What’s next for gender-affirming care in CT?

Public media looks good on you. Get stylish sweatshirts, coffee mugs from your favorite shows, and unique items for babies and pets. Visit CTpublic.org/collection to look good. Feel good. Do good. This week on The Wheelhouse. [MUSIC PLAYING] The politics of hormones. Barriers to gender-affirming care for kids who are trans, and who may break them down. [MUSIC PLAYING] [MUSIC PLAYING] For Connecticut Public, I'm Frankie Graziano. This is The Wheelhouse. The show that connects politics to the people. We got your weekly dose of politics in Connecticut and beyond right here. The Trump administration wants to bar hospitals from providing gender-affirming care to children who are transgender. But states are fighting back, challenging with the lawsuit that ultimately vacated a declaration from the US Department of Health and Human Services to carry out Trump's directives on gender-affirming care. This hour, we're talking about access to gender-affirming care for kids who are trans and looking at how Connecticut lawmakers are responding. We're going to start with a look at how the White House has targeted gender-affirming care treatments for trans youth. And we'll do it with Lindsey Dawson. She's the director of LGBTQ+ Policy at KFF. Thanks so much for being here, Lindsey. Thank you so much for having me. Folks, if you have some thoughts on the Trump administration's directives regarding gender-affirming care treatments for minors, hit us up 8-8-7-2-0, 9-6-7-7. Lindsey, since day one, the administration has targeted gender-affirming care literally a day after the president was inaugurated. Came an executive order seeking to end what's being deemed chemical or surgical mutilation of children, unquote. That's what they said. Exactly. So this started even before the president took office, running and campaigning leading up to that election. The president really started to make gender-affirming care an issue that the administration was going to take front and center. There was a day one executive order that sought to define sex as simply male and female, effectively a racing transgender people, and then about a week after that, the president put out another executive order that really lay out the administration's all-hands-on-deck approach to limiting access to gender-affirming care, and especially for young people. What are ways they've tried to enforce these actions that they've made, these executive orders? I understand at one point there was an FBI portal or something like that that launched in sort of some way to get civilians to turn in providers in some way, was that something that was a thing? That's right. So as I mentioned, this has been a real all-hands-on-deck approach, which is quite remarkable given that such a small share of the population is trans and that not all transgender people seek gender-affirming care. But the administration has done things like set up an FBI portal where people can identify providers offering these services. But the biggest actions that have been taken have been proposed rulemaking and the declaration that you already spoke of that really seeks to dramatically limit gender-affirming care and stoke fear among providers as well. OK, so that's where we're going to go into next. I'm going to hope you could spell it out for me. In December, we had the proposed rules and the declaration. Could you describe each of them for us here? Yeah, certainly. So in mid-December, the administration issued two proposed rules and a declaration. And before I describe the contents, I think it's important to understand that a proposed rule is just that. It's a proposal. It doesn't take immediate effect. It requires a comment period, which allow stakeholders to write into the administration and say what they think about the proposal. Do they support it? Do they not support it? And then the government considers those comments. And then if they issue a final rule, that's the regulation that takes effect. But in doing so, they also have to respond to the comments. And the two rules that came out were the first one proposed to prohibit federal Medicaid funding from covering gender affirming care services for youth. States could use their own state dollars, but it would be quite sweeping and limit gender affirming care for youth covered by the Medicaid program. The second proposed rule that came out would be to prohibit hospitals that receive Medicare and Medicaid payments from offering gender affirming care services to youth. The hospital is targeted by this rule. It's the majority of hospitals. And even if a hospital wanted to continue to provide this care, they can't financially just not going to be able to do so. When you look at all of the health care spending that happens in a hospital, nearly half of it comes from Medicare and Medicaid. So hospitals are just not this going to be in the position to say, we want to follow best practice medicine and offer these medically necessary services. But forgo these payments that make our delivery system sustainable. Here in Connecticut, we're told that hospitals have unwound their gender affirming care treatment programs, partially in response to this. And it really actually came in the summer, which was more closer to the executive action than it was these declarations reached out to prominent gender affirming care programs in Connecticut in reaction to the recent federal