Nevada GOP governor signs transgender health bills while vetoing another, bucking party trends

The former Clark County Sheriff’s signing of a bill on Monday requiring health insurance companies including Medicaid to cover all gender-affirming surgeries was the third major bill related to transgender health and civil rights to reach his desk.

Another bill he signed earlier this month requires the states’ Department of Corrections to adopt mental and medical health standards for transgender and gender-nonconforming people inside the state’s prisons, including cultural competency training for guards.

Democratic-controlled Legislatures like Nevada’s have moved several bills protecting transgender health care, civil rights and legal protections including a half dozen states from Oregon to Colorado. But Lombardo’s signature comes as Republican governors throughout the country have curtailed transgender-related rights and medical procedures, widening the gap between the Republican base and the only Republican to unseat a Democratic incumbent governor in the 2022 midterms.

“Nevada has for a very long time been a live-and-let-live type of state,” said transgender rights advocate Brooke Maylath, who worked on all three bills. “And I’m glad to see that this governor has not been hijacked by the divisiveness that we’ve seen in other states.”

Still, Maylath criticized Lombardo for vetoing a bill earlier this month that would have protected providers of gender-affirming services from losing their medical license and prohibited the executive branch from assisting in out-of-state prosecution. She said that the absence of those protections would exacerbate Nevada’s already-existing provider shortage.

In his veto message, Lombardo said the bill would hinder his office’s ability to “be certain that all gender-affirming care related to minors comports with State law,” and to ensure public health and safety standards.

Lombardo’s latest signature for the bill requiring health insurance companies to cover all gender-affirming surgeries comes after Oregon’s Democratic governor signed a nearly-identical law in May.

Lombardo garnered criticized from many his own party after the bill signing, including from Nevada’s Republican National Committeewoman Sigal Chattah, who called him a “laughingstock across the nation” in a tweet.

“I implore people to read the bill in its entirety,” Lombardo said on Tuesday at a press gaggle for another bill signing, adding that it mainly shores up already-existing protections. “And you will see it’s not as draconian or detrimental or immoral as people are portraying it to be.”

Democratic Senator Melanie Scheible, one of the bill’s sponsors, had framed the legislation as a way to save the state money due to potential losses in lawsuits against state Medicaid. She cited a 2015 declaration from the state’s division of insurance that prohibits the denial of medically necessary care on the basis of gender identity.

“The idea is to clear up any ambiguity and to put the answer in the statute, instead of waiting for an answer from a court,” Scheible said in an interview earlier in the session.

Many credit the declaration as to why more major gender-affirming surgeries are increasingly deemed “medically necessary” rather than “cosmetic” in Nevada by insurance companies, thus making more gender-affirming surgeries covered.

Still, many procedures — hair transplants, facial feminization surgery and voice modification among them — are often still classified as “cosmetic” despite their role in treating gender dysphoria, regarded as a medical condition that results in severe distress because of a mismatch between gender identity and gender assigned at birth.

Proponents have said the bill does more to enshrine existing rights rather than expand coverage that would already be mandated when brought through the appeals process or the courts because of the 2015 insurance mandate. Opponents largely worried about potential costs to Medicaid and to health insurance agencies, as well as having opposition to gender-affirming surgeries as a whole, particularly for younger patients.

It passed along party lines in the state Senate and Assembly, with Republicans opposed.

Lombardo also bucked party trends earlier this month when he signed another bill into law that further codified already-existing protections that ensure commissions that oversee medical licenses do not discipline or disqualify doctors who provide abortions.

Stern is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service that places journalists in newsrooms. Follow Stern on Twitter: @gabestern326.