The Missouri House sent legislation to the governor's desk Wednesday morning barring transgender youths from beginning gender-affirming care.
The bill passed 108-50. Only three Republicans joined every Democrat in opposition: House Majority Leader Jon Patterson, a doctor; Rep. Chris Sander, who is gay; and Rep. Gary Bonacker.
Democratic Rep. Peter Merideth of St. Louis asked Patterson, one of the legislature's only physicians, why he dissented. Patterson commended the bill but said he can "see both sides of the issue."
He said he trusted physicians and patients, but not without some hesitation.
The bill originated in the Senate, gathering compromise language after a multi-day filibuster by Democrats. The resulting legislation has a clause allowing those who have already begun treatment to continue. It also includes an expiration date on the ban on puberty blockers and cross-sex hormones of four years. The ban on gender-affirming surgeries is permanent.
A version of the legislation passed by the House earlier this year did not contain those compromises.
"Last month, we sent a bill over to the Senate that I was and am extremely proud of, with protections that go even farther than the bill I bring before you today. ... But because of little to no action over there, that piece of legislation will most likely die at six o'clock on Friday," said Rep. Brad Hudson, R-Cape Fair, the legislation's sponsor.
At a news conference following Wednesday's vote, Sander said he made it clear to House leadership that he intended to speak out against the bill during floor debate. However, despite standing to be recognized during the entire debate, House Speaker Dean Plocher did not call on him.
Sander, who has been threatened with censure by the Jackson County GOP, said the actions of his party have made him question whether he is still a Republican.
"My hand was raised all morning," Sander said, later adding: "They wouldn't let me speak in the House, where I was elected by the voters in my district that voted for me twice."
Gov. Mike Parson vowed to call a special session if the bill, and a limit on transgender athletes, did not make it to his desk by the time the legislature adjourns at 6 p.m. Friday. Democrats rose in opposition to the bill to share stories about transgender loved ones.
Rep. Doug Clemens, D-St. Ann, said he grew up in a conservative, Irish-Catholic environment. It took him years to understand the gender-affirming care process, he said.
"I can't allow (the legislature) to take the rights away from someone being themselves," he said. "It's a horrible thing that we do."
Rep. Maggie Nurrenbern, D-Kansas City, said she had "incredible" transgender kids as students when she was a teacher. Now she has heard of families with transgender kids leaving the state.
"Some of our best and brightest kids that I had are leaving our state," she said. "So I see this today as I walk in and think about what we're doing here is that this is a bit of a farewell speech today for some of the families that we've come to know and love and respect."
St. Louis Democrat Ian Mackey, who is gay, said he has been living with dread as the House approached passing the bill.
"When I say that I'm hurt as a member of the LGBTQ community, not nearly to the extent as these little kids are, I don't care whether you meant to harm me or not," he said. "I'm still harmed. And these kids are still harmed."
In response, Republican rose in defense of the measure and of their colleagues who pressed for its passage.
Rep. Wendy Hausman, R-St. Peters, said her "heart breaks" for friends and family in the "transgender community."
"This is just to make sure that children do not make decisions that could affect the rest of their lives. They might not have all the information, and we want to make sure that they get that information," she said.
After passing the health care bill, the House voted 109-49 to send a bill to the governor restricting student athletes to competing according to their sex assigned at birth. Rep. Jamie Burger, R-Benton, said the legislation was a way to help female athletes.
"Biological males are bigger, they are stronger, and they are faster," he said. "The majority of women simply cannot compete."
Merideth called the legislation "the epitome of bullying."
Merideth said previous debates showed that young kids competed similarly, but males gained a competitive advantage after puberty. He asked Patterson why.
"The testosterone," Patterson, said. "It's just the nature of human beings."
Merideth asked what advantage a biological male child would have if he took puberty blockers.
The current Missouri State High School Activities Association rule allows transgender athletes to compete according to their gender identity once they have been on cross-sex hormones for a year.
"If puberty is the thing that is causing those things to play out in a way that really makes a difference in an athletic achievement, isn't blocking puberty a way to get in the way of this happening?" Merideth asked.
Patterson responded: "You still have the height differences, the bone differences, the strength differences. You can't block it completely."
Merideth said endocrinologists, which specialize in hormones' role in puberty, have told him otherwise.
He argued the "blanket policy" wasn't compatible with cases of athletes taking gender-affirming hormones or those with intersex characteristics.
Patterson said the bill creates "a level playing field" for "the vast majority of athletes." He voted in favor of the legislation.
Sander, who voted against the transgender athletes bill, said the ramifications of the House vote will be huge.
"Say goodbye to NCAA events in St. Louis and Kansas City," he said. "We don't care about any of that. We just want to be discriminating and unwelcoming to people around the world, and we also want to tell people who live here to get out of our state."
In a statement released after the House vote, Sen. Greg Razer -- a Kansas City Democrat and the chamber's only openly gay member -- called Tuesday a "sad day for the LGBTQ community."
"We are all hurting," he said, "but we will persevere just as we have at every point in our journey when government has acted on the wrong side of history. We will keep moving forward, and no law can stop that."
The Missouri Independent, www.missouriindependent.com, is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.