By Nina Heller, CQ-Roll Call

WASHINGTON — Doctors and advocates say efforts to ban gender-affirming care and the often inaccurate language lawmakers use to do it exploits most Americans’ relative unfamiliarity with transgender people to push a political agenda.

As those efforts have grown — nearly exclusively led by Republicans — they have superseded both abortion rights and same-sex marriage as the go-to social issue among conservatives in the lead-up to the November elections.

The attacks have had an impact. Kellan Baker, the executive director of Whitman-Walker Institute, a D.C.-based health clinic specializing in LGBTQ+ health care, said that basing these attacks on falsehoods helps craft the narrative of transgender people as a “boogeyman” in order to scare people.

“There’s less than 1 percent of the U.S. population that is transgender, which means that many people don’t know a transgender person personally, or even if they do, they maybe don’t know that much about what medical care for transgender people looks like,” Baker said.

“And so it’s very easy to project this kind of false image of a boogeyman, to have this kind of nightmare scenario that’s not real.”

Most major medical and mental health associations in the United States, including the American Medical Association, American Academy of Pediatrics and the American Psychiatric Association, say gender-affirming care, which includes a wide range of services including hormone therapy and surgical procedures, is medically necessary.

“This is not just kind of made-up care, or just, we’re kind of freestyling it,” said Terrence Weeden, a staff adolescent physician at Whitman-Walker. “This is supported by multiple organizations, professional organizations, who are providing guidelines.”

In April 2021, the American Medical Association sent a letter to the National Governors Association urging its members to oppose laws that limit choices for health care by families and providers related to gender-affirming care after Arkansas passed a law that would prohibit physicians from providing gender-affirming care for minors.

“We believe it is inappropriate and harmful for any state to legislatively dictate that certain transition-related services are never appropriate and limit the range of options physicians and families may consider when making decisions for pediatric patients,” the letter said.

The bill was vetoed by Arkansas Gov. Asa Hutchinson, a Republican, who called it a “vast government overreach.” The Arkansas State Legislature successfully voted to override his veto. A federal district judge in Arkansas struck down the ban in June 2023 as unconstitutional. It was then appealed to the U.S. Court of Appeals for the 8th Circuit, where judges heard arguments for the case in April. The case is ongoing.

Efforts to ban gender-affirming care in state legislatures have a ripple effect in Congress.

“Mutilating children is bad — that’s generally a good stance to take,” said Rep. Daniel Crenshaw, R-Texas.

Crenshaw, who does not have a background in medicine, said doctors who practice gender-affirming care are performing “pseudoscience” and recommended that doctors should “read a book.”

Gillian Branstetter, a communications strategist for the American Civil Liberties Union’s LGBTQ and HIV project, said lawmakers like Crenshaw base their attacks on a concern for children’s well-being to get support for their views.

“That’s all designed to inflame people’s emotions,” Branstetter said. “Because they know people are generally concerned for children, and they want to use the mantle of protecting children to go after trans kids more broadly.”

The focus on rhetoric like Crenshaw’s is part of an effort to discredit health care that has been established as safe and to manufacture doubt, Branstetter said. Part of that, she said, is to use as many lies as possible to see what sticks with people who may have never met a trans person like Branstetter.

“I don’t think the goal is getting people to believe one lie. It’s throwing out as many lies as possible in order to make people believe in nothing so that when they hear from transgender people ourselves or the parents of transgender youth or medical experts or medical organizations, that they aren’t believed either,” she said.

Medicine misconceptions

Though attacks on gender-affirming care have increased over the past few years, many of the medical procedures under the umbrella of gender-affirming care are not new.

Puberty blockers were first approved by the FDA in 1993. Originally approved to temporarily delay puberty in children who were going through it too early, they block the release of hormones leading to puberty-related changes in the body. Such treatments are also reversible — a child who was taking them would be able to eventually go through puberty if they stopped taking them, Weeden said.

“Essentially, puberty is paused. And basically, that allows that youth or that child to kind of explore their gender, explore if they really want to pursue hormones or not. And so puberty-pausing medications are reversible,” Weeden said.

Weeden said that one misconception people have about gender-affirming care is how long it takes for people to start certain aspects of care, such as puberty blockers or hormone replacement therapy.

Unlike other medications, the process isn’t as simple as getting a prescription after one appointment — people will see multiple providers, including a behavioral health specialist, before they start the medication. The process, Weeden said, can take weeks to months.

“It is a multidisciplinary approach in that you have input from behavioral health specialists and clinicians, psychiatrists, sometimes an endocrinologist . . . A lot of different specialties come together in agreement to support this view in their transition,” he said.

In the case of minors, all aspects of gender-affirming care, from puberty blockers to hormone replacement therapy, are done only with parental consent, Weeden said.

