Nearly 500 anti-LGBTQ+ bills were introduced in statehouses across the U.S in 2023. While many were defeated, the ACLU has tracked more than 80 bills that were passed into law. These include measures banning gender-affirming care for minors, banning trans athletes from playing in K-12 sports and prohibiting minors from attending drag story hours and shows. While some of these laws are currently being challenged in court, the growing number of these types of laws is leading to a queer migration of people to places like Oregon that have stronger protections for the LGBTQ+ community, according to service providers here.
Katie Cox is the executive director of the Equi Institute. Meg Miranda is the integrated behavioral health program manager at Outside In. And Jesse, whose full name we won’t be using for his protection, is a transplant from Missouri. They all join us now to share more on this trend and what it means for Oregon as a whole.
The following transcript was created by a computer and edited by a volunteer:
Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. Nearly 500 anti-LGBTQ+ bills were introduced in statehouses across the country in 2023. Many didn’t pass, but more than 80 bills are now law according to the ACLU. These include measures banning gender affirming care for minors, banning trans athletes from playing K-12 sports, and prohibiting minors from attending drag story hours and shows. While some of these laws are currently being challenged in courts, this surge is leading to a queer migration to places like Oregon that have stronger protections for the LGBTQ+ community according to service providers here. I’m joined now by two of those service providers, and someone who fled his home state to live in a place where he can be himself. Katie Cox is the executive director of the Equi Institute. Meg Miranda is the integrated behavioral health program manager at Outside In. And Jesse, whose full name we’re not gonna be using for his protection, is a transplant from Missouri. Welcome to all three of you.
Katie Cox: Thank you so much for having us.
Jesse: Yeah, it’s great to be here.
Miller: Jesse, to start with you, can you give us a sense for what your daily life is like right now?
Jesse: So I work in outdoor education. Day to day, I am, at least during the school year, teaching classes for kids about survival skills. Sometimes I joke that I teach children how to use knives and light fires.
Miller: I know kids love that, being a parent of young kids. “I can finally play with this stuff?”
Jesse: Yeah. And I find that it’s really empowering. We also do a lot of foraging and shelter building, and also free play where kids can just do what kids do for fun on their own.
Miller: So that’s your work. Could you be doing this work if you hadn’t come to the Northwest?
Jesse: Throughout college in Missouri, I worked at summer camps. But I wasn’t out as trans there, and I also wasn’t out as queer to any of the parents or children that I worked with. So, yes, but I’m able to do it in a way where I don’t have to be hiding aspects of my personal life from the people that I’m working with here.
Miller: Well, let’s go back. Can you describe your childhood, and what I understand is a very religious upbringing in Missouri?
Jesse: Yes. I was raised Southern Baptist, but also particularly, the Southern Baptist Church gives pastors a lot of leeway for the specifics of the theology they promote, and the pastor leading my church believed that the world was going to end in 2012. There were a lot of other churches that were on board with that also. And even though he wasn’t the leader of my church, Harold Camping was the person that that pastor was most influenced by.
Miller: When you were growing up in that world, did you think everything was going to end in 2012?
Jesse: Yes, I believed that I literally was not going to make it to adulthood. And it also came with a lot of extremely patriarchal, Quiverfull-esque beliefs. My family wasn’t Quiverfull, but a lot of other families in that church were, and we were about a 30 minute drive from where the Duggar family lives. So that was just very culturally prominent.
Miller: What does Quiverfull mean?
Jesse: Quiverfull is a religious ideology where people believe that there is a religious obligation to have as many children as possible, and then raise those children to take political positions in the government to influence policy. It’s specifically very theocratic and dominionist. And dominionism, the word comes from the idea that Christians should have dominion over the rest of the country.
Miller: How did all of this affect your understanding of being trans, of being queer?
Jesse: Like many people raised in that environment, I was kept from knowledge of what being queer even is for a long time. I was able to find other people like me, and slowly learn what the feelings I was having even meant, mainly because I went to public school. I had friends and contacts outside of that environment. And I was kind of lucky in that regard, because a lot of people raised this way are far more isolated than that. Public libraries were also very, very important. And I know that that’s a current battleground. I was finding information through friends and teachers and books and the little internet time I had that wasn’t monitored.
