The Tennessee House of Representatives passed a bill last week to create a transgender “watch list” that also pushes detransition medical treatment. The state Senate will consider it on Wednesday.

House Bill 754/State Bill 676 has been deemed “ugly” by LGBTQ advocates and criticized by healthcare information litigators as a major privacy concern.

The bill would require “gender clinics accepting funds from this state to perform gender transition procedures to also perform detransition procedures; requires insurance entities providing coverage of gender transition procedures to also cover detransition procedures; requires certain gender clinics and insurance entities to report information regarding detransition procedures to the department of health.”

It would require that any gender-affirming care-providing clinics share the date, age, and sex of patients; any drugs prescribed (dosage, frequency, duration, and method administered); the state and county; the name, contact information, and medical specialty of the healthcare professional who prescribed the treatment; and any past medical history related to “neurological, behavioral, or mental health conditions.” It would also mandate additional information if surgical intervention is prescribed, including details on which healthcare professional made a referral and when.

HB 0754 would also require the state to produce a “comprehensive annual statistical report,” with all collected data shared with the heads of the legislature and the legislative librarian, and eventually published online for public access.

The bill also reframes detransitioning as a major focus of gender-affirming healthcare — despite studies showing that the number of trans people who detransition is statistically quite low, around 13 percent, and is often the result of external pressures (such as discrimination or family) rather than an issue with their gender identity.

This legislation stands in sharp contrast to federal protections restricting what healthcare information can be shared. In 1996, Congress passed the Health Insurance Portability and Accountability Act, or HIPAA, requiring protections for all “individually identifiable health information,” including medical records, conversations, billing information, and other patient data.

Margaret Riley, professor of law, public health sciences, and public policy at the University of Virginia, has written about similar efforts at the federal level, noting the Trump-Vance administration’s push to subpoena multiple hospitals’ records of gender-affirming care for trans patients despite no claims — or proof — that a crime was committed.

It has “sown fear and concern, both among people whose information is sought and among the doctors and other providers who offer such care. Some health providers have reportedly decided to no longer provide gender-affirming care to minors as a result of the inquiries, even in states where that care is legal.” She wrote in an article on the Conversation, where she goes further, pointing out that the push, mostly from conservative members of the government, are pushing extracting this private information “while giving no inkling of any alleged crimes that may have been committed.”

State Rep. Jeremy Faison (R-Cosby), the bill’s sponsor, said in a press conference two weeks ago that he has met dozens of individuals who sought to transition genders and ultimately detransitioned. In committee, an individual testified in support of the bill, claiming that while insurance paid for gender-affirming care, detransition care was not covered.

“I believe that we as a society are going to look back on this time that really burst out in 2014 and think, ‘Dear God, What were we thinking? This was as dumb as frontal lobotomies,’” Faison said of gender-affirming care. “I think we’re going to look back on society one day and think that.”

Jennifer Levi, GLAD Law’s senior director of Transgender and Queer Rights, shared with PBS last year that legislation like this changes the entire concept of HIPAA rights for trans Americans in ways that are invasive and unnecessary.

“It turns doctor-patient confidentiality into government surveillance,” Levi said, later emphasizing this will cause fewer people to seek out the care that they need. “It’s chilling.”

The Washington Blade reached out to the American Civil Liberties Union of Tennessee, which shared this statement from Executive Director Miriam Nemeth:

“HB 754/SB 676 continues the ugly legacy of Tennessee legislators’ attacks on the lives of transgender Tennesseans. Most Tennesseans, regardless of political views, oppose government databases tracking medical decisions made between patients and their doctors. The same should be true here. The state does not threaten to end the livelihood of doctors and fine them $150,000 for safeguarding the sensitive information of people with diabetes, depression, cancer, or other conditions. Trans people and intersex people deserve the same safety, privacy, and equal treatment under the law as everyone else.”

Voters in Nashville and surrounding Davidson County made history Thursday as Olivia Hill won an at-large seat on the Metro Council, making her the first openly transgender official elected to public office in the Volunteer State.