court order vacating a US health and human services declaration to bar hospitals from providing gender affirming care to children. Yale New Haven and Connecticut Children's Hospital did not respond to an email requesting comment. They announced last summer they'd no longer provide gender affirming care medication to trans children in their care. We did hear back from middle sex hospital. A spokesperson wouldn't specify the kind of care that they provide. In a written statement, middle sex hospital says, quote, is monitoring the situation while continuing to provide the safest, highest quality health care and the best experience possible for our community. As you said, a lot of that has been sort of unwound and rolled back. Hospitals having a tough time because there are some financial reasons there, obviously. But what are the states doing in response to this declaration? Yeah, I know I think what you stated is important about where the hospitals are going. And when they did roll back care, it really are on. Even in this happened across the country, right? This wasn't just something that happened in Connecticut. But almost every health system in public facing comments, including Connecticut Children's and Yale, directly tied, rolling back that care to a complex and threatening legal environment, and to these executive actions. And so there has been a back and forth with states and responding to how their providers are responding to both the executive order, but also these proposed rules and the declaration, which we can get into, if you'd like. Yes. And I think providers are stuck between a rock and a hard place, particularly in states like Connecticut, where there might be non-discrimination policies. Providers do not want to be sued and have their entire programs dismantled, but they do want to provide the best practice care. And state AGs have at different points in time, sort of push states to reengage in this care, but are also aware of the environment in which these providers are operating. And so it is deeply complex. Yeah. And you talked about individual attorneys general. Maybe a Latisha James is somebody that's in New York. I'm not sure if you have any awareness or idea of that situation versus others, because it seems like New York may be-- some of the care might be more active than it is here in Connecticut. I'm not sure the scale of access versus the two. But it seems like it might be a little more care available in New York. Even in New York, we've seen care roll back. I think the AGs can come out and say, we want you to continue to provide this care. And you could be in violation of state law if you don't continue to provide this care. But providers and provider, legal and counselor, is still in a tough place of trying to figure out what can their providers do and both be in sort of-- in not violating state law, but also without threat from the administration. And so it's an increasingly difficult position for them to navigate. And we are seeing states challenge some of this. We haven't seen challenges to those proposed rules because they are proposed. But we would likely see challenges if they were finalized. We did see challenges to the declaration, including by Connecticut. And the declaration was recently vacated by the court. That declaration was a little bit different from the proposed rules because it actually sought to develop a new standard of medical standard for health care, which is deeply unusual. Usually, we see medical standards from professional bodies like medical associations or maybe a guidelines group from organized by the federal government meetup of professionals and subject matter experts. And so to see Secretary Kennedy pursue a declaration and try and develop a standard of care was very unusual. And the court found that in fact, he lacked the authority to, you know, add early established standards of care. This is Oregon V. Kennedy that you mentioned. And this is the decision that you said that vacated the declaration. but yet uh. even though that declaration is vacated we're still an environment where hospitals are not comfortable providing a full range of care. That's right. That's right. The declaration has been vacated. The proposal rolls linger, but we have seen just continued pressure from the administration that puts providers in a really difficult position. For example, right after the declaration, officials started tweeting the Office of Inspector General would investigate providers based on that declaration. It's a little bit of a cat in mouse where providers are really trying to figure out what they can do and how they can best serve their clients, their patients without being in violation of federal policy. Another recent ruling involving General Affirmary Care that I want to talk about here that I think you can help me out with here. A US Supreme Court decision last month came down against the state of Colorado's ban on conversion therapy. I want to make sure I have that right. What does the ruling mean in the landscape? We're gending affirmative care treatments for minors are being targeted. Right. Conversion therapy is a widely condemned practice. All the major medical associations across the United States criticize it, state it lacks evidence, state it's ineffective, and it can create harm. It's when a provider seeks to change somebody's sexual orientation, typically from being LGBTQ to heterosexual or