June is Pride Month, and with Republican Governor Joe Lombardo signing two gender-affirming bills, Nevada's gay-friendly reputation is reaching new heights.

But just how gay friendly is Nevada really?

Some local advocates will tell you work remains.

Among them are Andre Wade, State Director for Silver State Equality; Karl Catarata, Nevada State Director for the Human Rights Campaign; and AJ Huth, Director of Public Affairs & Civic Engagement at The Center.

Thank you all for joining us.

Let's start with the work that has been done.

SB 163 has been signed into law, and it requires health insurance companies, including Medicaid, to cover gender-affirming care for transgender minors and adults.

How big of a deal is this, Andre?

(Andre Wade) It's a really big deal.

It's something that the Senator Melanie Scheible had been working on for a couple of years.

The bill didn't pass in the last session.

So we're really excited that we got the bill passed this time around.

And the bill really requires that insurance companies to not discriminate for insurance coverage for transgender folks.

-AJ, how big of a problem was this?

(AJ Huth) I had a friend of mine, actually, that went to get gender-affirming care, and they had to pay out-of-pocket because even though the care was covered on their insurance, the doctor didn't take that because the insurance was not paying the claims fast enough.

And so they are requiring some of our, you know, friends to pay out of pocket.

-Okay.

Gender-affirming care, Karl, is described or is defined by the Human Rights Campaign as medically necessary for the well-being of many transgender and nonbinary people who experience symptoms of gender dysphoria or distress that results from having one's gender identity not match their sex assigned at birth.

For our viewers who may be wondering, what is considered "medically necessary"?

What kind of care?

What kind of examples could you provide them?

(Karl Catarata) Absolutely.

This specific care and specific treatment is supported by many of the major American Medical Associations and organizations out there-- doctors, medical providers --making sure that we are expanding and supporting our trans and nonbinary community when it comes to the care and access needed to live a full and equal life.

-And why are they supporting this?

-Yeah, this is-- it's the right thing to do.

It's the right thing to do when it comes to making sure that people in America are able to live their full life, right?

You know, you want to make sure that the way that you want to live your genuine life, you're able to get that access.

Specifically here in Nevada, we've been able to have the opportunity to be able to create these services and expand our civil liberties to protect our trans/non-binary community.

But it's unfortunate that other states don't see the same way.

-And when you talk about medical organizations supporting this care, a lot of it has to do with mental health, correct?

-Yes.

Yes, a part of gender-affirming care is mental health services.

It's also social affirmation, especially for young people.

So when we talk about gender-affirming care, people always go to surgeries and operations, which is not always the case.

Not every transgender person wants to have surgical procedures, and not every medical provider prescribes that.

-Could you give some more examples of what medically-necessary care would look like, AJ?

-Yeah.

So, you know, you mentioned the American Medical Association, also the American Psychological Association, has proven over and over again that, you know, affirmation and supportive services are necessary for the mental well-being of people who are trans or even people that are gay and lesbian.

Bisexual as well.

And so, you know, mental healthcare is part of gender-affirming care.

As Andre said, we can't go right to the medical piece.

Sometimes it's just that affirmation.

You know, honoring somebody's pronouns can be-- that's gender-affirming care.

And it's these little things that are very important to affirm that, you know, our young people are who they say they are and that we trust them and we believe them and we support them.

-And I'll add it's anywhere from facial feminization to voice therapy.

And so it's a lot.

It's a litany of procedures that, again, just aren't surgical in nature.

-Say those two again.

You said... -Vocal therapy-- -Vocal therapy.

-and facial feminization.

-Okay.

-So often insurance companies see facial feminization as cosmetic, like people just want to look beautiful for the sake of looking beautiful.

But if someone who's a trans woman can have their facial features feminized so they can be more in line with their gender and, quote/unquote, paths in society and not be harmed because they look a certain way, then that's life saving.

And so it's beyond just cosmetic surgery.

It's about them being aligned with their gender.

-So medically necessary, life saving in that it's perhaps preventing suicide?

-Yes.

And even unfortunately, homicides.

Let's be honest.

-And also-- -How so, homicides?

Andre, sorry.

-There are hundreds of trans people, thousands sometimes across the world, that are being murdered simply because of who they are.

And someone's passibility can really impact their ability to navigate their lives with safety.

-Oh, I see.

Okay.

-And I wanted to expand.

I mean, my colleague, Andre Wade from Silver City Equality, and AJ from The Center, put it really best, right?