But for Sen. Ted Cruz, R-Texas, the guidance from major medical organizations and from physicians like Weeden is insignificant.

“​​It is never medically necessary to sterilize or castrate a child. And it is only adults in pursuit of a political agenda who do that to little boys and little girls, even though an eight-year-old lacks the emotional maturity to make lifelong decisions and give up the ability to be a mother or father because of peer pressure in the moment,” Cruz said.

“My opposition has been really on the minors side of it,” said Sen. James Lankford, R-Okla.

Many Republicans, like Cruz, often point to surgery for youth as a driving force behind their objections, portraying it as a common procedure for trans youth.

But most transgender youth who receive gender-affirming care do not have surgery as minors. A study published in 2023 in JAMA Network Open tracked more than 48,000 patients who had operations in hospitals and outpatient surgery centers. It found that, of those who had gender-affirming surgery from 2016-20, fewer than 8 percent — 3,678 — were aged 12-18. Surgeries in younger patients were primarily breast and chest procedures, while genital surgical procedures were more common in older patients.

Such procedures for youth are rare, and when they do happen, happen only with the consent of parents and in consultation with multiple other health providers, Weeden said.

“This is an informed-consent process with consent from parents and support from providers and professionals. So we cannot do any of this without the consent from their parents,” Weeden said.

Legislation

Seventy-five anti-trans bills have been introduced during this Congress, including bills that would prohibit trans people from serving in the military and a bill that would make it a felony for doctors to perform gender-affirming care on minors, according to the Trans Legislation Tracker, an independent database tracking bills affecting transgender people across the United States.

At the state level, 638 bills have been introduced across 43 states in 2024, with 45 of them having passed. Of those introduced, 466 failed. The remainder have yet to move.

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Although there has yet to be a federal law restricting access to gender-affirming care, 25 states have laws that limit youth access to gender-affirming care, according to KFF, a health care think tank.

Restrictions on gender-affirming care have made their way into a series of must-pass appropriations bills.

They’ve also been attached to must-pass authorizations: An amendment to the fiscal 2025 National Defense Authorization Act that would prohibit TRICARE from covering and the Defense Department from furnishing gender transition surgeries and gender hormone treatments for individuals who identify as transgender. The House adopted the amendment June 13 by a vote of 213-206. The bill ultimately passed the House by a vote of 217-199.

The Senate Armed Services Committee approved its version of the NDAA last month, which also included an amendment to prohibit the Defense Department from providing gender-affirming surgeries to transgender servicemembers or insurance coverage for any gender-affirming medical care for transgender youth whose parents are serving in the military.

The bill would likely not pass the full Senate with such an amendment, let alone get signed into law by President Joe Biden.

But for Branstetter and others, that doesn’t make the existence of these bills any less frightening.

“Part of the effort is again dehumanizing trans people from a kind of person into a toxic influence that can be stamped out,” Branstetter said.

Ariel Cohen contributed to this report.

©2024 CQ-Roll Call, Inc., All Rights Reserved. Visit cqrollcall.com. Distributed by Tribune Content Agency, LLC.

By Beth Dooley, Star Tribune

What’s the best-tasting ricotta? The ricotta you make yourself.

Free of stabilizers and preservatives, homemade ricotta is much easier to make than you may think. The fresh-tasting results are leagues above anything packed into a plastic tub from the supermarket; plus it costs less, too.

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Ricotta is a staple throughout Italy, used in dishes that are both savory and sweet. It can be made into a filling for ravioli, lasagna and manicotti and is a wonderful base for a quick, light gnocchi. This time of year, ricotta is fabulous swirled into sautéed garden vegetables and herbs to sauce pasta.

When lightly sweetened, kissed with vanilla or lemon, ricotta becomes the base for a rich ice cream. Whip it with a little heavy cream to fill cannoli or a pastry crust, or bake it into a chocolate cassata, that luscious Italian cake. Whisk in a little yogurt and honey and pile it onto the season’s best blueberries and raspberries.

Don’t stop there. Stir in basil pesto and toss into a cold pasta or grain salad; slather it onto a focaccia sandwich with roasted eggplant and a thick, sliced tomato; fill a savory tart; or smear it on bruschetta and top with cucumbers, basil and a drizzle of balsamic. And ricotta pancakes are rich and light and perfect when topped with more ricotta, berries and a swirl of honey.

Making fresh ricotta is super simple. All you need is a half-gallon of milk, lemon juice, cheesecloth and about a half-hour of time — most of it hands-free. While traditional ricotta is made with the whey leftover from processing other cheeses that rely on starter cultures and rennet, today’s recipe is for quick small-batch ricotta to make at home. One try and you’ll never go back to store-bought ricotta.

