The successful diffusion of gender-affirming care bans in the U.S.: how partisanship functions as a mechanism of policy diffusion

Abstract

Since 2015, the diffusion of anti-trans policies among the states has targeted the ability of transgender Americans to participate in athletics, change identification documents, use public facilities - such as bathrooms or locker rooms, and obtain gender affirming healthcare. The banning of gender affirming care (GAC) has resulted in increased reports of transgender youth suicide attempts in states that ban care. The proliferation of gender affirming care bans is problematic as it has negative health implications for transgender Americans. The diffusion of GAC bans can be traced to partisan interest groups, who actively diffuse anti-trans policies through venue shopping among the fifty state legislatures, and strategically advocating for the implementation of their policy preferences in legislatures amenable to their policy goals. To assess how partisan interests succeed at diffusing policy, I examine the diffusion of gender affirming care bans from 2021 to 2024 using textual analysis, measuring the cosine similarities of the 26 GAC bans to evaluate potentiality of copy and paste legislation, before performing a multivariate regression and an event history analysis to assess how this type of anti-trans policy has diffused across state legislatures. I find that partisan interests successfully diffused GAC bans in states that share their partisan identity, as states have sorted ideologically on LGBTQ+ policies. This finding is further evidence against the idea that states function as laboratories of democracy; instead, as states become sorted along partisan lines, transgender minors and adults find their rights and freedoms limited by what state they live in (Taylor et al. 2024). Rather than acting as laboratories of democracy, states are engaging in a democratic race-to-the-bottom as freedoms and rights are questioned and stripped from their citizens. These findings support past research questioning the reality of states functioning as laboratories of democracy (Tyler and Gerken 2022; Grumbach 2022, 2023), as well as research that finds the erosion of LGBTQ+ rights are linked to conservative messaging and are fundamentally attacks on democracy (Stein 2023; Taylor et al. 2024) – this expands our understanding of how a morality policy, such as anti-trans policies, are increasingly linked to partisanship and that this results in conservative controlled states adopting policies that restrict democratic rights and freedoms.