The GOP primary’s newest hot button issue

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BATTLE LINES — It’s a presidential election first: the issue of gender-affirming care, especially for those under 18, is front and center in the 2024 Republican primary.

The bulk of candidates have taken hardline stances against gender-affirming care for minors, matching Republican state lawmakers across the country who have targeted legislative efforts toward restricting it.

Yet there also are a few voices of moderation in the GOP field, including former New Jersey Gov. Chris Christie and former Arkansas Gov. Asa Hutchinson, raising the likelihood that the issue surfaces at the Aug. 23 presidential debate.

Hutchinson vetoed a ban on gender-affirming care for minors as governor in 2021, and has continued to oppose similar bans, citing concerns about government involvement in family life. Christie has made similar arguments, walking the line between the party’s widespread opposition to transgender healthcare and traditional conservative wariness of government overreach.

“Parents should be the ones who work with their children to work through some of these difficult problems,” Christie said Sunday on Face the Nation. “You’re talking about over the last three years, less than a thousand minors who have been involved in this in terms of transitioning in — in a country of 330 million people. That’s what I’m talking about in terms of small, it’s not that the issues don’t matter. It’s that they don’t matter to the great, vast number of people in this country who want to be helped.”

At least 20 states have laws limiting access on gender-affirming care for minors, including gender-affirming surgery, as well as puberty blockers and other hormonal treatments. In response, Democrats in largely blue states have passed “shield” laws protecting access to care in the state, accommodating those who travel to receive care and the doctors that treat them. But given the financial burden of relocation and the long waitlists to receive care in states where it is available, lawmakers and activists alike are hoping that Congress will take larger-scale action on the issue.

In March, Representatives Pramila Jayapal (D-Wash.) and Ed Markey (D-Mass.) introduced a Transgender Bill of Rights, a series of protections for transgender people which includes “recognizing the right to bodily autonomy and ethical healthcare by expanding access to gender-affirming medical care” and “protecting transgender people from discrimination in healthcare.”

A ruling out of Tennessee’s 6th Circuit last week marked the first time a federal court permitted a ban on gender-affirming care for minors to take effect. Now, Democratic state lawmakers are scrambling to secure protection against similar bans — and pushing Congress for more action on the issue.

“I would love to see, across the nation, standards that are set by our Congress, leveling the playing field from a legislative perspective,” said Vermont state Rep. Taylor Small. “ I think one way that we can get progress going on the national scale is when we see individual states stepping up, and affirming these rights and values that we share and hold. That only puts further legislative pressure to have this be a nationwide policy rather than piecemeal.”

Defenders of transgender medical care for minors cite the approval it has received by medical associations like the American Medical Association and the American Academy of Pediatrics as a potentially life saving treatment. Opponents have argued that youth lack the maturity to make life-altering medical decisions and have cast doubt on the long-term medical outcomes of gender-affirming surgery in particular. Gender-affirming surgery is uncommon among minors; according to one estimate, in 2021, about 42,000 children and teens across the United States received a diagnosis of gender dysphoria.

Bans on gender-affirming care have been challenged — and resoundingly blocked — in federal courts, including in Arkansas, Alabama, Florida, Indiana and Kentucky. The Tennessee decision allowing a ban on gender-affirming care to take effect marked a “radical departure” from precedent, said Beth Littrell, a senior supervising attorney at the Southern Poverty Law Center.

With the ban in place, Tennessee medical providers will be prohibited from providing gender-affirming care to minors.

Youth who leave Tennessee to seek care would be protected under shield laws like the ones passed in several blue states, which largely exempt recipients and providers of gender-affirming care in that state against criminal charges originating in states where it is banned. In Colorado, Democratic state Rep. Brianna Titone sponsored such a bill adding protections for patients seeking gender-affirming care in the state, as well as Colorado providers who treat them.

Transgender youth and their families increasingly find themselves forced to travel across state lines to receive care. State Rep. Leigh Finke (D-Minn.) said that people enter Minnesota frequently to receive care now that the state is a “gender-affirming care island in the upper Midwest,” surrounded by states where care has been restricted. Many also choose to make those relocations permanent, she said.

“People don’t want to go to a state to receive health care and then return to a state where their children or their own identities are being targeted,” Finke said. “So there’s more relocation now than we expected when we started this at the beginning of the session and I think that is a trend that will continue.”

Welcome to POLITICO Nightly. Reach out with news, tips and ideas at [email protected]. Or contact tonight’s author at [email protected] or on Twitter at @lucyehodgman.

What'd I Miss?

— Former senator launches bid for New Hampshire governor: Former Sen. Kelly Ayotte (R-N.H.) launched her campaign for governor of New Hampshire today, aiming to succeed Chris Sununu in a highly competitive race. After Sununu last week announced his decision not to run for a fifth term in 2024, candidates from both parties wasted no time joining the fray. In the GOP primary, Ayotte faces competition from former state Senate President Chuck Morse.

— DOJ sues Texas and Gov. Greg Abbott over Rio Grande barrier: The Department of Justice sued the state of Texas and Gov. Greg Abbott today for building a floating barrier at the southern border that the state says will deter migrants but that the Biden administration calls a threat to public safety. The lawsuit, filed in federal court in Austin, alleges that Abbott violated the law by building structures in the Rio Grande River without authorization, creating an obstruction in U.S. waters. Earlier today, in a letter to the Biden administration Abbott vowed that Texas won’t comply with the DOJ’s plans.

