Act 626 of 2021

Act 626 of 2021 was the first ever bill passed in the United States to outlaw any gender-affirming medical treatment for persons under eighteen years of age. It became law over the veto of Governor Asa Hutchinson on April 6, 2021, attracting national and international criticism of the Arkansas legislature. Groundbreaking though the bill was, it was but one of many passed during the 2021 Arkansas General Assembly that specifically targeted trans citizens, and Arkansas was one of more than thirty states in 2021 in which Republican Party legislators introduced such bills. On June 20, 2023, a federal judge struck down the bill.

House Bill 1570, dubbed the “Save Adolescents from Experimentation Act,” was written by Representative Robin Lundstrum of Elm Springs (Washington and Benton counties) and introduced into the Arkansas House of Representatives on February 25, 2021. The following reasons were given, according to the text of the bill, for outlawing such medical treatment for minors: “Only a small percentage of the American population experiences distress at identifying with their biological sex” and “Even among people who have undergone inpatient gender reassignment procedures, suicide rates, psychiatric morbidities, and morality rates remain markedly elevated above the background population.” In response, the act outlawed providing “gender transition procedures” (including the prescription of puberty blockers or “cross-sex” hormones) and performing “gender reassignment surgery, as well as referring any patient to another healthcare professional for such matters.”

On March 9, 2021, the bill was approved by the Public Health, Welfare, and Labor Committee. Chairperson Rep. Mary Bentley gave proponents of the legislation a collective forty-five minutes to testify before the committee, while the sixteen opponents who signed up to testify were limited to two minutes each. Supporting the bill, Joseph Backholm of Washington DC, a senior fellow for Biblical Worldview and Strategic Engagement at the Family Research Council, suggested that doctors encouraged gender reassignment as a way to make money. Testimony by actual doctors, however, centered upon the fact that such surgery on minors simply was not done in the state, while other medical interventions, such as medication, were sometimes necessary to preserve the mental health of a patient experiencing gender dysphoria. One witness, Chris Attig (an attorney, former U.S. Army captain, and father of a trans son), was arrested for exceeding his two minutes at the order of Representative Jack Ladyman. The following day, the bill passed the House 70–22 largely on party lines, with eight not voting. The Senate passed the bill, again primarily on party lines, on March 29 by a margin of 28–7, sending it to Governor Hutchinson.

Hutchinson spent several days without publicly stating his intentions one way or another. National medical groups opposed the bill, noting that transgender youth experienced lower rates of suicide if they were permitted access to the necessary treatment, and that youths had been permitted access to such treatments for decades. By this point, Gov. Hutchinson had already signed other bills directed against trans persons, including a ban on transgender athletes from participating in girls’ or women’s sports, as well as the so-called “Medical Ethics and Diversity Act,” which allows healthcare workers and insurance companies to refuse non-emergency medical services to individuals on the basis of the “exercise of the right of conscience.”

In a surprise move, Gov. Hutchinson vetoed HB 1570 on April 5, 2021, while also stating that he fully expected the legislature to override his veto. In a public statement, he said, “I do hope my veto will cause my Republican colleagues across the country to resist the temptation to put the state in the middle of every decision made by parents and healthcare professionals.” The following day, April 6, the legislature, as expected, overrode his veto by a vote of 75–25 in the House and 25–8 in the Senate, a comfortable margin given that Arkansas law allows for the legislative override of a veto with only a majority vote. The American Civil Liberties Union (ACLU) immediately promised to file suit.

That evening, Gov. Hutchinson appeared on Tucker Carlson Tonight, a Fox News talk show, to defend his veto, insisting that no corporations had pressured him to veto the bill. Indeed, no major Arkansas corporations ever publicly opposed the legislation—a stark difference from 2015, when the leadership of several major Arkansas companies, such as Walmart and Acxiom, came out against the so-called “Religious Freedom Restoration Act,” which would have, as originally constituted, permitted businesses to discriminate against particular individuals and groups by reference to their own individual religious beliefs. Hutchinson later reiterated his reasons for vetoing the bill in a column in the Washington Post.