The Tennessean reported that Hill secured one of the council’s five at-large seats in Thursday’s runoff election with 12.9 percent of the vote, as of 10 p.m. Thursday night. She joins a historic number of women elected to the council. All five at-large members will be women, as well as 17 district councilmembers. That adds up to 22 women — a majority of the 40-member council.

“I want to say that I am elated,” Hill told the Tennessean after the historic win. A Nashville native, Hill graduated from Hillwood High School in 1983. She then served in the U.S. Navy from 1986-1995 and saw combat overseas during Desert Storm.

LGBTQ+ Victory Fund CEO Annise Parker released the following statement after Hill was elected:

“Nashville voters clearly reject the hateful rhetoric that has grown louder in Tennessee politics lately. Olivia’s victory proves that transgender people belong everywhere decisions about them are being made, including local office. I know Olivia is well-prepared to take her seat on the Metro Council and work to make Nashville and Davidson County a more welcoming place for all.”

The Metropolitan Council (officially the Metropolitan Council of Nashville and Davidson County) is the legislative body of the consolidated city-county government of Nashville and Davidson County.

By the time North Carolina Gov. Roy Cooper signed into law the repeal of House Bill 2, also known as the “Bathroom Bill,” in 2017 it was estimated that the state had lost up to $3.5 billion in revenue. Almost six years later, more than 500 similar anti-transgender bills have been introduced in nearly all 50 states and economists anticipate devastating financial consequences.

Tennessee, which borders North Carolina, on July 1 enacted a law that bans health care providers from offering gender-affirming care to minors. Trans minors that were receiving gender-affirming care prior to the law taking effect had to stop treatment. 

The Tennessee General Assembly Fiscal Review Committee issued a report on Feb. 28 that found the bill would not only increase state spending to be in compliance with the law, but would also jeopardize federal funding opportunities. 

The law defines sex as “the biological state of being female or male, based on sex organs, chromosomes, and endogenous hormone profiles.” 

“Proposed language may result in increases to state and local expenditures associated with compliance measures, potential civil litigation, and could jeopardize federal funding,” the report says.

The report states the U.S. Education Department said the bill could jeopardize the state’s funding under policies that provide protections for students and define sex differently than the state’s law. The committee put estimated education funding losses at just over $1.2 billion.

The Tennessee Department of Health could also lose up to $750 million in federal grant money for being out of compliance with Title X, which provides family planning services for low-income families and also provides a different definition of sex than Tennessee’s law.

While it’s unknown what the total cost to Tennessee will be, many LGBTQ performers and business owners let out a sigh of relief when a federal judge blocked the state’s proposed drag ban before it could go into effect. The state has already appealed the decision.

Under the law, a first offense would be classified as misdemeanors and punishable by up to one year in jail and a $2,500 fine. Following offenses would be classified as Class E felonies punishable by up to six years in prison and a fine of up to $3,000.

While Tennessee’s law may have been blocked, four other states are considering similar bans. Texas, Florida, Arkansas and North Dakota have all introduced potential drag bans, with Florida’s being temporarily blocked by a district court decision. 

The state has appealed the ruling.

These bans raise questions for touring productions that include drag, in addition to local businesses. “RuPaul’s Drag Race” alums BenDeLaCreme and Jinkx Monsoon will be taking their holiday tour across North America this winter, and planning tour dates around where drag may or may not be banned has become a considerable factor.

“Because our tour is for a limited amount of time, we always have to be selective about where we’re going,” BenDeLaCreme told Vulture. “Unfortunately, it’s far enough out that I don’t know where the laws will be, and I am making decisions in a way where I’m like, ‘All right, we have to know we’re going to be able to go, so we’ll have to avoid these spots.’ It’s deeply upsetting because those communities need us, but it’s hard to know what to do.”

Given federal court rulings that have blocked anti-trans bills around the country, there is some hope that further bills will also be restricted. The American Civil Liberties Union has already promised to track and challenge anti-trans and anti-drag bills that are introduced in state legislatures.