— Biden taps new legislative affairs head as spending fight approaches: President Joe Biden today named longtime Hill aide Shuwanza Goff as his director of legislative affairs, just in time for the coming high-stakes spending negotiations with Republicans. Goff, the first Black woman named to the role, will succeed Louisa Terrell, who’s held the position since the start of the Biden administration and steered the White House’s multitrillion-dollar agenda through narrow congressional majorities. Goff’s new role will be particularly critical in the coming weeks, given her amicable relationships with House Republicans, including Speaker Kevin McCarthy, as she takes on the task of navigating a divided government and a looming government shutdown threat.

Nightly Road to 2024

OFFSPEED PITCH — Former Congressman Will Hurd wants to show voters that he brings something different to the GOP presidential primary, writes Jazmine Ulloa in the New York Times. A Black Republican who has represented a majority Latino district and wants to broaden his party’s appeal, he is not, as he puts it, about “banning books” or “harassing my friends in the L.G.B.T.Q. community.”

It’s a hard sell in a primary that so far has been dominated by culture-war issues that are the focus of the front-runners as well as by the legal issues surrounding former President Donald J. Trump. Hurd has the most difficult of paths ahead. He has been on the campaign trail for only a little more than a month and is lagging behind his opponents in staffing, name recognition and fund-raising. The latest quarterly filings showed he had just $245,000 in cash on hand.

WIRED IN — Donald Trump’s presidential campaign is preparing to host hundreds of caucus trainings in Iowa. The super PAC effectively running Ron DeSantis’ field operation is collecting commitment cards in Walmart and Culver’s parking lots.

Iowa is the land of opportunity for Republican presidential contenders. And, with the exception of former New Jersey Gov. Chris Christie (“We don’t have an Iowa operation,” a spokesperson put it bluntly) nearly all of them have an Iowa-specific plan. Here’s POLITICO’s definitive guide to who’s wired — and who’s not — in Iowa, based on interviews with nearly three dozen Republican operatives, strategists and campaign officials working in the first-in-the-nation caucus state

DECISION DAY — Despite Donald Trump’s apparent inevitability, a baker’s dozen Republicans are hoping to become the party’s 2024 nominee for president. That is possible for any of them if the field narrows to a two-person race before Mr. Trump has the nomination sewn up. For that to happen, Republican megadonors and influencers—large and small—are going to have to do something they didn’t do in 2016: get candidates they support to agree to withdraw if and when their paths to the nomination are effectively closed. That decision day should be no later than, say, Feb. 26, the Monday following the contests in Iowa, New Hampshire, Nevada and South Carolina, writes Sen. Mitt Romney in the Wall Street Journal.

AROUND THE WORLD

INFLUENCE LIMITED — The saga over Israel’s judicial overhaul is showing the limits of President Joe Biden’s yearslong approach to swaying that country’s government, write Nahal Toosi and Alexander Ward.

Israel’s parliament passed controversial reforms today to curb the powers of its Supreme Court, making it harder for the justices to rule on policies passed by the legislative body. That came after a long, mostly quiet campaign by both Biden and U.S. officials to convince Prime Minister Benjamin Netanyahu and his unusually right-leaning government to drop the proposals, arguing that they were too divisive to push through — especially as the nation convulses in protest.

But that monthslong, behind-the-scenes diplomacy broke out into open tensions in March when Netanyahu, who is on trial for corruption charges, denounced the “pressures” from the White House.

After the measure passed today, White House spokesperson Karine Jean-Pierre said in a statement: “As a lifelong friend of Israel, President Biden has publicly and privately expressed his views that major changes in a democracy to be enduring must have as broad a consensus as possible. It is unfortunate that the vote today took place with the slimmest possible majority.”

In 2021, as yet another war between Israel and Hamas-led Gaza broke out, the president privately urged Netanyahu to accept a ceasefire, even though he at first defended the prime minister in public. When a moment to stop the fighting presented itself, Biden openly demanded that Bibi end the strikes in response to rocket attacks. The Biden administration boasted that the end of hostilities after 11 days was in large part due to the private tough love that Biden prefers during tricky diplomatic moments.

Biden, who considers the bond between Washington and Jerusalem “bone deep,” tried the same play with the judicial overhaul. This time around, they weren’t so successful.

IN COMMUNICATION — The American-led U.N. Command said today it has started a conversation with North Korea about a U.S. soldier who ran into the North last week across one of the world’s most heavily fortified borders.

Andrew Harrison, a British lieutenant general who is the deputy commander at the U.N. Command, refused to say when the conversation started, how many exchanges have taken place and whether the North Koreans responded constructively, citing the sensitivity of the discussions. He also declined to detail what the command knows about Pvt. Travis King’s condition.

“None of us know where this is going to end,” Harrison said during a news conference in Seoul. “I am in life an optimist, and I remain optimistic. But again, I will leave it at that.”

Nightly Number

RADAR SWEEP

FANDOM’S BIGGEST STAGE — What does Comic-Con — and superhero fandom — look like without some of its biggest stars? Given the Screen Actors’ Guild strike, we just found out. Reporting from Comic-Con for WIRED, Elizabeth Minkel took us inside the San Diego event where fans, in past years drawn by some of the movie stars in attendance, this year were clearer about their allegiances to characters. The event felt like a throwback to earlier versions of the convention. Between superhero movies having a disappointing box office performance and the strike delaying production, could this year look more like the future of Comic-Con and fandom in addition to the past?

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