Fresh Ricotta

Serves 4 to 6

Whole milk makes the best ricotta; avoid lower fat and nonfat milk. Do not use UHT — ultrahigh temperature — pasteurized cream, as it won’t set up. The longer you allow the curds to drain, the firmer the ricotta will become. Store any leftovers in a covered container in the refrigerator. It will keep for about a week. If you don’t have time to make fresh ricotta, you can still whip up ricotta cream from store-bought versions. Pile it onto fresh berries and use on berry shortcake. From Beth Dooley.

1/2 gallon (8 c.) whole milk, not UHT pasteurized (see Note)

1/3 c. lemon juice or 1/3 c. white vinegar

1 tsp. salt

Directions

Pour the milk into a 4-quart pot, set over medium heat, and bring it to 200 degrees. The milk will become foamy and begin to steam; remove from the heat if it starts to boil.
Remove from the heat. Stir in the lemon juice and salt. Let the milk sit for about 10 minutes until it separates into clumps of milky white curds (check using a spoon). If it hasn’t curdled, add another tablespoon of lemon juice and wait a little longer.
Set a strainer over a bowl and line with cheesecloth. Pour the curds and the whey through the strainer. Let the ricotta drain for about 30 to 60 minutes. Store in a clean, covered container and refrigerate.

Fresh Ricotta Cream for Berries

1 c. fresh ricotta

1/4 c. heavy cream

1/2 tsp. vanilla extract

1/4 c. sugar

Directions

Put the ricotta, cream, vanilla and sugar into a medium bowl. Whip with an electric mixer until light and fluffy.
Pile onto dishes of berries.
Store leftover ricotta cream in a covered container in the refrigerator for up to a week.

Beth Dooley is the author of “The Perennial Kitchen.” Find her at bethdooleyskitchen.com.

©2024 StarTribune. Visit at startribune.com. Distributed by Tribune Content Agency, LLC.

Caitlin Reilly | (TNS) CQ-Roll Call

WASHINGTON — Trade groups and companies responsible for this year’s largest lobbying expenditures so far upped the ante in the first half of 2024 compared to a year earlier, defying expectations for an election year slump.

K Street’s top 10 clients shelled out $162.3 million through June, up 13% from the first half of 2023. Part of that was due to heavy legislative activity during the first quarter, which saw enactment of two big spending packages and House passage of a $79 billion tax bill that got hung up in the Senate.

Topping the list are old standbys that regularly populate the top 10: the U.S. Chamber of Commerce; National Association of Realtors; Pharmaceutical Research and Manufacturers of America, known as PhRMA; American Medical Association; American Hospital Association; and Business Roundtable. All boosted their lobbying expenditures in the first half of this year above the same period in 2023.

Changes to this year’s top 10 include the American Chemistry Council and AARP, the chief seniors’ lobby group, elbowing their way in. Meta Platforms Inc., parent of Facebook and Instagram, pushed into the top five, wedged between health care titans PhRMA and the American Medical Association, the main physicians’ lobby.

Lobbying expenditures dipped in the second quarter, from $89.1 million to $73.9 million. But top K Street officials said uncertainty around the elections continues to drive client demand — and revenue — as companies prepare for all possible November outcomes.

“Election years bring some trepidation for the lobbying business because of the uncertainty about the legislative outlook and political outlook, but interest is heightened beyond belief right now,” said William Moschella, co-chair of the government relations department at Brownstein.

Moschella’s firm — also known as Brownstein Hyatt Farber Schreck LLP — reported $17.6 million in lobbying revenue in the second quarter, up 8% compared to the first quarter and 12% above the same period last year.

Brownstein’s top clients include private equity giant Apollo Global Management and two Apollo units, internet service provider Brightspeed and insurer Athene Holding Ltd., contributing a combined $2.6 million to the firm’s bottom line last quarter, according to disclosure forms. Tax policy was a main topic of concern, including on corporate and international taxes and the taxation of private equity investments, as well as broadband deployment issues.

Lobbyists said they expect revenue to remain elevated through the end of the year, despite lower odds of major legislation getting enacted.

“I honestly think it’s going to be more the same,” Moschella said. “Even though the number of legislative weeks are kind of dwindling, I think that there is so much attention on 2025 that that interest is going to remain high.”

Loren Monroe, a principal at BGR Group, said the unusual degree of uncertainty around the elections, as well as preparing for the expiration of many provisions of the 2017 tax law at the end of next year kept spending high.

“Anytime there’s potential change and uncertainty of who’s going to be in charge, it leads to an uptick in business. Our experience is clients want to have all scenarios covered,” Monroe said. “There’s so many different variables of what it’s going to look like after the November elections that a lot of our clients are looking to us to give them guidance and insights into how the changes could impact their priorities. Where are they at risk? Where are there opportunities?”

