The DeSantis Strategy: emergency in Florida
There is an emergency in Florida right now, but you wouldn’t know it if you opened the average news website. While it’s hard to pinpoint exactly which institutional failing made it possible for Florida Governor Ron DeSantis to implement a near-total ban on gender-affirming care for all ages across the state, I suspect at least some of the blame should land at the feet of the very same media that has since completely failed to cover it.
As ZInnia Jones points out on a new site she’s set up to spread awareness on the situation in Florida, somewhere in the vicinity of 100,000 trans adults have found themselves abruptly without providers and unable to fill prescriptions which pharmacies will no longer honor. Many providers, fearful of the political climate are pre-emptively dropping patients from their rosters.
People who suddenly find themselves without care, including those who have been on HRT for decades, face an artificially-created bottleneck which prevents all but three types of providers from writing prescriptions and blocks appointments via telehealth, which since COVID-19 cover an enormous proportion of visits with medical providers. For those in rural areas who rely on telehealth, this alone is prohibitive. For those that are able to find providers, said providers are required to use forms that currently don’t exist. In the absence of these forms, providers who fill prescriptions face potential loss of licensure after June 16th.
DeSantis telegraphed his strategy as early as 2021, but the wheels were set in motion years before by the Alliance Defending Freedom. By putting several key appointees into state-level positions, DeSantis was able to usurp most of the legislative process. This both allowed DeSantis to expedite his plan, but also to create the veneer of local medical consensus. One pattern that is particularly common in these sham hearings is to point to other places that have implemented similar restrictions due to reactionary politicians. Unlike peer-review, these restrictions require no actual scientific scrutiny.
Between surgeon general Joseph Ladapo and Agency for Healthcare Administration secretary Jason Weida, Florida was able to implement ban on pediatric gender care by creating sham hearings used to justify eliminating care for trans youth. During these hearings, “evidence” manufactured at the behest of the ADF and groups like the American College of Pediatrics was brought out to justify going against current medical consensus.
For the AHCA, the end result was the state medicaid agency refusing to cover gender-affirming medical care for any age, intentionally targeting lower-income communities first. DeSantis and Weida via AHCA opened the door for a much broader attack through the Florida Board of Medicine (FLBOM) which has now heightened the restrictions placed on patients and providers so drastically as to have overwhelmed the remaining gender-care system. The recent passage of SB 254 cements these changes into law and the effects are already devastating.
The inclusion of extremely specific requirements so stringent their existence creates de facto bans comes directly from the anti-abortion lobby. Through the use of TRAP laws, many abortion clinics were closed not by total bans, but by needlessly specific regulations on things like hallways and door width. These created impossible infrastructural requirements that would have necessitated rebuilding clinics. As with SB 254, anti-abortion laws also created staff credentialing requirements in excess of what is either needed or available. One such anti-abortion measure included requiring physicians to have local hospital admitting privileges. The requirement limiting prescriptions to NPs, DOs and MDs eliminates huge numbers of providers, and does so without any medical reason whatsoever. Likewise, the requirement that specific forms be used creates an additional burden that allows the state to stall out clinics who still persevere. Until the forms are issued, compliance is impossible.
While it’s tempting to point out how likely this strategy is to be replicated nationally as a way of spurring people to action (GOP legislators have already introduced legislation similar to SB.254 in congress) what is happening in Florida is itself an emergency. This should be on every channel, in every newspaper and every magazine. It’s up to us to make that happen.