Miller: When did leaving your home first start to seem like a possibility?
Jesse: I would say around the end of my time in college. That was kind of like 2018, 2019. And then I actually moved in late 2020.
Miller: Was there a final straw for you?
Jesse: It was a few things. I think the most relevant here was [when the] state senator from my hometown introduced a drag queen story hour ban bill. And this was in 2020, so it was like the first of its kind as far as I’ve been able to find. Obviously that legislation is a lot more common now.
I think the straw on the camel’s back metaphor is really solid there, because it was also just like a slow building up of “okay, I can tell that more of my neighbors feel negatively about people like me. I’m feeling less safe in this place.” So… yeah.
Miller: What kind of a toll did that take on your mental health?
Jesse: Well, I have been diagnosed with PTSD. But it’s complicated, because being able to find community here has been so extremely helpful with that. I was in a much worse place when I was physically in Missouri than even right after I moved here.
Miller: It was instant.
Jesse: Pretty much. And I don’t want to paint a picture of completely lacking support in Missouri either, because there are a bunch of wonderful people that are still fighting the good fight there. It’s just a relief here to know that there are many, many more people that would have my back if a hate crime or something were to happen to me.
Miller: Katie, can you give us a sense for what the Equi Institute offers?
Cox: Yeah, absolutely. Our mission is to enrich the health of the trans, queer, intersex, and gender diverse communities in Portland through trauma informed care, culturally-specific services, and social justice advocacy. And the primary way that we are doing that currently is through our community health program, which is staffed with a team of community health workers and certified recovery mentors that share identities of those that we are serving. It’s a really important part of the peer element in this work. And they work with folks to provide peer support, services and systems navigation, harm reduction, recovery support, and health education. And that’s probably the neatest way that I can put it.
The overall picture is that we really work hard to fill in the gaps that exist in our current systems, and catch people who often fall through the cracks of our larger both health care systems and housing systems as best we can.
Miller: How common is it these days for people to reach out to your organization in search of resources or guidance or services after moving to Oregon from another state?
Cox: We’ve seen about a 60% increase over the last few months of folks coming to us from out of state seeking safety, health, and housing access.
Miller: 60% increase. What has that meant for your organization?
Cox: A big meaning of it is that we need more space to operate out of, because we currently have one office inside of Portland’s Q Center. But we have also built up our staff and we have six peers on staff now to address the need that we see emerging.
Miller: Willamette Week had a really good article about this issue last month, about people who have fled red states and come to Oregon. They quoted the parent of a trans kid who moved here from Texas who said “what would you do if your state was depriving your children of best practice life saving health care, and the penalty is that the state can put you in jail?”
But moving away from one place is different from choosing to move to another. Katie first, what do you think makes Oregon a good option for people who are fleeing anti LGBTQ+ laws?
Cox: Oregon is one of 14 states in the entire country that covers gender affirming care under our state Medicaid program. We have some of the most progressive health care laws. In fact, Governor Kotek recently signed House Bill 2002 into law which, among other things, expands coverage of certain critical gender affirming procedures including facial feminization, surgery, and electrolysis. And so we have very progressive health care laws in this state.
But Portland itself has also touted itself as a very LGBTQ friendly place to be in general. And so I think that we’re number two or three on the list nationally for highest population of LGBTQ people.
Miller: Jesse, what brought you to Oregon? There are a number of blue states that are a lot more welcoming to members of the LGBTQ+ community than Missouri. Why Oregon?
Jesse: I think a lot of it is Oregon, and somewhat Washington, but more Oregon’s, long, long track record of being very progressive on these issues. Specifically the ex-evangelical circles that I was in, it’s kind of a known thing that you can move to Portland and you will be safe. For example, the guys who used to run Exodus International, which was like an ex gay organization, when they publicly came out and were like “we were wrong to do this, actually, we’re gay,” they stated like “we are settling down in Portland because that is a safe place for us to go.” And that’s a very public example, but it’s also just known within these communities that Portland is specifically where you can go. I think it also helps that Oregon is one of the most secular places in the United States.