Monroe’s firm reported $11.1 million in revenue last quarter, up 3% from the first quarter and 8% from the second quarter last year. Among BGR’s biggest revenue-generating clients: semiconductor and wireless products manufacturer Qualcomm Inc.; the American Health Care Association, the largest trade group for nursing homes and assisted living facilities; and the government of India.

By the numbers

Interest groups tend to fall out of and into the top 10 from quarter to quarter. But tallying up the top 10’s activity is still useful in measuring broad industry trends, since it demonstrates the relative firepower aimed at influencing policy.

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The uptick so far this year came despite the usual slowdown in lobbying expenditures during election years as legislative output slows to accommodate campaigning, and amid an economic recovery that analysts say is losing steam.

Of this year’s top 10 lobbying spenders, only Amazon’s — down about 3% — dropped from this point last year.

Meta Platforms increased spending by 43% compared to the same period last year. Legislation to require social media platforms to provide greater protections for children using their sites picked up momentum this year after whistleblowers from Instagram and Facebook testified that Meta ignored warning signs about risks to children online.

The Senate last month passed a bill that would require companies to design online platforms in a way that mitigates harm to users and bar them from sharing children’s personal information without parental consent. Meta has not taken a stance on the package.

PhRMA boosted spending by about 16% this year over last. The Chamber of Commerce increased its spending by about 6%, while the Business Roundtable spent about 10% more compared to this time last year.

Chemical industry, AARP ramp up

The American Chemistry Council and AARP, formerly known as the American Association of Retired Persons, significantly increased lobbying spending, by about 54% and 27%, respectively.

American Chemistry Council spokesman Scott Openshaw said his group’s heavier activity was driven in part by a “comprehensive seven-figure campaign” calling on the Biden administration to “stop regulatory overreach” and promote manufacturing competitiveness.

The group also lobbied on EPA’s “flawed approach” to implementing 2016 updates to the chemical regulation law known as the Toxic Substances Control Act, Openshaw said, and pushed for the House-passed tax package and its restoration of lapsed business breaks as well as repeal of new Superfund taxes on chemicals.

In a statement, AARP said it ratcheted up spending in association with the group’s first in-person Washington “fly-in” in five years to support family caregiver legislation. AARP also lobbied to uphold Biden administration rulemakings on minimum nursing home staffing standards and on financial advisers’ fiduciary duties to investor clients.

AARP and the chemical industry group replaced CVS Health Corp. and the Open Society Action Fund, the lobbying arm of the left-leaning philanthropic group founded by billionaire financier George Soros, on the top 10 list for the first half of the year.

The Soros-backed group, also known as the Open Society Policy Center, has dramatically reduced its lobbying since the final years of the Trump administration, though it reported a big uptick in early 2023 amid an effort to repeal authorizations for the use of military force against Iraq that passed the Senate but died in the House.

CVS Health’s expenditures dropped substantially in the first half of this year after a flurry of early 2023 activity around legislation aimed at cracking down on pharmacy benefit managers’ practices.

Spending mostly tapered off in the second quarter, with six of the top 10 groups cutting their lobbying expenditures below the previous quarter.

Spending by the Chamber of Commerce dropped about 40% from the first quarter. Neil Bradley, the chamber’s executive vice president and chief policy officer, said that was more a function of when bills came due rather than any particular policy shift. Spending by the American Medical Association, PhRMA and Meta also dropped by more than one-fifth from the first quarter.

Tax cliff

Preparing for the expiration of many of the individual and business provisions from the 2017 tax law at the end of next year persisted in the second quarter as a source of lobbying activity and interest, K Street officials said.

Akin — also known as Akin Gump Strauss Hauer & Feld LLP — credited preparation for next year’s tax negotiations, and the addition of former House Ways and Means Chairman Kevin Brady, R-Texas, to their staff, for a record second-quarter performance for the firm: $13.8 million in lobbying revenue. Akin’s second quarter revenue was up 6% from the same period last year; it fell less than 1% from the first quarter.

BGR Group’s Monroe said the firm is encouraging early engagement with members on next year’s tax cliff, especially in light of member and staff turnover since passage of the 2017 law.

“Businesses are very much trying to find the right words and the right emphasis to put forward as they engage, because it’s a whole new ballgame,” Monroe said. “There’s enormous turnover in Congress, among the staff, among the committees of jurisdiction members. There’s not as nearly as much historical perspective. And so in many ways you’re having to approach offices with a blank slate and to make your case again, regardless of what happened.”

Brownstein’s Moschella added that the firm is telling clients to consider all provisions “on the table” next year given high debt and deficits, despite Republican promises to fully extend the law.

“Being involved now, educating members of Congress now is of paramount importance,” he said.

___

©2024 CQ-Roll Call, Inc., All Rights Reserved. Visit cqrollcall.com. Distributed by Tribune Content Agency, LLC.