1. United States
2. Mich.
3. Letter

The Fourth Circuit's recent ruling allowing West Virginia to exclude gender-affirming surgery from Medicaid sets a dangerous precedent that threatens healthcare access for transgender adults. I need you to publicly oppose any legislation or policy that restricts adult access to gender-affirming care and to support federal protections for this essential medical treatment. The court's reasoning is deeply flawed. It claims states can constitutionally "encourage citizens to appreciate their sex" by denying care, and characterizes medically necessary procedures as "dangerous" and "ineffective" despite a 40-year follow-up study showing high patient satisfaction, improved outcomes, and zero regret. This contradicts established medical consensus and creates a roadmap for states to ban adult care entirely. Gender-affirming care is lifesaving. Denying coverage doesn't just create financial barriers—it denies people access to treatment that reduces mental health crises and improves quality of life. The Heritage Foundation has already announced that adult care bans are their next target, and this ruling gives them the legal framework to pursue it. This isn't about minors or parental rights anymore. This is about whether adults can access medically necessary healthcare. I expect you to stand against any effort to restrict or criminalize gender-affirming care for adults.