New Headwind For ‘Gender-Affirming Care’ For Children: Soaring Malpractice Insurance Costs

Where the controversy over so-called “gender-affirming care” for minors is concerned, government regulation commands most of the attention. However, as any well-read libertarian will tell you, market forces can also impose their own powerful form of regulation. Happily, we’re beginning to see market forces create a major impediment to the practice of irreparably altering the bodies of confused adolescents.

Those forces have emerged in the form of soaring malpractice insurance premiums for clinics that use hormones, puberty blockers and surgeries to address gender-confused children. Many insurers are refusing to offer coverage at any price. 

That’s what The Project of the Quad Cities found. The Illinois practice was ramping up its capabilities at its clinic on the Iowa border, with a goal of catering to Iowa minors who could no longer receive gender-altering services in their own state after they were banned in March.

Then they tried getting insurance. “I didn’t anticipate that it was going to be a big deal,” the clinic’s Andy Rowe told Time. However, a long list of medical malpractice insurers threw cold water on their ambitions.

“The first one specifically excluded gender-affirming care for minors. The next response was the same. And the one after that. By early November, more than a dozen malpractice insurers had declined to offer the clinic a policy.” – Time 

When the clinic finally found an insurer willing to provide coverage, Rowe was hit with sticker shock. He’d anticipated a premium of $10,000 at most. The actual price: $50,000. Appealing to donors, the clinic has almost raised enough funds to absorb that cost. In the meantime, its vision of a border clinic bustling with Iowa children hasn’t been realized.

Insurers’ mounting unease comes as a growing number of suits are being filed by individuals against doctors they accuse of rushing them — as children — into permanently altering their bodies rather than addressing adolescent angst over puberty.

This month, now-20-year-old Isabelle Ayala sued her Rhode Island doctors and others described in her suit as “a collection of actors who prioritized politics and ideology over children’s safety, health, and well-being.” One of them is alleged to have determined in a single, one-hour visit that she should be given cross-sex hormones, overlooking factors that included autism, ADHD and PTSD from being sexually assaulted as a child. Ayala told the New York Post:

“I just really don’t want this to happen to other vulnerable young girls. I don’t want puberty to be the enemy. I don’t want our natural biology to be the enemy.”

To some extent, the insurance-premium mechanism of market-driven regulation reflects changes in government regulation: Several states have extended the statute of limitations for filing malpractice lawsuits springing from gender-altering therapies and surgeries. In Arkansas, for example, the threat of a suit will now hang over the insurer of a gender-transition practice for 15 years after minor patients turns 18. That’s a sharp contrast to the typical requirement that a suit be filed within one to three years of injury.

“If state laws increase the risk of civil liability for health professionals, premiums will be adjusted accordingly and appropriately to reflect the level of financial risk incurred by the insured,” the Medical Professional Liability Association’s Mike Stinson told Time. 

Insurers, acting out of their own self-interest, are disincentivizing a risky activity that some governments allow and many even encourage: Chalk up another benefit to society delivered by what Adam Smith called “the invisible hand.”