured in a class-action antitrust lawsuit filed against the delivery companies in a federal court in Manhattan.

Capping commission fees is popular because it implies that restaurants can keep a larger fraction of their revenues, thereby protecting their profit margins. But several considerations cast doubt on whether these price controls will be successful in helping small businesses, and whether they may unintentionally harm gig workers on delivery platforms.

First, delivery companies can respond by simply doing less business in areas and sectors where the regulation exists. In a study analyzing 14 U.S. cities that have implemented temporary or permanent fee caps, researchers found that small restaurants experienced a decline in orders and revenues after the policies were enacted.

Contrary to the wishes of regulators, the study also found that demand for local restaurants in regulated cities was 6.8 percent lower compared to chain restaurants (which were not subject to the fee caps). The researchers also concluded that delivery companies reduced promotional efforts for restaurants in regulated cities and began promoting nearby restaurants from non-regulated cities instead.

The rapid emergence of “ghost” or “cloud” kitchens – cooking facilities set up for delivery-only meals – also challenges the narrative that commission caps will be successful. Delivery companies may begin to substitute listing local restaurants on their platforms with these ghost kitchens, which would not be subject to fee caps.

Second, it’s a mistake to assume that delivery companies will not find ways to spread out the lost revenue. Several decades of price control history highlight creative loopholes around these regulations. For example, landlords have enacted parking, key and service fees in response to rent control in New York City. Indeed, DoorDash added new flat fees – “regulatory response fees” – in 57 out of the 68 locations where it was subject to commission caps. For example, customers faced a $1.50 “Chicago fee” and $2.00 “Oakland fee.” These fees increase the prices of takeout, which can also lead to fewer orders and lower sales volumes for restaurants.

But what’s often ignored is the impact on gig workers. Delivery workers on the platforms earn per order, and a decrease in orders in response to the cap results in fewer income opportunities.

In this way, commission caps may run contrary to policy goals, which seek to help gig workers. It is not clear whether restricting the amount of fees that companies collect causes companies to also reduce the payments gig workers receive per order. A statement by DoorDash highlighted that their fees do cover “Dasher” pay.

Local governments must carefully analyze whether their commission fee caps are resulting in unintended consequences like these. This is especially important in areas that have witnessed a surge of women on delivery platforms post-pandemic. The female labor force participation rate has continued to lag, and gig work provides an opportunity for women who may otherwise be unable to take on traditional employment, often because of child care obligations.

There may be alternative solutions that minimize harm to restaurants and gig workers, such as the tiered-fee models that San Francisco officials endorsed last week. This idea, which is beginning to be offered by delivery platforms in unregulated areas, allows restaurants to choose among a range of fees: 15 percent involves basic services such as listing and delivery, but 30 percent comes with more extensive promotional efforts, a guaranteed number of orders and low customer fees to attract more business.

While the intention to support local restaurants is notable, price controls are notoriously ineffective. Tiered-fee models that allow restaurants to choose their fees and services may be able to do what policymakers cannot do on their own, without the additional harm to local restaurants and gig workers.

Liya Palagashvili is a senior research fellow with the Mercatus Center at George Mason University and an affiliated research fellow at New York University School of Law.

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Biden to visit Kentucky in wake of deadly floods

President Biden on Monday will travel to eastern Kentucky to visit families affected by the recent flooding and to survey recovery efforts, the White House announced on Friday.

The president will be joined by first lady Jill Biden and visit with Kentucky Gov. Andy Beshear (D) and first lady Britainy Beshear. The group will visit a local Federal Emergency Management Agency (FEMA) state disaster recovery center to hear about recovery efforts.

Biden late last month declared that a major disaster exists in Kentucky and ordered federal aid to supplement recovery efforts in the areas affected by severe storms, flooding, landslides and mudslides that began on July 26.

Beshear announced on Thursday that Biden approved individual assistance for Kentucky’s Owsley County, bringing the count of counties FEMA has approved for assistance to eight. Thirty-seven people have died so far from the flooding, WCTI-12 reported.

Biden also traveled to western Kentucky in December to survey damage with Beshear following the tornadoes in the region.

The trip to Kentucky would be the first significant one for Biden since his bout with COVID-19. As of Thursday, Biden had tested positive for six days with a rebound coronavirus infection that has been seen in some patients who take the antiviral treatment Paxlovid.

He had to cancel trips to Pennsylvania and Florida last month when he first tested positive for the virus.

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Watch live: Biden signs two COVID-19 relief program fraud bills

President Biden on Friday afternoon will sign into law two bipartisan measures to take action against those who commit fraud in abuse of COVID-19 small-business relief programs.

The signing event is scheduled for 1 p.m. ET.

Watch the live video above.

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