- [Narrator] The State House and Senate approved new limits on transgender athlete participation in female competitive sports in schools.

This is State Lines.

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[lively music] ♪ - Hi there, I'm Kelly McCullen.

Joining me for this week's discussion, Rick Glazier of Campbell Law School.

Hello, Rick, good to have you back again.

- Nice to be here, Kelly, thank you.

Senator Amy Galey of Alamance and Randolph counties joins us, Republican.

And Democratic State Senator Graig Meyer of Caswell, Orange, and Person counties, and WUNC radio's Colin Campbell, you're a reporter but you're so much more over there.

I won't dare ask for the in depth... - Yeah, it might take a while.

[chuckles] - Well, welcome to public media, my friend.

- Yeah, glad to be here.

- All right, well let's settle up and go.

Big week in the General Assembly, the North Carolina House and Senate have each approved separate bills to require women's competitive sports events in schools be limited to athletes who were born biologically female.

There is no question, it's the top issue for North Carolina this week.

- [Narrator] The State House and Senate's passage of similar legislation to limit transgender female participation in competitive women's sports in schools is not without some key differences.

Namely, the House approved a bill that covers our state's community colleges and intramural teams on UNC system campuses.

- I can't imagine that there would be any opposition to the idea that women should be forced to compete against biological males in sports.

- And I think that the high school associations authority is perfectly good to work with the situation at a much more hands-on level than from up here coming in attacking a very, very small group of people who probably already have enough on them as young people.

- [Narrator] Supporters of limiting women's competitive sports participation to biologically born girls and women say transgendered females possess dominant physical traits related to them formally being male.

But opponents worry that lawmakers are senselessly fueling a mental health crisis and are solving a problem that statistically and practically doesn't exist in North Carolina.

- I'm obviously troubled by this bill.

I understand that the suicide ideation rate amongst transgender youth is over 80%, and 40% of transgender youth that committed suicide.

I feel like we're further stigmatizing the community.

These kids just wanna play sports.

I don't see there's any competitive disadvantage in the middle school and high school level.

- The years of data have indicated that after many years of hormone treatment, there is still a very significant and clinically significant difference in the abilities of males to compete on a physical level.

And so this bill makes sense and it is an opportunity for all.

- [Narrator] Skeptics say that one student in North Carolina could be affected by any new state law limiting transgender participation in women's sports.

But supporters argue transgender issues and the entire debate is moving quickly through our society.

So the timing is right.

- All right.

First topic, we're gonna kick this off to you, Senator, because well, you've passed your version of the bill, some subtle differences in the house.

Your take on this issue, and why was this week the week both chambers decide to do similar legislation, just ride down the same railroad track?

- Well, I think that was just a coincidence.

We had our bill filing deadline in the Senate, and a lot of bills were filed at one time.

We're ramping up, getting ready for crossover coming on May 4th.

So I think that was just a coincidence.

My take on all of this is it comes down to really two issues within the fairness and women's sports.

One is competitiveness.

You want women's sports teams to be, you look at, there's divisions within college conferences, they are for a reason.

Athletes within the same sport, they have different abilities.

And so when you bring in an athlete who has had the benefit of testosterone for years with their body, they have a significant advantage over women playing the same sport.

So, maintaining competitiveness for women, I understand that the women's US soccer team, the most elite players in the world, they lost to a team of 15-year-old travel players in a scrimmage.

Male athletes, biologically male athletes are superior in strength and size and speed to women of the same age.

The other issue for me is privacy, privacy in women's locker rooms.

If you have, so there was a interesting article in the Washington Post in February that talked about the crisis for American girls in their self-esteem.

One in three is suicidal.

30% of our teenage girls in the United States today are suicidal.

That same article said that 17% of them in this federal story reported being raped, being forced to have sex against their will.

So you bring a young woman like that into the locker room, and she is undressed and next to a biological male.

What is the impact on her?

What about her mental health?

What about her ability to play a sport that she enjoys, that she's trained at for years, to be able to get the benefit of potential scholarships but also that physical health and that mental wellbeing, that's important for our girls too.