cisgender. And nearly half of the states have banned to protect against healthcare providers and SKS therapists from engaging in conversion therapy. Colorado therapists said that they wanted to be able to provide these services to their clients and sought to challenge the state ban. So before the Supreme Court, was the question, does the Colorado law censor speech between therapists and their patients based on viewpoint? Does it violate the free speech clause? And in order to sort of tease that out, the court had to decide, did the ban ban speech purely or is it actually banning a practice or conduct or speech is incident to that conduct? Interestingly, while the court said that the Colorado law is an egregious assault on free speech, it technically did not invalidate the Colorado law. The nation's highest court sent the case back to the lower courts to apply a strict or a standard of scrutiny. And so we'll see what happens in those lower courts. But they were pretty clear that they saw that the Colorado law does violate speech. And it was purely about speech. But it is a bit of a, we need to wait and see what happens at this point in time. And could you just at least, as we finish up here, try to get into the fear with that ruling? Is it that this could be adopted in a larger setting or excuse me in other states or other cases? Yeah, I mean, I think it could stand to threaten what, these laws for me being able to stand in other states. Importantly, the court did not weigh in on the safety or effectiveness of conversion therapy. The fear is that these practices could be more widespread without protective laws in states. And while individuals could still bring suit against practitioners for individual harm, it is not as sort of protective as having a state law that protects against a practice that is widely seen as harmful. Questions about this case or anything else that is happening in the administration right now related to this topic. There is a policy tracker at kff.org, which Lindsay Dawson has contributed to KFF's director of LGBTQ+ policy. Thank you so much for coming on the show, Lindsay. After the break, we zoom into Connecticut and how access to gender affirming care has changed under the Trump administration. Questions on what you've heard so far? Hit us up 888-720-9677, 888-720-9677. Support for this podcast comes from Hartford Health Care. Elevating health is funded by Hartford Health Care. The Hartford Health Care Heart and Vascular Institute recently performed a first of its kind ablation procedure. Dr. Eric Crespo, medical director of the Hartford Health Care Electrophysiology Lab talks about this major cardiovascular advancement. When people have a heart rhythm problem, we often do a procedure called an ablation. Historically, that's been done by burning the tissue with radio frequency energy, but that carries risk in certain parts of the heart. And there's now a newer technology called Hulsfield that's not temperature-based. So it allows us to use the right energy in the right place. Typically used to treat a fib and atrial flutter, having access to this apharasphere mapping and ablation procedure is great news for patients. Dr. Crespo explains. It's important to have a Connecticut because now patients here in the right and their own backyard have access to this. They don't have to go to New York or Boston to get access to this kind of cutting edge technology. To learn more, go to ctpublic.org/elevatinghealth. This is the Wheelhouse from Connecticut Public Radio. I'm Frankie Graziano. You heard last segment about the White House's attacks on gender-affirming care. Treatments for minors. Now let's talk about how families in Connecticut are impacted. Melissa Combs is an organizer with a queer-led grassroots organization dedicated to LGBTQ+ rights advocacy called Equality Connecticut. Melissa, thank you so much for being here. Thank you for having me. Thank you for coming up here and coming on the show. I appreciate it. Yona Tangi is the president of Glamma, G-L-M-A Health Professionals Advancing LGBTQ+ Equality. Good morning, Yona. Good morning. I appreciate you coming on to talk to us as well, Yona. If folks have questions regarding gender-affirming care, someone you know having to go out of state for their treatments give us a call 8-8-7-2-0-9-6-7-7. Yona, I'm going to ask you the first question. When transgender children seek care, can you help us understand the range of gender-affirming care that they may be looking for if they are seeking it at all? Yeah, absolutely. I definitely think a lot of this care has a lot of stigma around it and there's a lot of like a speak about it and there's a lot of misinformation. For the majority of trans youth, it really is actually just counseling and mental health support and affirming mental health support as they may explore their gender and also just sort of seek care. For older adolescents, there may be hormone therapy or other sort of medical treatments. For some of the younger adolescents, there may be puberty blockers. That is something that definitely also is over-indexed in conversations. It's not something that is necessarily why they used, but it is a very important medical intervention for a select number of youth. And then finally, there's surgery, which again is a very small population usually of older adolescents that are seeking surgery, but that's sort of the full range of care in terms of