We are trying to make sure that when one wants to live their full life, making sure that they have the access and care that is medically necessary, but also the social impacts that can also help somebody live a more positive, open, and also a life that is of-- a good quality life.

So for example, we're talking about Senate Bill 163, where nondiscrimination for insurance coverages for gender-affirming care.

Nevada, we're seeing that our lawmakers say that, yes, we understand and we agree that this is medically necessary, but also this is good when it comes to our community.

But other states don't see the same.

And when we're talking about pronouns and social impact, tolerance and equality are big things that for the LGBTQ community we want to make sure that we see happen.

-The surgery aspect, is that included in this, in this bill?

Gender confirming surgery, gender affirmation surgery, some people have called it gender reassignment surgery, Andre, is that included as medically necessary in this bill?

-It can be considered medically necessary if the doctor prescribes it.

And you know, when it comes to young people, there were extra standards and steps that a physician and parents who are a part of the decision making for this for their minor child would have to take in order for that to be provided for them.

And so without this law, these additional standards for young people would not have been in place.

And so it's really a good thing that-- we already had gender-affirming care allowable, like with Medicaid, but this bill makes it to where other insurance companies cannot discriminate simply because someone is transgender.

And if we didn't put those additional steps in there for minors, who wouldn't have those additional protections?

So it's a really good thing that Melanie Scheibel, Senator Melanie Scheibel, added that, and Governor Sisolak-- excuse me --Governor Lombardo recognizes that and was able to sign the bill into law.

-Oh, well, I'm gonna pick up on that.

You said Governor Sisolak, who was the previous governor, a Democratic governor.

Governor Joe Lombardo, new governor, Republican governor, signed some gender-affirming bills?

How surprised were you, AJ?

-I'm very happy.

And I think it just goes down to I feel like he took the time to actually read the bills, look at the content of what was in them, and made the decision based on that.

I'm very grateful that, you know, he has taken the measures on these issues that he has.

-When you say that he actually read the bill, of course, right?

I mean, does that not happen?

Why have I heard that a couple of times now?

-We hope so.

So for viewers at home, sometimes elected officials may read or may not read.

Luckily, we have great elected officials here in Nevada, lawmakers and policymakers, who do actually read the bill.

We have a great legislature that is a citizen-based legislature where our legislators and lawmakers do read through the bills, meet with constituency groups, meet with interest groups like us here today, and actually work with our groups to making sure that every sentence or every paragraph in the bill is reflected when it comes to the community.

Unfortunately, some states aren't like that.

Some states are not as fortunate as Nevada.

And when it comes to this specific bill, Governor Joe Lombardo's team, it looks like, you know-- we're very grateful, and we're very-- we commend the Governor when it comes to the work that he is doing to expanding care for our trans and non-binary community, specifically for our LGBTQ community, because other governors across the country unfortunately aren't doing that.

-Right.

Does this mean that the Human Rights Campaign will endorse Joe Lombardo if he should run for re-election?

Does this constitute enough for that?

-Great question.

You know, we'll definitely meet with the Governor and look towards the next election.

But we definitely supported Governor Sisolak, and we'd support proequality legislators who are interested in expanding LGBTQ equality.

But we'll work with anybody.

We are a nonpartisan organization.

We work with Republicans and Democrats across the country from local, state, and federal levels.

And we want to make sure we are expanding rights for LGBTQ people across the country, because it's the right thing to do.

-Do you want to add to that, Andre?

-Sure.

It's saying we're a nonpartisan organization.

We will look at the votes that any Republican has done on our bills.

And if they have higher marks, then we consider an endorsement.

We would love to have all legislators be in the line with our issues simply for the policy and the impacts of our community and not make things a culture war.

So we are more than happy to endorse anyone who's supportive, regardless of their political affiliation.

-AJ, that is what I've been hearing a lot in regards to SB 163.

The Governor did not make this about culture; he made this about policy.

What does that mean to you?

-Well, and he made it about protecting Nevadans.

And I think that that's the most important piece.

There's been so many states around the country that I think are just putting out misinformation.

And they're just going to, even though they say that they're not, they're really targeting our community, especially our transgender kids.

And to know that the Governor that leads this state is not doing that and is actually taking a look at what the people in our community need, I think is commendable.

-Let's move on to another piece of legislation that he signed, the former Clark County Sheriff signing SB 153, which puts into place protections for incarcerated transgender people.

What kind of protections, Andre, and why was this needed?

-So there are standards of care that are needed for really a lot of people in-- who are incarcerated, including women who need access to feminine hygiene products.