- Senator Meyer, the counterpoint, there was no votes on this bill, plenty of them.

Your take?

- Look, this bill unfortunately continues to drive the type of divisive dangerous language that is really making it difficult on all of our communities to figure out how do we want to be as a United States of America and targeting a marginalized group with things like, assumptions that if you have a transgender girl in with other girls, that you're going to have sexual assaults, which doesn't happen.

We've had an established process for how the high school athletic association looks at these cases and only two cases where there's been a transgender girl joining a girl sports team and all of this is all to cover up for the things that we're not doing.

It's to keep a social issue generated in the media.

And when we're not working on affordable housing, where we haven't taken on any significant gun safety measures, it really bothers me that we're using this type of divisive language to hide that we're not taking on the big issues.

- Can I respond to that?

- Absolutely.

- So I don't think that I said anything that was targeting a marginalized group.

I emphasized and focused on the impact on that young woman and how she might feel with her experience having been raped, having been sexually assaulted, being in the locker room naked next to a biological male who is naked.

I think that her perspective is just as important and having those spaces that are safe for her.

And I'm not at all insinuating that the biological male is a threat to her personally, that he is going or they are going to do something that is hurtful physically to the biological female that's in that locker room.

But I think still having been the victim, if a person who has been the victim of a sexual assault, having to be in the presence of someone who has a penis is can be upsetting and threatening to that person also when she is disrobed in the locker room.

- So I do DEI work with schools and we help schools figure out how to navigate these issues all the time and navigate them in sensitive, responsible ways that make sure everyone feels respected and included 'cause that's what you want in public schools.

You want everybody to feel like they have a way to be fully included, whoever they are, whatever their identity is, to participate, to learn, to do sports, all of those things.

- So how do you do that?

What do you say to her?

- Well, hold on one second.

The challenge is this.

When there are real ways to get it right, when the rhetoric about it associates that the suicide rates for those girls, we are all concerned about, and the sexual assault rates on those girls, which we are all concerned about, is somehow connected to the presence of trans students or trans athletes.

There's not a connection between those things.

And the suicide rates and the sexual assault rates on trans girls is even higher than it is on cisgendered girls.

So we should be working on getting this right.

We should be helping our schools and our families figure out how to navigate this complex and changing space in a way that makes sure that everybody is included.

And part of the problem with the legislation is it's a one-size-fits-all solution, pushing aside what we've already been working on with the high School Athletic Association to get it right case by case to learn and get better over time.

- I think that my issue with what you're saying is that it puts the onus on the victim of the sexual assault to speak out for herself.

That it puts the onus on her to bring it out.

"I've been sexually assaulted.

I feel uncomfortable."

I don't think she should have to do that.

I think that we should have safe spaces for biological women where they don't have to justify their own presence.

- I agree completely that it's never right to put someone who has been victimized in the role of addressing the power dynamics.

Whether that be someone who has suffered sexual assault or someone who is trans.

And so in a responsible way to approach this, a school, the principal, the coaches, they're gonna talk to everybody and they're gonna work on figuring out, "This is what we're doing this season, this is who our team is.

How do we do this so that everybody feels included?

I wanna talk to you.

I wanna hear what everybody has to say what your ideas are."

Because you're gonna have to get on the field together and you're not gonna do well in the field together if you've got dissension in the locker room, whether it be because of this or any other issue.

And I think across the state, across the country, educators of all types wanna get this right.

They do.

If you go into education is 'cause you wanna make every kid feel included.

- What I hear from all of that is that the young woman who's been the victim of an assault will be made to feel like she has to step aside to make room for somebody else, that her feelings are less valid than someone else's feelings.

'Cause I don't know how you reconcile the two.

I truly don't.

- I think- - And one thing I really wanna emphasize is I am very confident that my colleagues in the Senate, all 50 of us, want to fight sexual assault and we take violence against all women very, very seriously.

I would never wanna say anything that would intimate otherwise.

But I think that it's important to remember that women have been told for 10,000 years, "You come in second to the man.

Your place is you have to step aside.

