You raise excellent points, while reminding me that physicians and surgeons should be free to make care decisions based on their patient's need rather than ability to pay.

Since the Tennessee legislators appear to be intentionally targeting medical care like HRT prescriptions, care that typically happens outside a hospital setting, it's a little bit harder to make big-money arguments. Of course, Tennessee is targeting surgery also, tossing medical and surgical care together into the same bag of practices they want to stop.

I think for me, it's hard to separate this issue from my objections to the way healthcare works in general in this nation.

Tennessee can only target private insurers because we've allowed private insurers to make money from healthcare. In this case, private insurers profiting from administering Medicaid are vulnerable to pressure. I always sort of knew Medicaid was not a self-administering program, that third parties earn money by managing Medicaid for states.

That's not a terrible thing on its own, given that large insurance companies have the expertise and systems in place to do this. But ... we're left with a system where money talks more than patients.

It's bad enough that Medicaid patients themselves have to put up with care-rationing decisions by insurance companies that have a financial dog in the fight.

But this Tennessee proposal makes things even worse. They're threatening to cancel contracts to insurance companies that administer Medicaid, on grounds that have nothing to do with how those companies administer Medicaid.

The obvious harm to transgender people is what I focused on in my story, but what about harm to Medicaid patients? What's Tennessee going to do next year if this law is in effect and they can't contract with any insurance company specializing in administering Medicaid? Because that is what would happen.

I can only imagine that Medicaid patients in Tennessee would experience a good deal of chaos and often have trouble receiving needed medical care.

But since Medicaid patients are poor, Tennessee lawmakers don't have to worry about that. It's not like they'll be losing political contributions, and poor people are much less likely to vote.

Bottom line? In the United States we allow healthcare to be a big-profit business. Conservatives want it that way and fight to keep it that way.

And as we're seeing right now, they will not hesitate to take advantage of that to try to ration healthcare based on right-wing ideology.