And so when you have standards of care that align with people's gender identity so they will have trained-- staff will be trained on how to refer to someone who's transgender and their gender pronouns, make sure they have access to mental health services, gender-affirming care, and the right housing.

And that's important because there's often transgender people who are mistreated while incarcerated simply because they are transgender, and we want to try to mitigate that.

And so we are happy that the Director of Department of Corrections, Dzurenda, is in agreement with these standards of care.

They've been doing a really great job, and they follow the PREA standards, Prison Rape Elimination Act, that has a lot of transgender provisions in there.

And so making sure that these standards are in place, regardless of who's the director at the time and regardless of any staff at the time, is really important.

So we're really glad that Dzurenda and his team are doing the right thing.

And this law will just help solidify things for the future.

-I think, in general, some people struggle to have any empathy for people who are incarcerated.

So what would you say to people who are struggling, particularly with this who, who think that this is giving preferential treatment?

That has been some of the opposition noted against this bill.

-Yeah, I mean, basic human rights extends to every single person, whether or not you-- going to jail or going to prison is not-- should not be a death sentence.

So making sure that we have basic human decency and human rights within Nevada prisons, specifically in a state like Nevada, we need to make sure that we're protecting-- we are protecting the care and the quality of care when it comes to human beings in our corrections.

And again, we commend Governor Lombardo for making this specific step, and we're looking forward to continuing expanding care for our LGBTQ community.

-Speaking of opposition, I got so excited in our previous conversation about what we were discussing that I forgot to bring up the opposition to SB 163, which is the health care coverage for gender-affirming care.

Medicaid included in that.

An opposition letter to it from the Nevada Republican Party was, quote, This bill allows children to obtain permanent surgical procedures paid for by our tax dollars and does not require any parental notification.

Is that true?

-Let's go back to the conversation about reading the bill.

Obviously, they did not read the bill.

And even Governor Lombardo, when asked about him signing the bill, made a statement like: Read the bill; that's not what it says.

And so again, there are additional steps that minors would have to take with their parents with parental consent and oversight to have access to surgeries and operations for gender-affirming care that a doctor would also have to prescribe.

And so it's categorically false, that statement.

And it's misleading.

It's misinformation, and it's dangerous.

-Taxpayers, though, as Medicaid-- you wanted to add something, AJ?

-Well, just this whole narrative that's being pushed out.

I think that people get a really scary image and fear in their heads because they don't really know our community.

And so your mind can make up some very disturbing images.

And I think that people are thinking, well, you know, kids are going in and they're getting genital surgery.

Right?

And that is very rare.

I don't know of any kids that had genital surgery at all, but genital surgery in general is not like a huge push.

When we're talking about, you know, surgeries like that, it's mostly top surgeries.

So breast augmentation, breast reduction.

And those are, you know, the most common when it talks to surgery, but again, these are not things that are being performed on minors.

And the the parents are involved in these conversations.

I don't know of any young person that can just go to a doctor and be like, I want genital reconstruction surgery, and that's going to happen.

That is not happening.

It's a ridiculous narrative that's out there, and I'm glad that you asked about it, because we need to dispel some of these myths and fears.

-For adults, you mentioned top surgery, maybe breast enhancement surgery.

Should that be covered under Medicaid?

You would argue yes.

-Absolutely.

There, you know-- there are specific municipalities and different corporations that also do cover this for our straight colleagues or straight allies.

But when it comes to this specific care, you know, when we're talking about reducing homicides, reducing suicides, reducing and making sure that we are allowing the full well-being of our trans and non-binary colleagues, we want to make sure that this is not something that you walk into your doctor's office and say, This is-- this is, you know, I just wanted to do this.

This takes over a course of months and years and actual talking to several physicians, doctors, mental health professionals to making these serious changes to one's life.

So short answer, yes.

-Okay.

You want to add-- Okay.

The other argument is from the Nevada Libertarian Party, as well as the Nevada Republican Party, that this is going to increase the cost of health care for everyone, the mandated coverage.

Your response to that?

-That's also not true.

There are about, including young people, there are about 8,100 transgender people estimated to be in Nevada.

Not even all of those folks will want gender-affirming care and be-- that's covered by insurance.

And so the increase would be minuscule.

And so people always talk about the increase in insurance coverage.

But we are paying for things that we may not otherwise want to with our insurance company.

We're still paying into the pool, and that's just how it works with our Byzantine healthcare system.

-AJ, why are you smiling?

-Just the way you described that.