You have to get outta the way because somebody else is more important than you."

And I think that when it comes to this issue, her perspective is just as important as everybody else's.

And we shouldn't make her feel like she's wrong for not wanting to be there.

- Yes.

And if her perspective is just as important so is her perspective, right?

You have two hers in this situation.

I think if you went to schools and you talked to how they're navigating this, you'll see that there really are pathways to not put the burden on one side or the other.

- [Sen. Amy] The biological- - There really are ways to get it right.

- The biological male still has a team that they can play on.

They can play on the team with the other biological males where they have the same advantage of testosterone and they have the same biology, ultimately.

And so there is an alternative for that person.

There is no alternative for the biological female if she feels uncomfortable and she would ultimately leave the team.

And I would be very interested to know how much that happens.

We don't have, I don't know, do we have studies?

Do you have any kind of documentation that shows that there are girls who go through all of that stay in sports?

- I mean, I would actually say from my experience and that this isn't study, but you're much more likely to have trans students of any gender who are disengaging because of what they're afraid is gonna happen to them, even in a good team dynamic, than you are for a student who is cisgendered.

- Colin, I listen to a lot of the debate on this issue.

One thing is for sure, both sides have a lot of passion.

There are tears on both sides, there's sincerity on both sides and there's fear on both sides.

How does Republicans Democrat, if possible, how do you bridge it?

And as a reporter, how do you tell a story that correctly encapsulates the dynamic of the Democratic position largely and the Conservative Republican position largely?

- You know, it's really tricky 'cause even it comes down to, I mean, you've listened to debate.

Both sides are using different terminology.

So as a reporter, trying to describe the issue here, what terminology do I use in a way that's neutral?

That's really tricky.

I mean, it's really, as you mentioned, it's an emotional issue.

- Are you nervous about how you're using language writing stories about transgendered issues?

Absolutely, because I wanna make sure that I'm not offending anyone on any side of this issue where people have deeply-held views, and trying to stick to the facts of what actually is the practical implication of this type of legislation on the individual people on both sides of it in a locker room, regardless of who you are.

And that gets really tricky to do in a way that just describes it to people and lets them make up their own minds about these really difficult hot-button issues.

- Rick Glazier, many democrats think the the feds are gonna come in and apply some Title IX standards to some of this.

I don't know how far that goes into the schools.

I'm not a lawyer, but your take on whether this is a legislative issue, whether it's a technically a legal or a court issue at the end of the day.

- Well, it may be a legal or court issue at the end of the day.

The United States House of Representatives passed a bill pretty much on party lines, this week, as I recall, that would seek to do what this bill does and more.

I don't think it's gonna get a hearing in the United States Senate.

And the White House has already indicated they would veto it, but it also tried to deal with it in the context of Title IX.

Title IX is clearly involved here.

What Title IX will require will be litigated, not just in this state, but in other states.

But I think this great discussion that the two senators had plus the discussion that happened in the legislature shows the depth of knowledge on the issue and the depth of what we don't know about the issue.

And suggests to me that, particularly when we're only dealing with a few students.

I mean, this is not something that's happening in every school everywhere.

That there is time to sit down and reflect and that communities need to be involved in making decisions that are very specific for their communities, for their children.

And that a bill that attempts to be permanently restrictive as to all is probably not a good solution for something that is so personal, and so unique, and so community based.

So, as a lawyer, this would be a case where I would say this is prime for mediation, and prime for communities to be involved.

And as both senators have said, all stakeholders to have their opinions heard.

What it isn't prime for, I think, is a one size, and I think this is Senator Meyer's point, a one-size-fits-all bill that's preemptive and prescriptive.

And I think that's gonna lead to more trouble than it's gonna solve.

- Senator Galey, do you think this legislation's one-size-fits-all or do you think it hits right where it needs to in terms of applying policy on women's competitive sports in schools?

- I think it hits right in the right point.

We had a, also we had a coach who came and spoke at the General Assembly in the past week who said that her job is to win.

She does not want to have biological males on her college team, but her job is to win.