The same day that HB 1570 became law, Republicans in North Carolina followed suit and introduced a bill banning the same medical treatments for people under twenty-one. Alabama had already done so. Later that same month, the Texas state legislature began consideration of a bill that would designate such medical treatment for minors as child abuse. By mid-August 2023, twenty-two states with Republican legislative majorities had enacted similar legislation.

On May 25, 2021, the ACLU filed its promised suit against the state, seeking to block the implementation of the law, on behalf of a group of families with transgender youth and two doctors and their patients. On June 17, 2021, the U.S. Department of Justice sided with the plaintiffs in a filing in the court case. Later that month, the State of California banned state travel to Arkansas and sixteen other states on account of anti-trans legislation. On July 21, 2021, Judge James Moody blocked enforcement of the law while the court case was ongoing. On August 25, 2022, the Eighth Circuit U.S. Court of Appeals upheld the injunction, blocking enforcement of the law pending the actual trial.

On June 21, 2021, Business Insider published an investigation of the campaign finance records of the lawmakers who supported Act 626, finding that the political action committees (PACs) of many companies that have represented themselves publicly as LGBTQ-friendly siphoned money to said legislators, including Walmart, ExxonMobil, AT&T, and Entergy. On January 19, 2022, a number of state-based corporations and non-profit organizations filed a friend-of-the-court brief against allowing the law to go into effect.

The suit filed by the ACLU began on October 17, 2022. Plaintiffs rested their case on October 21, with the remainder of the trial set taking place later in the year due to conflicts in the judge’s schedule. On June 20, 2023, Judge James Moody ruled that the law violated the constitutional rights of the youth affected, their parents, and doctors involved in the treatment. On July 20, 2023, Attorney General Tim Griffin appealed the ruling to the Eighth Circuit of the U.S. Court of Appeals; on September 7, 2023, he requested that the full court, rather than a three-judge panel, hear the case first, and this request was granted the following month. Oral arguments began on April 11, 2024.

For additional information:
Act 626 of 2021. Arkansas State Legislature. https://www.arkleg.state.ar.us/Acts/FTPDocument?path=%2FACTS%2F2021R%2FPublic%2F&file=626.pdf&ddBienniumSession=2021%2F2021R (accessed June 5, 2021).

Bowden, Bill. “Ruling Affirms Block of State’s Gender-Care Ban.” Arkansas Democrat-Gazette, August 26, 2022, pp. 1A, 4A. Online at https://www.arkansasonline.com/news/2022/aug/26/8th-circuit-rules-in-favor-of-arkansas/ (accessed August 26, 2022).

Dylan Brant, et al. v. Leslie Rutledge, et al. https://wp.api.aclu.org/wp-content/uploads/2023/06/win-in-arkansas.pdf (accessed June 21, 2023).

Ellis, Dale. “8th Circuit Hears Gender Care Appeal.” Arkansas Democrat-Gazette, April 12, 2024, pp. 1A, 5A. Online at https://www.arkansasonline.com/news/2024/apr/11/entire-8th-circuit-hears-arguments-on-states/ (accessed April 12, 2024).

———. “ACLU Sues to Block New Transgender Law.” Arkansas Democrat-Gazette, May 26, 2021, pp. 1A, 4A. Online at https://www.arkansasonline.com/news/2021/may/26/aclu-sues-to-block-new-transgender-law/ (accessed June 9, 2021).

———. “AG Seeks Review of Ruling on Ban for Gender Care.” Arkansas Democrat-Gazette, September 8, 2023, p. 2B. Online at https://www.arkansasonline.com/news/2023/sep/08/ag-asks-federal-appeals-court-to-reconsider/ (accessed September 8, 2023).

———. “Arkansas’ Gender Law Illegal, U.S. Filing Says.” Arkansas Democrat-Gazette, June 18, 2021, pp, 1A, 6A. Online at https://www.arkansasonline.com/news/2021/jun/18/arkansas-gender-law-illegal-us-filing-says/ (accessed June 21, 2021).

———. “Doctor Questions Gender-Care Ethics as Trial Testimony Ends.” Arkansas Democrat-Gazette, December 2, 2022, pp. 1A, 6A. Online at https://www.arkansasonline.com/news/2022/dec/02/transgender-care-trial-ends-with-witness/ (accessed December 2, 2022).