medical treatments and behavioral health treatments. But the really important thing I think for people to remember is that the most important thing is access to affirming mental health services. And that is usually what is utilized the most. What's available to folks now for the context of this conversation and what might not be available? Yeah, so it really depends on the states because depending on what state you live in, there are different kinds of care brands. I would say in the current landscape because what we're mostly seeing is hospital shutdown their programs. What has really been restricted is access to surgery for those few that are seeking surgery. But you know, hospital programs were also some of the larger providers of some of the medical treatments and also counseling too. A lot of them had interdisciplinary centers where they had counselors, surgeons, and prescribed sick hormone therapy, endocrinologists, et cetera, all working under one roof. So when those places closed, a lot of these long-term relationships that these trans youth had with clinicians that are really important to have those relationships, those good relationships that great rapport were injured. There are usually still depending on what state you're in, smaller individual clinics or community health centers that are sort of providing this care, some of them were discreetly. And they can usually provide some of those mental health services as well as the medical treatments like poor month therapy and in some cases blockers. So though for some, the smaller clinics, actually the blockers is a little bit more difficult to provide. The surgery is definitely where you would see the biggest restriction in access, but just in terms of like these closures because these hospitals oftentimes provide it multiple different kinds of services, it is just more difficult to find care. And also it's difficult for families to sort of have to transplant to a new practice, especially after establishing some very important relationships. Difficult to find that care, but from a linear perspective too, that likely means going private and also paying more money for this care? Oftentimes yes, if it's a smaller individual clinic, although there are many community health centers that also will, oftentimes that we qualify by community health centers that will provide this care. But unfortunately, the hospitals, a lot of those community health centers are also very vulnerable from some of the threats that are going on. A lot of them are still trying to find ways to do it, but certainly, yeah, it could be that it's a private pay system, and so that can be difficult for families, especially for families that may be using public insurance. It can be more difficult to find the provider that's accepting new patients as well. And you can also have a lag as well, because as you know, if you kind of if a clinic shuts down overnight, you usually can't get an appointment like the next week, you know, there's usually a little bit of a lag there. So certainly it causes a lot of distress on the whole family when they suddenly become sort of like displaced for medical practices and having to find a solution. And it's even worse, of course, for families and states where it's a total ban, and we are seeing a lot of displaced families having to actually, in some states, travel out of states to seek care. I'm lucky that it's not as much of their case in Connecticut as of yet, but I'm certainly even when a hospital closed-town has practiced, it can be something that's very difficult for families. Displaced. Good word to use. Thank you for introducing that to us in the context of this conversation. Melissa Combs is from a quality Connecticut in addition to lobbying on behalf of the Out Accountability Project and organizing for a quality Connecticut. You have a child undergoing gender affirming care treatments first and foremost, how's your kid doing at this time? Well, despite the hostile national climate, he is thriving, but that speaks to the extraordinary effort that all parents and caregivers have to put in to ensure that their child is thriving and obviously with the lots of access to care that made things more difficult. So, but he is in a great school with the great learning environment, a supportive learning environment. As a patient of Yale, we've found care and we are actually going out of state to find that care because there is a health care desert that's been created in the northern half and southeast parts of Connecticut because of what's gone on in the past year. But he's great. Can he get certain services in Connecticut and then go out of state for the other ones or is it all pretty much? It will, it depends. CCMC completely shuttered their program, it's just gone. Yale took a different hack and they stopped prescribing to adolescents. And that means that their program remains open and they have expanded their mental health supports in addition to some other things that were a part of their program, like the parent support groups, teen support groups, things like that. So, they have remained open, they just can't prescribe. So, if you have an adolescent on puberty blockers or hormone therapy, you are having to go to a different practice to get that. People here, what we spoke about in the last interview when I talked to Lindsay, the situation that hospitals find themselves in. So, it's like that crude math. I think