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DeSantis has nearly unchecked power for his anti-trans agenda — he built it that way

The Florida governor has methodically stacked the state’s health department board with political appointees who oppose transgender rights.

Trans people across the U.S. have been overwhelmed this year with wave after wave of petty, hateful conservative state legislation aimed at further marginalizing us from our everyday lives. In my own trans circles, we often talk about safe places we may be able to flee to in case things continue to go south for us. But one thing is clear: Going south to Florida is not an option.

There’s a reason that Florida is the epicenter of the anti-trans movement and why other states are emulating Florida’s approach to marginalizing trans people. And there’s a reason Republican Gov. Ron DeSantis, a presumptive 2024 presidential hopeful, is able to so effectively steer the state’s anti-trans agenda in ways that threaten the lives, health and safety of trans people like me. 

The situation is dire, and trans people in Florida are desperate.

Where DeSantis’ approach has been unique among a growing list of anti-trans states is in his methodical stacking of the state’s health department board with political appointees who consistently oppose transgender rights. This can be traced back to 2022, when DeSantis started running for re-election, with the appointment of four conservatives in June 2022 to the state board of medicine. The practice has steadily continued, with DeSantis appointing two conservative pediatricians to the same board in December 2022, as he prepared for his much-discussed likely presidential run.

Importantly, at the center of Florida’s anti-trans movement isn’t the state’s Legislature, which has passed restrictions on trans athletes and has proposed one of the most draconian bans on gender-related care in the country, but its health department. The Florida Board of Medicine, now full of DeSantis appointees, has unilaterally imposed several policies, including banning youth gender-affirming care and proposing to ban insurance coverage for adult transition care through its executive council, which has repeatedly voted along party lines against trans rights despite massive turnout at meetings to protest the proposals. 

More than a year of calculated decisions and appointments have led to a top-down administrative dictatorship that effectively bullies a highly marginalized demographic for the political gain of DeSantis. 

The situation is dire, and trans people in Florida are desperate. “Oh my God, it’s horrible,” said Andrea Montañez, an LGBTQ immigration organizer at the Hope Community Center in Orlando, which hosted an event on International Transgender Day of Visibility in March held by Health and Human Services Secretary Xavier Becerra. “You don’t wanna surrender,” Montañez said. “It’s so hard to wake up every day and try to justify my life or open the news: What is new against me today, again?”

Becerra spent the event meeting with trans kids, their families and survivors of the 2014 Pulse Nightclub shooting. President Joe Biden’s administration, along with several liberal-leaning state legislatures that have passed trans refuge laws for people fleeing government persecution in red states, has been a vocal ally of the trans community. “We want to make sure that wherever Americans are, including trans Americans, we’re making sure that we make it clear that health care is your right and we’re going to fight to enforce and make sure you get that right,” Becerra told me that day. 

DeSantis’ approach with the Florida Health Department shows that thinking ahead pays off politically.

Of course, the Florida Legislature is a culprit as well, and anti-trans executive actions aren’t unique to Florida; Texas Attorney General Ken Paxton infamously ordered the state’s Department of Family and Child Protective Services to investigate all parents providing gender-affirming care to adolescents as child abuse in 2022. Missouri’s recent consumer protection law proposes to restrict transition care for all people, including adults.  

Biden and Becerra’s HHS have actually shown themselves to be good at listening to the plights of red-state trans people. But while Biden has consistently told us that he “has trans people’s backs,” it’s often appeared difficult for his administration to back those words with actions. Beyond listening parties and sympathetic sentiment, how much is the administration willing to do?

Case in point: Less than a week after Becerra’s Orlando event, the Biden administration introduced what it labeled a “compromise” that potentially opens the door to allow schools to choose which sports ban trans kids from participating.  

While speaking with trans people and our families is one thing, pushing back against state-level policies is an entirely different challenge for HHS. Beyond interpreting federal law in ways that protect trans people, HHS can’t exactly swoop in and overrule local political actions that discriminate against trans people. It can, however, threaten funding if states don’t comply with areas of the law meant to protect trans people, like Rule 1557 of the Affordable Care Act, which states that discrimination on the basis of gender identity is discrimination on the basis of sex under federal law. That could potentially set up a politically charged faceoff between the Biden administration and DeSantis in a presidential election year.

The first ever openly trans Senate-confirmed government official, assistant Secretary of Health Adm. Rachel Levine, told me that Biden’s executive order last June laid out a number of deliverables for HHS to work on supporting trans people and trans youth in the U.S., including recommendations against conversion therapy, supports for vulnerable trans and LGBTQIA+ youth in detention and in foster care. 

“This is a strategy based upon a conservative think tank in Washington who thought that this would be a successful strategy to motivate the base for the 2022 election and 2024 elections and beyond,” Levine said. “I do absolutely acknowledge that the next two years are going to be difficult and maybe beyond more than that, but that I do not feel that these laws and actions will stand … I think this political strategy will fail.”

Levine’s words suggest that she and the Biden administration think winning on this issue will come at the ballot box in the next couple of elections, both in local Florida races and nationwide, as DeSantis continues to scale up his campaign for president. But in the meantime, it seems there’s little that can be done to push back against Florida’s attacks on trans people. DeSantis’ approach with the Florida Health Department shows that thinking ahead pays off politically, and that he has already decided to make anti-trans hate a central pillar of his political ambitions, potentially providing a model for other states to follow suit. When violent anti-trans orders come from the health community, not just from politicians, it can conceivably be more difficult to fight.

Montañez said events like Becerra’s in Orlando help give her the will to keep fighting for trans folks in her state. But hope is not enough. “We have to try everything. But what I say to the secretary today: don’t forget us,” she said. “We have to survive. Like a lot of people said, we’re not looking for allies, we look for accomplices.” With DeSantis’s board of medicine looking for ways to further hurt Floridian trans people, they could use all the help they can get.