———. “Returned to Birth Genders, 2 Testify.” Arkansas Democrat-Gazette, December 1, 2022, pp. 1A, 4A. Online at https://www.arkansasonline.com/news/2022/dec/01/two-former-transgender-people-testify-for-the/ (accessed December 1, 2022).

———. “Sociologist Testifies in Transgender Trial.” Arkansas Democrat-Gazette, November 30, 2022, pp. 1A, 8A. Online at https://www.arkansasonline.com/news/2022/nov/30/judge-in-transgender-care-trial-questions/ (accessed December 1, 2022).

———. “State Loses Court Bid to Lift Care Ban Block.” Arkansas Democrat-Gazette, November 17, 2022, pp. 1B, 3B. Online at https://www.arkansasonline.com/news/2022/nov/17/appeals-court-refuses-to-reconsider-temporary/ (accessed November 17, 2022).

———. “State Witness Faults Treatment Standards in Transgender Suit.” Arkansas Democrat-Gazette, November 29, 2022, pp. 1A, 7A. Online at https://www.arkansasonline.com/news/2022/nov/29/state-witness-in-transgender-care-case-testifies/ (accessed November 29, 2022).

———. “Transgender Medical Care Ban Rejected.” Arkansas Democrat-Gazette, June 21, 2023, pp. 1A, 4A. Online at https://www.arkansasonline.com/news/2023/jun/20/judge-blocks-arkansas-ban-on-gender-affirming-care-for-transgender-minors/ (accessed June 21, 2023).

———. “Trial to Begin Today in Care Ban Challenge.” Arkansas Democrat-Gazette, October 17, 2022, pp. 1B, 3B. Online at https://www.arkansasonline.com/news/2022/oct/17/trial-will-decide-fate-of-arkansas-law-banning/ (accessed October 17, 2022).

Fullerton, Allegra H., and Christopher M. Weible. “Examining Emotional Belief Expressions of Advocacy Coalitions in Arkansas’ Gender Identity Politics.” Policy Studies Journal 52 (May 2024): 369–389.

Hall, Madison, and Walt Hickey. “Arkansas Passed 2 of the Most Brutal Laws Targeting Trans Kids in the US. These Pro-LGBTQ Companies Pumped Hundreds of Thousands of Dollars to the Lawmakers behind It.” Business Insider, June 21, 2021. https://www.businessinsider.com/companies-that-funded-sponsors-of-arkansas-anti-lgbt-laws-2021-6 (accessed January 27, 2021).

Herzog, Rachel. “Companies Join to Fight State on Transgender Law.” Arkansas Democrat-Gazette, January 20, 2022, pp. 1B, 2B. Online at https://www.arkansasonline.com/news/2022/jan/20/anti-transgender-arkansas-law-would-harm-people/ (accessed January 20, 2022).

Herzog, Rachel, and Michael R. Wickline. “Ban on Kids’ Transgender Care Vetoed.” Arkansas Democrat-Gazette, April 6, 2021, pp. 1A, 6A. Online at https://www.arkansasonline.com/news/2021/apr/06/ban-on-kids-transgender-care-vetoed/ (accessed June 9, 2021).

———. “Judge Blocks Implementation of State Gender-Treatment Ban.” Arkansas Democrat-Gazette, July 22, 2021, pp. 1A, 4A. Online at https://www.arkansasonline.com/news/2021/jul/22/judge-blocks-implementation-of-state-gender/ (accessed July 22, 2021).

———. “Transgender-Bill Veto Overridden.” Arkansas Democrat-Gazette, April 7, 2021, pp. 1A, 5A. Online at https://www.arkansasonline.com/news/2021/apr/06/ban-on-kids-transgender-care-vetoed/ (accessed June 9, 2021).

Imbler, Sabrina. “In Arkansas, Trans Teens Await an Uncertain Future.” New York Times, January 18, 2022. Online at https://www.nytimes.com/2022/01/18/health/transgender-adolescents-arkansas.html (accessed January 18, 2022).

Krotoszynski, Ronald J., Jr. “The War on Trans Kids Is Totally Unconstitutional.” The Atlantic, May 16, 2021. https://www.theatlantic.com/ideas/archive/2021/05/anti-transgender-children-laws-unconstitutional/618864/ (accessed June 5, 2021).

