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Missouri hearing draws sharp divides over removing sunset on SAFE Act restricting gender-affirming care for minors
Summary
A Missouri House committee heard hours of testimony for and against making permanent restrictions on gender-affirming medical care for minors. Sponsors argued courts and international reviews justify removing the sunset; doctors, parents and advocates said the ban harms youth and removes clinical discretion.
A Missouri House committee on Jan. 28 held a lengthy public hearing on several bills that would remove the sunset on the state's 2023 SAFE Act and related measures that restrict gender-affirming medical care for minors.
Representatives sponsoring the bills described them as a narrow, protective step for children. Representative Jamie Gregg said the Missouri Supreme Court recently upheld laws limiting certain treatments for minors and denying Medicaid coverage for the procedures, and that removing the sunset would simply keep that legal protection in place. "This is going to continue to protect our children," Gregg said during the sponsors' presentations.
Supporters who testified described long-term clinical and ethical concerns. Jamie Reed, a former pediatric medical case manager who said she worked at Washington University and St. Louis Children's Hospital, urged members to keep the SAFE Act permanent. "The foundations that justified these interventions were never what they were sold as advertised," Reed said, arguing independent reviews have not found new high-quality evidence of long-term benefits for minors.
Physicians and parents opposing the bills said the restrictions have already damaged families and limited access to care. Dr. Brandon Barthel, an endocrinologist who treats transgender patients, told the committee that gender-affirming care involves "slow, thorough, meticulous evaluation" and that puberty blockers and hormones are used in a small minority of cases after multi-disciplinary assessment. "A total ban on care really removes this option entirely," Barthel said, adding that clinicians rely on individualized assessments.
Other opponents — parents, clergy and advocacy groups — described the ban's human effects: families who left the state for care, young people cut off from treatment, and increases in emotional distress. "Gender affirming care saved my life," said Reverend Elijah Anthony, a trans pastor from St. Louis, who urged lawmakers to consider the real-world consequences of denying care.
Committee members pressed witnesses on the evidence base. Sponsors cited recent court rulings upholding parts of the 2023 law and international reviews they said raised safety concerns for puberty blockers and hormones used in minors. Opponents pointed to statements from major U.S. medical organizations endorsing gender-affirming care and to studies and clinical experience showing improved mental-health outcomes when appropriate care is provided.
No committee vote on removing the sunset for the SAFE Act was recorded at the hearing. Earlier in the same meeting, the committee conducted executive sessions on unrelated bills and reported two measures out of committee: a House Committee substitute for bills 2069 and 2208 was reported do pass by roll call (7 ayes, 4 no's), and House Bill 2061 was reported do pass (7 ayes, 3 no's, 1 present).
The hearing featured repeated, sometimes heated exchanges between members and witnesses, and the panel limited public testimony to two minutes per speaker to manage the long agenda. The committee plans no immediate vote on the SAFE Act sunset bills at the conclusion of the hearing; sponsors and opponents are expected to continue advocacy in coming weeks.