And if it ultimately, if there's gonna be the law that transgender or biological males are going to be participating in women's sports teams, she's gonna recruit them.

She's gonna look for them 'cause she wants to win and she knows that they are stronger, faster, and more powerful.

- And I would argue you've got governing authorities here.

You've got the State High School Athletic Association for the high school, and for that matter, even at upper high school students, you've got NCAA at all levels for colleges.

I think someone whose opinion ought to be really looked at and talked to about this is Representative Morey, who was a former Olympic athlete and who, I think, would have as good a understanding as anyone, possibly, in the legislature.

I'd be interested to see what she had to say.

- Senator Meyer, is it fair in the argument for females who were born biologically female to say a transgender athlete can come in in competition and in one year dominate state records, win state titles, and I've put 16 to 18 years of work in.

Is that a fair stress point in women's sports?

I understand the debate over safety and whether there's a safety issue or not.

But at the end of the day, if a female-born, biologically female can't compete, do they have a gripe there?

- Look, fairness always matters whenever we're talking about sports and taxation, that's what people want, is they want fairness in those two things.

And so of course it matters, and that's part of why the high school Athletic Association and these other governing bodies that Rick is talking about take a look at every individual case of authorizing folks to do this, of, "Are we creating an unfair advantage here or is this a real situation we need to address?"

It's taken into consideration.

The other point that I would make that's related though, is when we're talking about high schools in particular, it's not all about winning, it's about educating kids.

High school athletics is about educating kids in teamwork, and working across lines of difference, and learning how to be competitive in appropriate ways.

And I think that tackling issues of gender identity as well as so many other forms of difference is a key part of why we use athletics as a way to help our kids grow.

- All right.

Thank you so much.

Let's shift gears towards another piece of legislation.

Did you have one last word?

- I did.

I have one last word.

Thank you so much.

One of the people that really concerns me is the young woman who's in 8th, 9th, 10th grade who comes home and says to her parents, "I don't feel comfortable at school anymore because of this happening.

I said something and this was, this response was not affirming of that, so I want to change schools."

And so ultimately you have people voting with your feet, and we see our people leaving our public schools all across the state.

And there's a lot of reasons for that.

But I think that our children feeling like they are being put as second-class citizens is part of it.

- And we have an intelligent audience.

Public media is one thing, we can talk deeply.

Folks, go read the bill.

It's out there.

You can read both of them and they'll be in negotiations on a final piece of legislation, and then I guess they'll reach an agreement.

I'm being presumptuous there.

Here's another bill, or at least a proposal.

Some senate Republicans, state Treasurer Dale Folwell, are proposing protections against high levels of medical debt.

It's a proposal that would largely limit large hospital's abilities to bill patients above what their health insurance company reimburses.

Spouses would not be held financially liable for their partner entering a nursing home.

Nursing home, when that time comes, and medical debt collectors would see their collection tactics severely limited.

Colin, you covered this story.

It's a good one, and it's very interesting, and a difficult bill to read because there's a lot to it.

- Yeah, absolutely.

There's a lot of different consumer protections that are proposed here but it's hard to sort of view it in the larger landscape 'cause all this is governed by federal regulations as well.

There's a lot of things that play into this.

This is a big issue for state treasurer Dale Folwell, who's no stranger to fighting with the hospitals.

Of course, he's now an announced candidate for governor next year.

So certainly this is an issue that has a lot of interest as a consumer issue.

I mean, we've all gotten hospital bills that show up, you know, three or four months after you've been in the hospital.

It's a fair amount that you maybe weren't expecting, you maybe hadn't budgeted for in your household finances.

So I think that's what gives this bill such resonance.

But it is a really complicated piece of legislation with a lot of different moving parts and different new regulations that would go into place should this become law.

The challenge is pretty vehement opposition from the state's hospital lobby.

They argue that the existing consumer protections out there are adequate.

They say a lot of the issues folks are having at the individual level, are really with the insurance companies, and that's where you should tackle this issue versus at the hospital level.

- Rick, were you in office still when Obamacare went through and- - I was.

- or the Affordable Care Act?

