This is about the ongoing attack on transgender people. They want all their medical records, and want to make the records public.
--Kim
Tennessee Republicans just voted unanimously to advance a bill that would put trans people's medical records on the internet. That's not a hot take. That's what the bill does.
HB 754, sponsored by Representative Jeremy Faison, is being sold as an insurance fairness measure. The pitch is that if your insurance covers gender-affirming care, it should also cover detransition care. Fine, sure, whatever. That framing is a decoy. The actual mechanism of the bill is a mass data collection operation targeting every trans person in Tennessee who has ever received care at a state-funded clinic, and it hasn't gotten nearly enough attention.
Here's what doctors would be required to hand over to the state: the specific date care was prescribed, the drug name, dosage, frequency, duration, and how it's administered, the patient's age and biological sex, the county they live in, and their full mental health diagnosis history. That last one is not a typo.
The state of Tennessee wants a list of every psychiatric diagnosis a trans person has ever received, tied to the exact date they got a prescription and the county where they sleep at night. The bill also requires the doctor's name and contact information. The state then takes all of this and publishes a "comprehensive annual statistical report" on the Department of Health's public website, in downloadable format, where the individual clinic data is not aggregated.
Faison's defense is that the forms won't include patient names, so technically it's not "individually identifiable." HIPAA actually disagrees with him. Under federal law, a patient's county of residence and the exact dates they received care are classified as individually identifiable health information. But HIPAA has an exception for data disclosure required by state law, which is exactly the trap Faison is building. The bill creates a legal obligation to violate privacy so that HIPAA can't stop it.
The comparison to the detransition data collection in the same bill is the tell. For detransition patients, insurance companies report to the Department of Commerce. They don't have to provide the specific date of care. They don't have to include the doctor's name. They don't have to list the patient's psychiatric history. The detransition reporting is genuinely minimal, collected by a different agency, with minimal penalties for noncompliance.
,The gender-affirming care reporting is the opposite on every single one of those measures. Doctors who don't comply face a license suspension of at least six months and their employers face fines up to $150,000.
So we have two data collection systems in the same bill, one for each group, and they are not remotely similar. If the point were really about insurance transparency, they'd look the same. They don't look the same because the point isn't insurance transparency.
What you end up with is a publicly downloadable file containing the county, age, sex, psychiatric history, prescription details, and treatment timeline of every trans person in Tennessee who sought care at a state-funded facility. You don't need a name when you have all of that. If you live in a small county and you're the only 22-year-old who got a specific hormone prescription on a specific date, you are on that list, and anyone with an internet connection and a grudge can find you there.
Faison has spent two years avoiding talking about this part of his own bill. When he testifies, he leads with detransitioners. The data collection clause is the longest section of HB 754, and it isn't mentioned in the bill summary at all. That's a choice.
The people who will be identified from this data are not abstractions. Tennessee's own Department of Health identified LGBTQ+ people as a high-risk population in their 2021 suicide prevention report. The state knows this community faces elevated risk of harassment and violence. They published a document saying so. Then they advanced a bill that makes it easier to find them.
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