Like we could do better to have better healthcare in this country.

-Oh, okay.

Okay.

[laughter] And we ask, we ask definitely our Libertarian and our Republican colleagues to meet with us.

Definitely meet with us.

Come to the table, right?

Come to the table, and let's come to a conversation because I know that this past legislative session, there were some frustrations.

So we're happy to talk, and we're happy to open up the discussion because this would actually be a good benefit to taxpayers and to the people of Nevada.

-Okay, a piece of legislation that Governor Lombardo vetoed was SB 302.

That aimed to protect healthcare workers who do provide gender-affirming care to minors.

During the legislative session, a local mom testified in support of it.

Let's hear from her, and then we'll discuss it.

-Good morning.

My name is Elizabeth Stearns--excuse me-- and I'm the mother of a transgender child.

Our son found the words to tell us he was transgender when he was 11.

He is now 17 and is thriving thanks to love and support from his family and his necessary affirming care.

Our family moved here from Texas in November of 2021.

We left our family, our friends, and our home after Texas lawmakers tried to pass laws that would criminalize our support of our son.

We nervously watched sessions like this, wondering if they would pass a bill that would prohibit his healthcare providers from continuing his care, would label us child abusers, remove our children from us, and put us in jail.

There was very little relief when the bills ran out of time and didn't pass, because we didn't think that would be the end of it.

Our son's doctors felt the same, as we received calls from some letting us know that even though the bills hadn't passed, and even though they knew how absolutely necessary his care was, they were now too scared to continue caring for minors.

-How common is this story, AJ, of people actually moving to Nevada because of the laws here or the laws that are in their state?

-We've gotten a lot of calls at The Center for people wanting to move to Nevada.

And in Las Vegas, that's where we received the calls, but also in contact with The Center, our center up in Reno, they're actually getting more calls up there than we are here in Las Vegas.

And so it's a-- it's a very real problem that's happening.

-Okay, Andre, the Governor in his veto message said that this inhibits the Executive Branch's ability to be certain that all gender-affirming care related to minors comports with state law.

It also decreases the Executive Branch's authority to ensure the highest public health and child safety standards for Nevadans.

How do you interpret that?

-We don't agree.

And with the signing of SB 163, these higher standards are in place.

And so it doesn't completely make sense, because it's the same coverage and care that's being provided with standards.

And if they don't have oversight because of SB 302, that means they're not going to have oversight with SB 163.

So it just doesn't make sense from a policy perspective.

But-- and they are continuing to just focus on minors.

Which there are many states that are trying to ban gender-affirming care for adults, so this shield law would also impact providers of gender-affirming care for adults.

And so it's unfortunate that the Governor and his team landed that way.

But if we have to go back to the drawing board for the next session, we will.

-And that's how it works, because a vetoed bill gets to go to the next session automatically.

We're running out of time.

I mentioned in the intro, how gay friendly is Nevada, really?

Let's start with you, Karl, because nationally, the Human Rights Campaign issued an alert for the safety of LGBTQ+ Americans.

Also the Department of Homeland Security said threats of violence against the community are up.

So what is going on here in Nevada?

Is there violence?

-Absolutely, yes.

So you know, there are 75 anti-LGBTQ bills that have been passed and-- passed and introduced across the country.

We want to make sure that here in Nevada we are welcoming our LGBTQ residents, tourists, and anyone who wants to come to Nevada.

Nevada is a place where LGBTQ people can feel safe.

Of course, we need to do more work.

And of course, when it comes to our state of emergency that the Human Rights Campaign has issued, the first travel advisory in 40 years of our organization and our existence, we really do ask Americans to really take seriously.

And if they identify as LGBTQ when they go to specific states, know your laws before you go.

Know your different safety before you visit that state.

But Nevada continues to lead the way, and we're very proud of our lawmakers.

And we're looking forward to continuing expanding.

-And, Andre, we've got like 20 seconds left.

What are the laws that make Nevada special?

-So USA-- USA Today , 2021, set Nevada as the best state for LGBTQ+ Americans to live because, if we look at the HRC Index around legislation or the Movement Advancement Project, we as Nevadans have passed the most innovative laws in the nation.

And so there's probably about two or maybe three or four that are listed on these indexes that we have not yet passed; whereas, there are many states that have only passed a few protections for LGBTQ+ people.

So the protections that we have are vast, and we have a lot more work to do.

-Including, though, the Equal Rights Amendment that was voted on this past election cycle, correct?

-Yes, the most inclusive Equal Rights Amendment in the nation.