we were talking on the phone about earlier this week where we have a small subset of kids here and so much dollars that come in here for Medicaid and of course, Medicare. So, that's kind of the situation that kids find themselves in at this time, really victim sort of of this crude math, would you say? Absolutely. And, you know, let's be real for a second. These hospitals faced extremely challenging choices. In Yale's case, they were looking at losing over $3 billion in patient revenue from Medicare and Medicaid. In CCMC, we calculated it to be somewhere around $700 million. And legal counsel at both institutions are the ones who made this decision and you know, really, I mean trans kids didn't stand a chance against that before the declaration. So, Yale and CCMC made changes to their programs in July of 2025. This was about five months before the Kennedy Declaration came out. So it's understandable or not understandable, but I guess it's remarkable that the Declaration came out and then there was the vacated order, but yet we don't know if anything's changed yet. Well, right. I mean, well, the decision out of Oregon is glorious and that there's a lot of wonderful language in it. You know, many things to that judge for recognizing that. Again, we have to remember that the Yale and CCMC made these changes five months before and they were inspired by different federal actions that had started, you know, January 20th as I believe it was Lindsey mentioned. It wasn't just executive orders, you know, I would say that the provider community, you know, caught wind of these potential CMS rules that were going to be proposed. And there was so there was a lot of talk about those. But then really I think the biggest chilling factor was in June of 2025, the Department of Justice issued 20 subpoenas to hospitals, children's hospitals around the country. Now we know from court documents and just others choosing to talk to the press that Boston Children's got one of those subpoenas and they have doubled down on remaining open. We know that the children's hospital in Philadelphia got one, we know a hospital in LA got one, but CCMC got that subpoena two, which is not widely known. But that is really the, I think the motivation for what happened. A big part of the chilling effect you're saying. Thank you for making that declaration. I just heard that point. I just want to make sure that I note that I reached out to try to get some kind of clarity from Yale and Connecticut children's and I didn't hear back. But nonetheless, I did reach out. Listening to Melissa's story, Yona, is this something you're hearing a lot about? Yeah, absolutely. There's a lot of fear out there. And I think in such large hospital systems, as Espen said, it's it's really scary for them. You know, I think in America our healthcare infrastructure just generally is already so strained. And they're a very risk of our systems. And we're talking about systems that are caring for a lot of people, like very many people and that are doing so from thin margins. The thing I also want to highlight though is that when a lot of these voices have closed their programs, they don't cite changes in medical guidance or evidence or the evidence base. They really are just citing fear of retaliation by the administration or other sort of issues. And I think that really just shows that the motivation for this is not changing opinions that providers not a change in the clinical evidence. It really is just fear of sort of government action against these different systems. So I think that that really goes to show what's the main driver of all of this is. From Connecticut public, this is the wheelhouse. You've been listening to Yona Tangi of Glamma and Equality Connecticut organizer Melissa Combs. They're not going anywhere after the break. How are states responding to Trump era action against gender affirming care? Hit a subcomment on our YouTube live stream or give us a call 8-8 720 967-887-720 967-7. 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And streaming at ctpublic.org/caregivings. Funding provided by presenting sponsor Benchmark Senior Living and Supporting Sponsors AARP Connecticut and Middlesex Orthopedic and Spine Associates. All hour we've talked about the politics of hormones and the access to gender-affirming care. We're going to finish up now by talking about ways Connecticut officials can preserve care. Still with us, Melissa Combs, organizer with a queer led organization dedicated to LGBTQ+ rights advocacy called the quality Connecticut. Thank you so much for for being on the show today. Yona Tangi is the president of Glamour, health professionals advancing LGBTQ+ equality. Thank you so much for coming on Yona. Not a lot of time left in the show. So if there's something you wanna talk about, access to gender, affirming care, call us now, but do be brief, 88-720-9677, 88-720-9677. Melissa, Connecticut has a shield law to protect reproductive health. I know this is something you know about, and you were actually recently at the Capitol, understanding what was gonna happen to this law. Before we talk about its expansion, what is the law that's in place now? - So for context and background, in 2022, the DOBS decision came out from the Supreme Court, and it eliminated federal constitutional protections of abortion care. And even before the decision was released by the court, several states like Texas put in trigger