Tennessee Republicans Advance Bill That Will Create a Public List of the State’s Trans People

House Bill 754 forces medical providers to hand trans people’s medical information over to the state, allowing the state to identify them. And under the bill, the data will be released to the public.

The Tennessee State Capitol in Nashville | Image: Wikimedia Commons

Editor’s note: HB 754 passed the Tennessee House this morning on party lines, 70-21. Democrats’ attempt to remove the provisions mandating the collection and publishing of trans people’s health information was defeated by Republicans again on party lines, 69-21. The bill’s Senate companion, SB 676, will likely be voted on sometime next week.

Yesterday, Tennessee Republicans voted unanimously to advance anti-trans House Bill 754. Sponsored by outgoing Republican Jeremy Faison, HB 754 has been framed as a way to force insurance companies to provide coverage of “detransition procedures” if they cover gender-affirming care. This idea isn’t new: last year, Texas passed a law mandating insurance coverage of detransition care, and in Utah, a similar bill—HB 258—is currently awaiting the governor’s signature after having already passed both legislative chambers.

But speaking at a House hearing, Faison departed from the narrative surrounding insurance companies and characterized it as an individual burden as well, stating that the bill aims to make it so that “if you want on your insurance the ability to transition, you also have to buy insurance that will also pay for a detransition.” In other words, it will force transgender Tennesseans to pay for coverage of detransition care that they will likely never need—extra coverage that will unnecessarily drive up their healthcare costs.

However, this is far from the worst thing HB 754 aims to do, because unlike other detransition coverage bills, Faison is attempting to use this one for a much more sinister purpose.

The bill would establish what Faison calls a “right to public transparency” surrounding gender-affirming care, which mandates that providers “report statistics regarding all gender transition procedures” to the Tennessee Department of Health. Some of these requirements are seemingly generic enough: through a form developed by the department, a provider would be required to report “the date on which” a patient received a “transition procedure,” the age and “biological sex” of the recipient, and information regarding the prescription or surgery.

Aside from these requirements, the bill would also impose a few more. First, a gender-affirming care provider would be required to report the “state and county of residence of the person receiving the gender transition procedure.” On top of this, each form must also include the prescribing doctor’s “name, contact information, and medical specialty.” Finally, the bill also requires that providers submit “a list of any diagnoses that” a trans person “has received of neurological, behavioral, or mental health conditions.” To wrap it all up, this data will be made readily available to the public via a “comprehensive annual statistical report” published on the DOH’s website.

If this is beginning to sound like it violates trans people’s medical privacy, that’s because it does: under HIPAA—which sets medical privacy standards in the United States—providers are prohibited from disclosing any “individually identifiable health information…that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.” According to the Department of Health and Human Services, this is defined to include a person’s county of residence and “all elements of dates (except year) for dates directly related to the individual…including admission date [and] discharge date.” And with some exceptions, data pertaining to a person’s medical diagnosis is also protected.

HB 754’s requirements conflict with this definition rather explicitly. Aside from mandating the collection of county-level treatment data, the bill requires that providers report “the date on which” a person received gender-affirming care—implying a specific date rather than just the year—something else HIPAA aims to protect. Furthermore, a person’s entire mental health diagnosis history is also considered identifiable.

HB 754’s reporting requirements with apparent privacy violations highlighted.

The bill attempts to circumvent these concerns by stipulating that “forms required under this section must not contain individually identifiable health information” as defined by HIPAA, and Faison echoed this when he spoke in favor of the bill during a hearing last year. However, the very explicit reporting requirements make it virtually impossible for providers to comply with this section unless they interpret the definition of “individually identifiable health information” narrowly.

Doctors don’t have a choice here, either. Any healthcare professional that is found to be in noncompliance with the reporting requirements will have their license suspended for at least 6 months, and their employer will concurrently receive a fine of up to $150,000. Additionally, the attorney general would also be allowed to bring action to enforce compliance, including by seeking medical records. Conversely, HIPAA makes broad exceptions for the disclosure of protected health information when required by state law, meaning medical professionals will not face consequences for breaching it.

That said, none of the purported safeguards make the information being gathered any less “individually identifiable.” After all, this information is considered protected for a reason; if shared with a member of the public, there’s considerable risk for it to be used to narrow down, and in some cases fully discern, a person’s identity. And in the hands of the government, that risk goes up significantly—especially if the data is only being collected for a tiny subset of the population, a subset that has already been targeted by the state in other ways.

Therefore, through HB 754, Tennessee will be effectively creating a list of the state’s trans people, and by targeting gender-affirming care, that list will be far more comprehensive than those made by Indiana and Kansas. Worst of all, given that there are no safeguards for the yearly “comprehensive report” the bill would commission, it’s highly likely that some or all of this data will end up in the hands of the public—which can then be used to identify and harass trans Tennesseans. And worryingly, that seems to be Faison’s goal.

This can be inferred by analyzing the bill’s other data collection provision, this time for detransition care. First and foremost, the data here will be collected by insurance companies and sent to the Department of Commerce and Insurance, a sharp contrast to the gender-affirming care data, which will be submitted to the Department of Health by medical providers. On top of this, the data being sought is much less specific, only requiring the number of detransition insurance claims made during a month, the age and “biological sex” of the detransitioner, the day they started their initial gender transition, and the patient’s state and county of residence. Like before, a “comprehensive annual statistical report” on this data will also be published.

Compared to the requirements for gender-affirming care reporting, the difference is stark: it doesn’t include the day the person sought care, the name of their doctor, or the person’s entire mental health diagnosis history. In fact, the only somewhat sensitive data being sought is county, which poses a much smaller risk without the other fields. At the same time, noncompliance with this requirement is not nearly as harsh, imposing no penalties aside from allowing the attorney general to enforce it through legal action.

This wouldn’t even be the first time Tennessee attempted to compile a list of the state’s trans people, either. In 2023, it was revealed that the Vanderbilt University Medical Center had turned over trans people’s medical records to the attorney general, who requested them under the guise of an investigation into “medical billing fraud.” And as concerning as this was, it was only limited to one organization, and, most importantly, the information was not made public.

So far, Faison has done his best to remain silent about the fact that HB 754 will create a public list of Tennessee’s trans people. When speaking on the bill, he often avoids mentioning the data collection clause entirely, and if he’s directly asked about it, he makes sure to quickly downplay the horrific nature of the provision before changing the subject back to detransitioners.

Until now, that’s worked well for him. The bill has received minimal media attention despite Faison having first proposed it 2 years ago, and even though the gender-affirming care data reporting portion forming the longest section of the bill, it isn’t mentioned in the bill’s summary at all.

As of this moment, House Bill 754 has not passed yet, and because of that, the fight is far from over. And it must be fought. Unless it’s defeated, every trans Tennessean will suddenly find themselves at risk of being singled out and targeted—both by the state and by members of the public wishing to harass and even potentially harm them. Simply put, the bill cannot be allowed to pass in its current form. The safety of Tennessee’s entire trans community depends on it.