If passed, North Carolina HB 805 will strip gender-affirming care coverage for the 750,000 North Carolinians on the State Health Plan. The bill has many other harmful implications. Here’s why no one (including AI) has recognized this one.
Section 3(a) of the bill outlines who will no longer qualify for State-funded gender-affirming health care. General Statute 143C-6-5.6(b) specifies minors, (b1) specifies incarcerated persons, and (c) states, “Subsections (b) and (b1) of this section shall not apply to the State Health Plan for Teachers and State Employees.”
This provision sounds as if the General Assembly is sparing transgender and nonbinary persons who rely on the State Health Plan (SHP). It is the opposite.
Nestled within Section 3(b) is a crafty trigger provision that will nullify subsection (c), and the trigger condition has already been met. SCOTUS vacated the 4th Circuit Court of Appeals ruling on Kadel v. Folwell on June 30, 2025, in light of the US v. Skrmetti decision. The State Treasurer’s press release foreshadowed it days earlier.
This means subsection (c) will expire 30 days later on July 30, 2025 – just one day after the General Assembly is scheduled to respond to Governor Stein’s veto. Rather than risk an evidence-based judicial review of Kadel v. Folwell, the GA will preempt the lower court’s decision.
How does the expiration of §143C-6-5.6(c) end gender-affirming care coverage for all SHP members? Previously, subsection (c) was written in the context of care for minors. Subsection (b1) has broadened that context by establishing that State funds cannot be used to provide access to gender-affirming care, directly or indirectly [1]. Correspondence with a SHP Board member supports this interpretation.
What remains unclear is whether gender-affirming coverage would end as soon as July 30, 2025, or with the launch of next year’s SHP on January 1, 2026. A June 18th press release suggests it would be “automatically and immediately.” If Governor Stein’s veto holds, SHP members will have to wait for the Kadel v. Folwell decision.
HB 805’s bait and switch language is contrary to the “transparency” Treasurer Briner promised with State Health Plan changes. Treasurer Briner often implies that the gender-affirming care exclusion saves taxpayers money, but research suggests it does not [2]. Teachers like myself are already upset about the SHP price hikes and potential provider losses, and may be further angered by surprise coverage changes – especially those born of little reason but hate.
[1] From HB 805 Section 3(a): “No State funds may be used, directly or indirectly, for the performance of or in furtherance of surgical gender transition procedures, or to provide puberty-blocking drugs or cross-sex hormones to any prisoner… or to support the administration of any governmental health plan or government-offered insurance policy offering surgical gender transition procedures, puberty-blocking drugs, or cross-sex hormones…” The inclusion of “to any prisoner” gives pause, but correspondence with a SHP Board Member suggests the Board anticipates the exclusion of gender-affirming care for all SHP members should HB 805 pass.
[2] These sources purport that providing coverage for gender-affirming care does not cost more money for large insurance plans: Atangan. 2023. American Journal of Law and Medicine, Padula et al. 2015. Journal of General Internal Medicine, Human Rights Campaign Foundation