“Now she wants to do transgender operations on illegal aliens who are in prison.” That’s what Donald Trump said about Vice President Kamala Harris on Tuesday night, in a debate moment that prompted head-scratching and derision. But what did it mean?
It appears to have been a reference to news that CNN reported on Monday, in a segment about Harris’s response to a 2019 ACLU questionnaire about rights for incarcerated people.
The question asked: “As President will you use your executive authority to ensure that transgender and nonbinary people who rely on the state for medical care—including those in prison and immigration detention—will have access to comprehensive treatment associated with gender transition, including all necessary surgical care? If yes, how will you do so?”
Harris’s response was yes, along with the following explanation: “It is important that transgender individuals who rely on the state for care receive the treatment they need, which includes access to treatment associated with gender transition. That’s why, as Attorney General, I pushed the California Department of Corrections and Rehabilitation to provide gender transition surgery to state inmates. I support policies ensuring that federal prisoners and detainees are able to obtain medically necessary care for gender transition, including surgical care, while incarcerated or detained. Transition treatment is a medical necessity, and I will direct all federal agencies responsible for providing essential medical care to deliver transition treatment.”
In the U.S., approximately 1.3 million adults and 300,000 youths identify as transgender, meaning their gender identity is different from the sex, male or female, they were assigned at birth.
And California policies have been groundbreaking when it comes specifically to its treatment of incarcerated transgender individuals.
In 2017, California became the first state to set standards regarding gender affirmation surgery for state prisoners—something that came after the approval of such a surgery for a transgender woman serving a life sentence. In other states, such surgery is often withheld unless a court decision orders it.
Later, in 2021, California Gov. Gavin Newsom signed a law—“The Transgender Respect, Agency, and Dignity Act”— requiring that every newly incarcerated person be asked particular questions to determine with which gender they should be housed, based on gender identity.
What is “medically necessary care for gender transition”?
According to the American Medical Association, such care includes a range of services—not necessarily all for each transgender individual—that “affirm gender or treat gender dysphoria,” which is the psychological distress resulting from an incongruence between one’s sex assigned at birth and one’s gender identity, according to the American Psychiatric Association.
Such services may include one or a mix of the following: mental health counseling, gender-affirming hormone therapy, non-medical social transition (through hair and clothing, for example), and gender-affirming surgeries—which can range from a facial feminization surgery and voice surgery to feminizing vaginoplasty or masculinizing chest or “top” surgery (a double mastectomy).
It’s considered medically necessary, notes the AMA, as “Improving access to gender-affirming care is an important means of improving health outcomes for the transgender population,” and receiving gender-affirming care has been linked to reductions in the rate of suicide attempts, decreased rates of depression and anxiety, and decreased substance use.
On Wednesday, following the New York Times declaring Trump’s “transgender operations” comment as the “wildest sounding attack line that was basically true,” ACLU’s Deputy Director for Transgender Justice Chase Strangio pushed back on social media. He called the characterization “dangerous, reckless, and misinformed,” adding, “Health care for transgender people is only ‘wild’ when you think of (and treat us) as a joke. This is not some throwaway point, some ‘attack line’. People in government custody die awaiting health care.”
When questioned about the survey responses ahead of Tuesday’s debate, Harris Presidential Campaign Communications Director Michael Tyler told Fox News,“This is not what she’s proposing, it’s not what she’s running on.”
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