laws. In other words, they were anticipating a favorable decision that would again eliminate access to care. And so these laws went into effect as soon as the DOBS decision came out and eliminated that care. So it ranges wildly. There are 19 states now that have extreme restrictions on abortion care or outright bans, and criminalizes health providers or providing this care. So what happened was anticipating here in Connecticut in 2022, they enacted the shield law, which protects providers from out of state, bad actors attempting to enforce their own state laws. And so the shield law was enacted in 2022, since then, advocates, group of advocates have worked together to expand the shield law. And the shield law now includes all legally protected care like gender affirming care. And it also this year we're aiming, that we're expanding the telehealth protections. And I will add that this is an excellent example of how a state can mitigate the harm done by federal actions like this. And so the same sort of strategy applies regarding these attacks on gender affirming care. So we have a duty to protect, to protect our providers and access to care for our residents. I will also add Connecticut was the first state to enact a shield law. And now today, 22 states plus DC have a shield law. And in practice, the best example I can give you the most public example is Dr. Carpenter in New York. Louisiana issued a warrant for her arrest, and Attorney General Ken Paxson in Texas came after her as well. And the New York Attorney General was able to use their shield law to reject the extra edition requests and their request from Texas. - This shield law expansion, you mentioned telehealth. Could you just get in a little bit to the finer point to where it would protect telehealth, at least from lawsuits, especially if you're an out of state provider. Excuse me, you're in Connecticut providing to somebody else because you could have a license across multiple states. And then there's also on the prescription bottle, there could be a change as well, where you wouldn't have somebody named, is that correct, a doctor to protect them from doxing or something like that? - So going back to the example of Dr. Carpenter in New York, Louisiana and Texas got her name because it was on a prescription pill bottle. There is a bill that's been introduced in Connecticut this year to change the requirements for what is on a pill bottle. So instead it would list the health system, like it would say Yale New Haven Health, it would not list the provider name. And the same would be true for, of course, any gender affirming care type prescriptions as to protect people from doxing and death threats and all of it. - You've been there, you've been a part of the conversation. Do we know if this will come up anytime soon? Are those separate bills or are they the same thing? - So the Sheldon is its own bill, it's Senate bill 295 and we anticipate that it will be called to the Senate floor any day. So we're at the Capitol every day waiting for that. The prescription pill bottle bill is a different bill and I'm not recalling the number and it is working its way through the system as well and we also hope that that will be called to the floor to provide that additional protection. It's not only to providers but to patients too. I appreciate that distinction 'cause now we can track the two different bills. I thought they were one for some reason. Thank you for making that clarification. Appreciate that. Yona, as we've discussed this hour, the federal government has taken several steps in Trump's second term here to ban gender affirming care. Attorney's general, including in Connecticut, sued the federal Department of Health and Human Services for a December declaration to quote, end the practice of sex rejecting procedures on children that expose young people to irreversible harm and quote, that declaration recently was vacated by a federal judge of Oregon v. Kennedy. So trans kids would still be able to access everything they need, right? - I mean, theoretically, but as we kind of discussed before, all of this is just also like a, it's a fear tactic. They're trying to make families afraid and providers afraid. And I think also if they're following the same playbook for gender affirming care that they are also for reproductive health care, and so are in terms of making providers afraid of providing risk care. So I think we kind of mentioned it before, like as things currently stand, could hospital systems still provide this care, technically speaking, depending on where you are, yes, but again, that's certainly state dependent. But there are very real reasons why they are concerned about this. There are things coming down the pipeline, which even though there will probably be continued legal challenges for every new thing that they actually produce, it still can be what it really just does, those creates sort of like a fearful environment for providers and for systems. And I think also especially when we think about what could like potentially eventually come and what they've done in some states, for example, for reproductive health care, threatening people's licenses and other things like that. This again is a risk averse community of providers and then also systems. And so yeah, it's just the culture of fear that's really going on right now. - You talked about providers there. How are they handling the ruling