Just in case you thought the current pearl-clutching about gender-affirming care for youth was based in reality — or if you believed them when they said it was just about "state’s rights" or youth," we turn once again to Tennessee.
There, a state level ban on gender-affirming care for those under 18 has just passed the state Senate and is headed to the state House. It was the first — first — bit of legislation on their docket this year, joining a wave of anti-trans GOP-led legislation in states this year .
What happened in Tennessee that required lawmakers to take such drastic action?
According to the coverage from WHJL in Johnson City, TN , Republicans in Tennessee "made the proposed ban a legislative priority after a series of tweets last year by conservative commentator Matt Walsh about Vanderbilt University Medical Center’s transgender clinic."
Walsh made exaggerated, untrue, and unfounded claims that the clinic "drugs, chemically castrates, and performs double mastectomies on minors."
The hospital replied "that since it created its transgender clinic in 2018, it had performed an average of five gender-affirming procedures on minors each year, all of which involved patients 16 years or older," all with parental consent and none involving "genital procedures."
So a series of exaggerated and outright untrue social media posts about a total of somewhere between ten to fifteen patients, none under 16.
A long list of medical associations and Tennesseans who showed up to oppose this bill.
Who showed up to support it? According to the Tennessean , those who testified in support of the bill were "conservative media personalities and two young women who said they regretted beginning gender transitions as teenagers." Those two women did not get their care in the state, because "both women received their gender transition care outside of Tennessee."
So: Exaggerated and utterly false tweets, about fewer than 15 patients, supporters had to go out of state to find just two people who "regretted" their care to testify, and yet, like South Dakota and three other states, this imaginary, non-existent crisis will take away needed medical procedures prescribed by a physician.
But if you think this just applies to Tennessee or those other four states, though, you’re wrong.
Now the Tennessee GOP has filed a bill — HB1215 — that would "block Tennessee’s Medicaid distributors from covering any gender transition treatments for adults," and would additionally "block any insurance company from contracting with TennCare, the state’s Medicaid agency, if their parent companies cover any gender transition treatments anywhere in the country."
This is another bit of anti-trans legislation to address a non-existent and imaginary crisis. A spokesperson from TennCare "said puberty blockers and hormone treatments aren’t tracked, though gender transition surgeries are already excluded from coverage." 
So what’s the purpose of HB1215?
To set a precedent and set the insurance company policy for large chunks of the nation.
This is a trial balloon. Tennessee is a relatively "safe" place to try this legislation out. But the key part is that the bill would "block any insurance company from contracting with TennCare, the state’s Medicaid agency, if their parent companies cover any gender transition treatments anywhere in the country."
In the current American healthcare system, there are relatively few large insurers and most of the parent holding companies operate in multiple states.
Of the large multi-state companies, it appears that at least Aetna, Cigna, Humana, and UnitedHealth Group would be directly impacted by this, since according to the NCQA report card, each of them operates Medicare or Medicaid plans in Tennessee, as well as commercial plans in Tennessee and other states.
Because of the wording of HB1215, it would those who have private insurance in addition to Medicaid and Medicare recipients.  Each of the insurers mentioned above, in order to keep their Medicare/Medicaid business in Tennessee, would have to deny coverage for gender affirming care for adults, nationwide on any of the plans owned by those parent companies.
Should this pass, it will get rapidly adopted in other, larger, and more populated Republican strongholds.
And while those big insurance agencies may be able to ignore the loss of the Tennessee market, that’s when things will get really bad.
At that point, insurers will have a choice: Either deny coverage for gender-affirming care anywhere, or give up a large multi-state customer base.
Luckily, friends, the Tennessee GOP has already shown us what to do by their own actions.
Take a moment to think about this.
If the concerted lies, hatred, and bigotry of a few people are enough to create this kind of change, then what could happen if you, I, and everyone reading this just … said something to push back.
Nobody is asking you to say a lot, or become a full-time activist. Nobody is saying you have to be the point of the spear.
But we are well past the point where the silence of everyday people has become equal to being complicit in their bigotry.
And if one dude’s tweets were enough to make them think it was a crisis, what do you think will happen if all of us respond back? 
 Although that shouldn’t matter; check your classism.
 A helpful guide on contacting your elected officials: https://www.usa.gov/elected-officials/