Miller: You were seeking that out after being steeped in a very particular version of Christianity.
Jesse: Yes.
Miller: Meg Miranda, what does it mean to be an integrated behavioral health program manager at Outside In?
Meg Miranda: Outside In as a whole, our organization’s mission statement is to help homeless youth and marginalized people to move towards improved health and self sufficiency. And as that relates to my role here, I work within our primary care services and offer behavioral health care services tied to primary care. So oftentimes folks who are seeking gender affirming care, maybe need some support with navigating the world as a newly out trans person or as a person who’s seeking a gender affirming surgery, etc, they would come to me or some of my colleagues to talk about that experience, to talk about what they need to move forward with social or medical transition. Also offering some stability to them during what can sometimes be a tumultuous time during early transition.
Miller: Have you seen the kind of increase that we heard from Katie?
Miranda: I would say yes. Overall, we have seen about a 6% increase in the number of trans and gender diverse clients that we serve through the clinic. And as far as my work is concerned, I went from writing one or two letters of support for gender affirming surgery per week to probably closer to five or six at this point.
Miller: Is transgender health care dependent on people getting a letter from you, or someone in your position?
Miranda: I would say yes and no. There are some standards of care that exist, put forth by a WPATH that kind of indicate what services can be done without a letter of support and which ones can’t. Generally speaking, anything that’s a surgical procedure requires at least one if not multiple letters of support from a behavioral health professional.
Miller: And that’s sort of global best practices for this kind of medicine. But what’s it like for you, in a sense, to be part of this gatekeeping system?
Miranda: To be completely transparent, it’s not my favorite thing. Often when I first sit down with clients to discuss this kind of letter process, I say to them “I understand that this feels gatekeepy, and if we want to get this covered by your insurance we’re gonna have to go through this muddy process together.” I think that unfortunately, clients who are trans and gender diverse are accustomed to the gatekeepiness of the insurance world. That’s not to say that it’s right. But people are accustomed to that, and are willing to work with me to get to where they need to be.
Miller: What have you heard about what it has been like for people to be living in states that are passing laws that actively work against them, places where people’s governments are making it hard for them to simply be who they are?
Miranda: It’s devastating. I work with a number of clients who have moved to or migrated to Oregon as a result of these laws being passed and the impact on mental health. When you’re fleeing somewhere that you know, that you love, that’s fighting against you, it’s insurmountable, the impact and the trauma that people are facing. I think once people settle here and they find a community, there’s some stability to be found. But until people find a community, I think it’s a very challenging transition.
Miller: I’m curious about that initial time after moving. It seems that moving part way or sometimes maybe all the way across the country, that can be its own kind of stressor, right?
Miranda: Yeah, absolutely. Even if you’re not fleeing for what feels like your life, and what in some cases is fleeing for your life, moving in general is stressful. So add in the complication of feeling like your own people, your own city or state is against you. It’s really tumultuous and really exhausting for people.
Miller: Jesse, have you been able to build a network of friends and support since moving here? I guess I’m imagining a network of support from scratch.
Jesse: Yes. A lot of it is the kind of informal networks that queer people have always used to find each other and find support. One of the actual trickier things when I moved, because again it was fall 2020, during the pandemic, was that a lot of the local gay bars were temporarily closed. So that tried and true avenue for finding community was not available. And I actually was able to start finding community through Portland’s anarchist community. A lot of the mutual aid events were very, very helpful, in terms of the gap I experienced in my employment. It was like a combination of both the material resources through mutual aid programs, and just social support from people being really friendly and nice.
Miller: Katie Cox, have you seen any class trends in terms of the migration stories you’ve heard? I imagine that in general people have to have some amount of money and life portability in order to pick up and just move across the country.
Cox: You know to be honest, not always. From 2016 to 2019, we facilitated a primary care program specifically for trans and queer folks. And even in that time, we were seeing folks coming to us from out of state who had packed everything into a car and just left. And when they got here, they didn’t have housing or connections or a plan because having access to the life saving health care that they needed was the most important thing. And so the majority of the folks that we’re working with on a day to day basis are often unhoused or insecurely housed, which is particularly difficult, because to be honest, Portland doesn’t have a very strong infrastructure for unhoused LGBTQ individuals.