here? How are providers that you talk to? How are you doing? - There's a lot of fear. There's a lot of concern and there's a lot of education that needs to happen. I think that providers, they hear something, they don't necessarily, we're not all legally trained, of course, that's not our jobs. We were trained to provide care. And now it's gotten complicated. And so people can feel it very easily overwhelmed. They don't necessarily understand like the what happens and something has like an injunction and sort of what the legal landscape is and what actually is and is not a threat for them. And so we see a lot of fear and a lot of requests for information, which is why and community organizations and legal organizations are so important. And why there's a lot of educational work that is ongoing and needs to continue to happen to providers and to systems about what actually is the current state of things, what are the risks and what are the risks? Like can you still be providing this care? Of course, he would hope that more systems would sort of stand up and have, as mentioned earlier in the show and just really stood by providing this care. But it's certainly a confusing landscape for many. There's a lot of fear amongst providers and that's very much intentional. They want providers and systems to not really feel like they know what's coming next and what's okay to do and what's not okay to do because when there's confusion, that's usually when people will just kind of throw their hands up. And the reason why, before I bring you in, Melissa, the reason why is because there's a license, people might be worried about losing their license. There's a lot of, there's also a doxxing I would imagine. So help me understand that culture of fear that's sort of capturing folks right now at this time. - Absolutely, it's about, I mean, a lot of it just comes down to the money. It's about funding for clinics and systems, which of course is very important. And there's a lot of patients that we need to take care of and that providers have attachments to and they wanna make sure that all of that care is still able to go on. And the medical community, one of the reasons why it is risk versus that we are very the tiktus people in America and you work a very long time to get a medical license, which then is like the way that you support yourself and you try to help others. I mean, people are very concerned about that. It's obviously there's a lot of sort of like legal things surrounding the license. And so I do think that that is actually one of the sources of fear as well that doesn't often get named. Just people are worried about doing something that's going to sort of threaten their livelihood and continue to be able to provide care. Not just about the funding systems on the larger scale, but on sort of the smaller level and people are afraid of what that could mean. Melissa, Connecticut is a so-called reproductive rights safe harbor. This is a lot of the conversation we've had since Dobbs, V Jackson, was overturned and since that decision was made in 2022. So, what does that mean to you? Well, if we truly are a safe harbor, then we need to be restoring care in the northern half in Southeast parts of the state. Many families in Connecticut are traveling to Massachusetts, Vermont, and Maine for care and we shouldn't have to do this. This is evidence-based, medically necessary, and legally protected care. And while I can understand by legal counsel at Yale and CCMC, made the decisions that they did, really it's time for the state to step in and using the similar playbook related to how the state responded to Dobbs, V Jackson, and really make sure that no Connecticut resident has to engage in medical tourism for this life-saving care. This is the last question, and tell me what you can here, because I know that there's a lot that's sort of in flux, but what recommendations can you give to people? What would you tell people to do? I would say if families, if parents' caregivers have questions about accessing gender affirming care, they should contact a quality Connecticut. We're happy to talk with families and with adults receiving care if they have questions, because many adults have lost their insurance coverage, federal employees, veterans, etc. Any questions? Contact a quality Connecticut. We're happy to answer questions. The website addresses EQCT.org. Y'all in a 20 seconds, tell me what you would recommend really quickly. Yeah, I mean, ideally, if there are families that have lost care, there are directories out there that you can try and find care on, things like the LGBTQ health care directory and others to try and help find other providers. Ideally, systems would also participate in helping families find alternative care if there have been changes, although I absolutely also agree with what was said in the future. We hope that more of these clinics and systems get the support that they need from the state and from legal counsel to reopen their doors. You know, Tangy, the president of Glamour, Health Professionals Advancing LGBTQ+ equality. Thank you so much for coming on the show. Melissa Combs, organizer with the quality Connecticut. Thank you for coming on today's show. Was edited by Patrick Skahill. Dylan Reyes is our technical producer. Thank you so much for listening and watching the Wheelhouse today. Have a good day. 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