Lancaster, Grant. “Court to Review Trans Health Care Law.” Arkansas Democrat-Gazette, October 7, 2023, pp. 1B, 8B. Online at https://www.arkansasonline.com/news/2023/oct/07/full-us-8th-circuit-agrees-to-hear-states/ (accessed October 10, 2023).

Langhorne, Will. “AG Files Appeal of Trans Ruling.” Arkansas Democrat-Gazette, July 22, 2023, pp. 1B, 3B. Online at https://www.arkansasonline.com/news/2023/jul/22/arkansas-attorney-general-appeals-ruling-in/ (accessed July 24, 2023).

Martin, Simona, Elizabeth S. Sandberg, Daniel E. Shumer. “Criminalization of Gender-Affirming Care—Interfering with Essential Treatment for Transgender Children and Adolescents.” New England Journal of Medicine, August 12, 2021, pp. 579–581.

Posner, Sarah. “The Christian Nationalist Boot Camp Pushing Anti-Trans Laws across America.” Insider, September 21, 2022. https://www.insider.com/christian-nationalist-trans-statesmen-academy-alabama-ohio-missouri-laws-2022-8 (accessed September 22, 2022).

Scott, Rebekah Hall. “‘Kids Feel Like They’re Being Erased’: Inside the Clinic Targeted by Arkansas’s New Anti-Trans Law.” Arkansas Nonprofit News Network, June 9, 2021. https://arknews.org/index.php/2021/06/09/kids-feel-like-theyre-being-erased-inside-the-clinic-targeted-by-arkansass-new-anti-trans-law/ (accessed June 9, 2021).

VanDerWerff, Emily. “Our Conversation about Anti-Trans Laws Is Broken.” Vox.com, April 2, 2021. https://www.vox.com/identities/22358864/trans-issues-sports-health-care-bills-laws-arkansas-alabama-montana-south-dakota (accessed June 5, 2021).

Vedder, Amy. “Not a Mere Creature of the State: Protecting Parental Rights in the Era of Anti-Trans Legislation.” Harvard Law and Policy Review 19 (Summer 2024): 279–306. Online at https://journals.law.harvard.edu/lpr/wp-content/uploads/sites/89/2024/10/19.1-MereCreature.pdf (accessed December 26, 2024).

Vrbin, Tess. “Arkansas Families Describe Living Where Lawmakers Are Hostile to Their Transgender Children.” Arkansas Advocate, May 3, 2023. https://arkansasadvocate.com/2023/05/03/arkansas-families-describe-living-where-lawmakers-are-hostile-to-their-transgender-children/ (accessed May 3, 2023).

———. “Federal Judge Strikes Down Arkansas Ban on Gender-Affirming Health Care for Transgender Youth.” Arkansas Advocate, June 20, 2023. https://arkansasadvocate.com/2023/06/20/judge-strikes-down-arkansas-ban-on-gender-affirming-health-care-for-transgender-youth/ (accessed June 21, 2023).

———. “Gender Bill Draws Capitol Protest.” Arkansas Democrat-Gazette, April 4, 2021, pp. 1B, 4B. Online at https://www.arkansasonline.com/news/2021/apr/04/gender-bill-draws-capitol-protest/ (accessed June 9, 2021).

Watts, Brook. “Commentary: How I Brought the Worlds to Fayetteville—and Why I Won’t Be There.” VeloNews, January 26, 2022. https://www.velonews.com/culture/commentary-how-i-brought-the-worlds-to-fayetteville-and-why-i-wont-be-there/ (accessed January 27, 2022).

Wickline, Michael R. “Transgender Treatment Ban for Minors Is OK’d.” Arkansas Democrat-Gazette, March 30, 2021, p. 6A. Online at https://www.nwaonline.com/news/2021/mar/30/transgender-treatment-ban-for-minors-is-okd/ (accessed June 9, 2021).

Wickline, Michael R., and Rachel Herzog. “Transgender Restriction Bills Move Ahead in State.” Arkansas Democrat-Gazette, March 11, 2021, pp. 1A, 4A. Online at https://www.arkansasonline.com/news/2021/mar/11/transgender-restriction-bills-move-ahead-in-state/ (accessed June 9, 2021).

Staff of the CALS Encyclopedia of Arkansas