Miller: We reached out to OHSU as a major provider of gender affirming health care to get their take on what’s happening, and they gave us a statement: “As other states have recently moved to limit or ban gender affirming health care, the OHSU Transgender Health Program has anecdotally noticed an increase in inquiries from people living in other states, and more referrals being submitted on behalf of those who are moving to Oregon. While OHSU is saddened to know gender diverse individuals are being forced to leave their home states out of fear for their health and safety, the Transgender Health Program is proud to be a part of a university committed to providing care for new and longstanding patients alike, as well as to be based in a state where gender affirming care coverage is being protected and expanded.”
Katie, I’m thinking back to that 60% increase that you talked about. Are there enough gender affirming care providers for Oregon’s existing trans patients, plus people who are coming from other states?
Cox: To be 100% honest, I don’t think so. Most of the gender affirming providers that I’m aware of, even in the Portland metro area, are on waitlist. It does take a little bit of time to get established. And Portland is its own bubble, but if there are folks living in other parts of the state, that access becomes even more challenging. There are not nearly enough providers across the state of Oregon to be able to provide this type of care. I don’t think that there are enough, and I think that there are pieces that our state, particularly the Oregon Health Authority, can put into place to hold providers accountable for providing gender affirming care across the state, and not just localized to Portland.
Miller: Jesse, can I ask you what has your experience been broadly in terms of your access to health care since you arrived?
Jesse: So I initially moved to Vancouver, not Oregon proper. But I was able to pretty quickly get on Molina Apple Health. And I didn’t fully take the plunge into hormone replacement therapy until about a year later. But especially compared to Missouri, I have found health care overall to be much, much easier to access here. The thing is though, that is not a particularly high bar. At the time that I left, Missouri was doing a ballot measure vote on getting a Medicaid expansion, and the vote passed with flying colors. And the state legislature has obstructed that by refusing to fund it. So my personal experience has been very positive, but that is with the contrast of having lived in a state where I had essentially no access to health care, or at least not health care that I could afford.
Miller: Meg Miranda, we’ve been talking about people coming to Oregon because of this relatively new wave of anti-trans legislation. But well before this wave, it was common for LGBTQ kids to run away because of a lack of support in their own homes. Has that continued?
Miranda: I think that the trend of LGBTQ folks running away from home because of the lack of support has continued. I think that a vast number of youth that we serve in our homeless youth continuum are LGBTQ identified. I believe that there are an astronomical number of reasons why folks become homeless and disconnect from their biological families. But I would say that a large number of the people that we serve, being not accepted for who they are, is a contributing factor to that.
Miller: Jesse, do you miss anything about your life in Missouri?
Jesse: I miss a lot of the very brave people in the queer community there. I miss caves and thunderstorms and a lot of the ecology there. Fireflies. It was really weird to learn that fireflies aren’t a thing in Oregon.
Miller: I totally know what you mean, I was surprised by that. I miss them coming from the east coast.
Missing people is serious, and missing a place that’s your home that you knew for decades is real. I’m wondering if you ever think about trans kids there who are not going to see you? You didn’t put it this way, but many people leave to save their lives. For many people it is that stark. I’m wondering if you ever feel guilty about leaving because of the other trans kids who are still there?
Jesse: I think there definitely has been some of that, essentially, survivor’s guilt. But it’s also like, I am still in contact through the wonders of the internet with a lot of the people that I knew in Missouri that were doing LGBT work. And it absolutely is rough. But I also want to emphasize that even if it’s fewer role models and the resources are harder to access, I’m pretty confident that most kids in Missouri aren’t going to be completely bereft of representation.
One of the things to remember about this most recent anti-trans push is that it is backlash to a wave of trans acceptance and visibility that we saw in the early 20-teens. So a lot of more public visibility is still there.
Miller: Jesse, Meg Miranda and Katie Cox, thanks very much.
Jesse is a transplant from Missouri who moved to Oregon about three years ago. Meg Miranda is the integrated behavioral health program manager at Outside In. And Katie Cox is the executive director of the Equi Institute.
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