Schilling criticized Biden’s proposal, saying it would “weaponize the federal government against Americans who recognize basic biology.”

State roots

As with the abortion debate, the debate over transgender health has its roots at the state level, where advocacy groups often work to push model legislation.

“It’s not as if these are initiatives kind of organically happening in different states,” said Brad Sears, founding executive director at the Williams Institute and affiliated faculty at the Center on Reproductive Health, Law, and Policy at UCLA.

“With both abortion and trans rights, we’ve seen the restrictions kind of starting at the state level,” said Transgender Equality Task Force Co-Chair Pramila Jayapal, D-Wash., who is the parent of a transgender child and was one of the first lawmakers to speak publicly about her abortion. “I think there has been, you know, a real push now to make this the defining issue, along with abortion rights.”

In some cases, both abortion and gender-affirming care have been lumped together, with at least five states — Oklahoma, Wyoming, Iowa, Missouri and South Carolina — considering penalizing businesses for reimbursing employees for health-related travel costs to seek an abortion or gender-affirming care.