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Republican attorneys general in at least four states have abused their oversight authorities to demand the private medical records of transgender minors and adults as part of a broader effort to restrict access to gender-affirming health care nationwide, according to a Senate Finance Committee report released Tuesday.

Investigations launched by Attorneys General Ken Paxton of Texas, Todd Rokita of Indiana, Jonathan Skrmetti of Tennessee and Andrew Bailey of Missouri into seekers and providers of transition-related care “demand a host of invasive items” such as lists of individuals referred for care and unredacted physical and mental health records, according to a report by the committee’s majority Democratic staff.

“Framed as civil investigations seeking to determine if there has been misuse of Medicaid funds (Tennessee) or violations of consumer protection laws (Indiana and Missouri), these campaigns investigate medical providers on their provision of transgender medical care,” the report states, adding that the investigations are motivated by “ideological and political goals.”

The Hill has reached out to the GOP attorney general offices for comment.

The office for the Tennessee attorney general said its investigation targeted health care providers, not patients.

“Our Civil Medicaid Fraud Unit began investigating after watching a video in which a VUMC doctor described how she manipulated billing codes to avoid insurance coverage limitations,” wrote Tennessee AG spokesperson Amy Lannom Wilhite. “There is no political exception to our fraud laws, and we will continue to investigate as the evidence demands, regardless of a doctor’s ideology.”

Gender-affirming health care for transgender minors is already banned in Texas, Indiana, Tennessee and Missouri under a slate of laws passed in 2023 that restrict access to puberty blockers, hormone therapy and surgery. Twenty other states have also heavily restricted or banned the treatments for minors and certain adults.

Tuesday’s report argues that the four attorneys general “have gone even further” than banning care statewide by “using their oversight authorities to investigate transgender medical care across the United States.”

In February, PFLAG National, a nonprofit LGBTQ advocacy group, sued Paxton after his office demanded the organization hand over information related to its support of transgender children receiving gender-affirming medical care. Paxton’s office said the request pertained to allegations of “misrepresentations” of transgender health care in violation of a state law protecting against false or misleading business practices.

Paxton is facing a similar lawsuit from Seattle Children’s Hospital, which sued the attorney general’s office in December after it was sent a subpoena demanding patient records of Texas residents who had received gender-affirming care. Paxton in November issued a similar demand to QueerMed, a telemedicine clinic based in Georgia.

The attorneys general of Missouri and Indiana have similarly cited consumer protection laws to justify investigations into transgender clinics. A short-lived emergency rule issued by Bailey, the Missouri attorney general, last year claimed gender-affirming treatments were already banned in the state under an existing law governing “unfair, deceptive, and unconscionable business practices.”

In Tennessee, the attorney general’s office has sent at least three civil investigative demands to Vanderbilt University Medical Center’s transgender health clinic over allegations of Medicaid fraud. TennCare, Tennessee’s Medicaid program, explicitly excludes gender-affirming health care.

“Attorneys General are weaponizing their oversight authorities for their own political gain, at the expense of LGBTQIA+ people and their families,” Tuesday’s report states. “Further, by implicating the Medicaid program, a cornerstone public insurance program for low-income Americans, these efforts undermine the integrity of public health care.”

Including Tennessee, at least 13 states prohibit the use of Medicaid for gender-affirming care.

In a statement, Sen. Ron Wyden (D-Ore.), chair of the Senate Finance Committee, said the four attorneys general in the report are “misusing their authority to terrorize transgender teens.”

“It’s shameful that law-enforcement officials are choosing to persecute teens trying to live their lives, just to score points with far-right activists,” he said. Wyden also criticized Vanderbilt University Medical Center’s decision to hand over patient records to the attorney general, calling the move an “utter betrayal.”

After issuing the report, Wyden and other Democrats in a letter to health care industry trade groups called on hospitals and health care providers to protect patients’ private medical records from “abusive legal demands by state attorneys general.”

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