- The Affordable Care Act.

- I don't want to sound, yeah.

What's happening to debate North Carolina about healthcare?

You've got Republicans and Democrats now siding on behalf of the consumer at least, you know, to some degree.

- Well I think there's a lot of good things happening, actually.

And the fact that that we have or are on the verge of putting in place, have put in place by the legislature, adoption of the Medicaid expansion capacity, which was delayed for some 10 or 11 years, is a wonderful bipartisan achievement for this session.

I think that consumer protection issues have always been sitting there as it relates, not only to the insurance industry, but as it relates to the hospitals and hospital bills and anyone who's gotten a hospital bill.

I think this is a very significant attempt to get at what have been years of problems.

And I think it's a good thing for this debate to be happening.

And I think it's a good thing for us to think that this is an area of regulation that needs to be looked at and improved.

And I think any consumer will benefit.

But in the end, if the consumer's gonna benefit through this, it's also all part of a process to create greater access and equity in healthcare capacity.

And as well to bring down healthcare costs.

- Senator Galey.

- Part of the bill caps the amount of interest that a hospital is allowed to charge, it caps it at 5%.

And I think it's good just to dwell on that for a minute.

The idea that people would have medical debt and hospitals would be making money off of that by charging an interest rate.

Now I understand that they have their own opportunity costs.

You know, they could be taking the money that's been paid, you know, and use it for other things.

So I don't think it's unreasonable for them to charge some kind of interest rate, but ultimately they would be profiting off of people's inability to pay their medical debt.

And I think that's surprising.

I think it would be better if it were linked to the inflation rate, but that is, you know, having that direct correlation written into legislation would be very difficult to implement.

I think 5% is a good settling point for that.

- Is legislation like this, this bill in particular, reflective of alleged behavior that lawmakers see large healthcare facilities engaging in?

Or is society changing in terms of, what is a conservative argument for making sure people have medical care access?

- I think that it's a reflection of us, the senators, the people in the general assembly, living in our communities with our own families, with our own experiences.

And our constituents reaching out to us to ask for help with different situations and hearing their actual stories.

- Senator Meyer, as a Democrat... We know where Democrats have stood on this since 2010, however, here it is, it's a bill, it's a Republican bill.

And I haven't looked to see if Democrats have signed on.

Your thoughts on it?

What are you hearing outta your caucus about this?

- What a great example of a bipartisan back pocket issue, right?

This is what you want the legislature to be focusing on.

And it's fascinating that Dale Folwell, a Republican, the treasurer's taken this on.

And I hope that Josh Stein, as the Attorney general who runs the Consumer Protection Division, will take this on as well.

Because it really does, this comes down as Senator Galey said, to how much money do people have to put into their healthcare expenses.

And no one should go broke by trying to be healthy.

- There was your sound bite, Colin.

However, lot of powerful interests in the legislature, lot of powerful leaders and conversations happen.

They seem to suggest their people are speaking to them, but what happens inside that legislative chamber and in those offices?

- That's the challenge.

There's a lot of lobbying around any healthcare issue and we've seen that with Certificate of Need and some of the stuff that got roped in to the Medicaid expansion debate.

This is gonna be no different.

This bill came up in the House last year, or two years ago, got one hearing, never made it through to the floor vote in the House.

The House tends to be more likely to decide with hospitals than the Senate does.

So I think this is definitely headed for a Senate floor vote and it may have bipartisan support when it gets there.

The House is the big wild card.

- 30 seconds.

- Yeah, just two quick points.

One is, and Colin mentioned this earlier, this bill's not in a vacuum.

There is enormous federal regulation intervening in it and it's gotta be figured out.

And the second point about it is a reminder.

While it's easy to jump on the hospitals, and I am fully on board with what this bill's trying to do, we also have to be careful that all hospitals aren't the same, right?

- There you go.

- Well.

- We got 10 seconds left, Rick.

Thank you as always.

Thank you for your thoughtful debate as well and thank you for watching "State Lines".

Email us if you'd like, I read every one.

And we hope to see you next time here on the show.

Have a great weekend.

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