California Gov. Gavin Newsom this week signed a series of privacy bills for transgender patients amid continued threats from the Trump administration.
But there was one glaring omission that LGBTQ+ advocates and political strategists say is part of an increasingly complicated dance facing the Democrat as he crafts a more centrist profile for a possible presidential bid.
Newsom vetoed a bill that would have required insurers to cover and pharmacists to provide 12 months of hormone therapy concurrently to transgender patients and others. The proposal was a top priority for transgender rights leaders, who said it was vital to preserve care as clinics close or curtail gender confirmation services under pressure from the White House.
Political experts say Newsom’s veto underscores how charged transgender care has become for Democrats nationally and, in particular, for Newsom, who as mayor of San Francisco engaged in civil disobedience by allowing gay couples to marry at City Hall. The veto, along with his lukewarm response to anti-trans rhetoric, they argue, is part of a troubling pattern that could damage his credibility with key voters in his base.
“Even if Newsom’s decision was not politically motivated, there are certainly political ramifications that he is well aware of,” said Dan Schnur, a former GOP political strategist who is now a politics lecturer at the University of California-Berkeley. “He’s smart enough to know that this is an issue that will anger his base, but in return, it might make him more acceptable to large numbers of voters.
Earlier this year on Newsom’s podcast, the governor told the late conservative activist Charlie Kirk that transgender athletes competing in women’s sports were “deeply unfair,” sparking backlash among his party’s base and LGBTQ+ leaders. And he has described trans issues as a “major problem for the Democratic Party,” saying Donald Trump’s trans-focused ads were “disastrous” for his party in 2024.
But in a conversation with YouTube streamer ConnorEatsPants this month, Newsom defended himself “as a guy who has literally put my political life on the line for the community for decades, been a champion and a leader.”
“He doesn’t want to face criticism as someone who, I’m sure, is trying to run for president when the current anti-trans rhetoric is so strong,” said Ariela Cuellar, spokeswoman for the California LGBTQ Health and Human Services Network.
Caroline Menjivar, the state senator who introduced the measure, described her bill as “the most tangible and effective” measure this year to help transgender people at a time when they are singled out for what she described as “targeted discrimination.” In a legislature in which Democrats hold supermajorities in both chambers, lawmakers sent the bill to Newsom on a party-line vote. Earlier this year, Washington became the first to enact a state law expanding coverage of hormone therapy to a 12-month supply.
In a message vetoing the California bill, Newsom cited its potential to raise health care costs, effects that an independent analysis found would be negligible.
“At a time when individuals are facing double-digit increases in health care premiums across the country, we must be very careful not to enact policies that further increase health care costs, no matter how well-intentioned,” Newsom wrote.
Under the Trump administration, federal agencies have been ordered to limit access to gender-affirming care for children, which Trump has described as “chemical and surgical mutilation,” and have demanded documents from or threatened investigations of facilities that provide it.
In recent months, Stanford Medicine, Children’s Hospital Los Angeles and Kaiser Permanente have reduced or eliminated gender-affirming care for patients under 19, a sign of the chilling effect Trump’s executive orders have had on health care, even in one of his most progressive states. nation.
California already mandates broad coverage of gender-affirming health care, including hormone therapy, but pharmacists can currently only dispense a 90-day supply. Menjivar’s bill would allow for 12-month supplies, following a 2016 model law that allowed women to get a year’s supply of birth control.
Luke Healy, who told lawmakers at a hearing in April that he was “a 24-year-old transitioner” and no longer believed he was a woman, criticized the effort to increase coverage of services he saw as “irreversibly harmful” to him.
“I believe bills like this force doctors to turn healthy bodies into permanent medical problems in the name of an ideology,” Healy testified.
The California Association of Health Plans opposed the bill on provisions that would limit the use of certain practices, such as prior authorization and step therapy, which require insurer approval before providing care and force patients and doctors to try other treatments first.
“These safeguards are essential to implementing evidence-based prescribing standards and responsibly managing costs — ensuring patients receive appropriate care while keeping premiums under control,” said spokeswoman Mary Ellen Grant.
An analysis by the California Health Benefits Review Program, which independently reviews health insurance-related bills, concluded that annual premium increases resulting from the bill’s implementation would be negligible and that “no long-term impact on utilization or costs is expected.”
Shannon Minter, legal director of the National Center for LGBTQ Rights, said Newsom’s economic argument “doesn’t make sense.” While he said he considers Newsom a strong ally of the transgender community, Minter noted he was “deeply disappointed” to see the governor’s veto. “I understand that he’s trying to respond to this political moment, and I hope he responds to it by shaping language and policies that can really bring people together.”
Newsom’s press office declined to comment further.
After the podcast interview with Kirk, Cuellar said, advocacy groups supporting SB 418 are concerned about a potential veto and pointed to the voices of other patients who would benefit, including menopausal women and cancer patients. It was a completely different strategy than what they might have done before Trump took office.
“If we had run this bill in 2022-2023, the messages would have been completely different,” said another supporter, who asked to remain anonymous because they were not authorized to speak publicly on the matter. “We could be very loud and proud. In 2023, we might have received a signing ceremony.”
Trans rights advocates have been so wary of the current political climate that some have also felt the need to avoid promoting a separate bill that would expand coverage of hormone therapy and other menopausal and perimenopausal treatments. That bill, authored by Assemblywoman Rebecca Bauer-Kahan, who spoke movingly about her struggles with perimenopausal health care, was also vetoed.
In the meantime, said Jovan Wolf, a transgender man and military veteran, patients like him will suffer.
Wolfe, who had taken testosterone for more than 15 years, tried to restart hormone therapy in March after a two-year hiatus in which he considered having children.
Doctors at the Department of Veterans Affairs told him it was too late. Days earlier, the Trump administration had announced it would phase out hormone therapy and other treatments for gender dysphoria.
“Having estrogen pumped into my body, it’s just not a good feeling for me, physically, mentally. And when I’m on testosterone, I feel balanced,” said Wolf, who eventually received care elsewhere. “It should be my decision and mine alone.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
