In This Episode
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TRANSCRIPT
Jane Coaston: It’s Tuesday, July 1st, I’m Jane Coaston, and this is What a Day, the show that says, I get it, Pennsylvania Democratic Senator John Fetterman, I get it.
[clip of Senator John Fetterman] Oh my God, I just want to go home. I’ve already my, I’ve missed our entire trip to the beach. My family’s gonna be back before we are. So, and again, I’m gonna vote no.
Jane Coaston: He goes on to say that he, like every Senate Democrat, is opposed to the Republican spending bill that would gut Medicaid and give tax breaks to billionaires, but I don’t know if there’s another Senate Democrat who sounds as absolutely over it as Fetterman. And as someone who has been over it since Inauguration Day, I get it. [music break] On today’s show, President Donald Trump heads to Florida for the grand opening of the so-called Alligator Alcatraz Migrant Detention Center, and the Trump administration is now accusing Harvard University of violating the Civil Rights Act. But let’s start by talking about gender-affirming care, namely what it actually looks like. The Supreme Court ruled last month in United States v. Skrmetti that the state of Tennessee could bar gender-affirming care for minors. The ruling itself centered on whether or not such a ban would violate the 14th Amendment’s Equal Protection Clause. The court found that because the Tennessee law didn’t discriminate on the basis of sex or gender identity, it doesn’t. According to the nonpartisan healthcare policy outlet KFF, 27 states have bans on gender-affirming care for minors, though in at least two of those states, Arizona and New Hampshire, those bans only apply to surgical care. Both Arkansas and Montana have had their bans on gender-affirming care for minors enjoined by the courts, and challenges to bans from other states are still ongoing. But I wanted to back up a second and ask, what does gender- affirming care do? And what do the providers working on the ground think of the efforts to ban access to it? I got the chance to speak to one such provider before last week’s Supreme Court decision, a doctor who works in a state that has recently restricted gender-afirming care for anyone under the age of 19. Dr. Alex Dworak Is the Associate Medical Director of Family Medicine at One World Community Health Centers. He specializes in LGBTQ medicine and is an advocate for access to gender-affirming care for youth in Nebraska. Alex, welcome to What a Day!
Dr. Alex Dworak: Thank you for having me.
Jane Coaston: What is gender-affirming care?
Dr. Alex Dworak: Gender affirming care is something that’s thoughtfully done, and it’s not just done for trans people. It’s a way of helping people feel more comfortable in their bodies, have better mental health, be more authentically themselves. And it really has informed the practice of all of my patient care, having learned to take care of trans people over the last several years.
Jane Coaston: How long have you worked with trans patients to provide this kind of care, and what made you decide to get into this line of work?
Dr. Alex Dworak: So I didn’t get any exposure to this in medical school or residency. Um. The first patient who I worked with was around 2010, I believe, so shortly after I got done with my residency training. And she was a Black trans woman who had HIV and high blood pressure. And those of us who study medicine know that it’s not an accident that all those things went together in her literal body. Part of it was being told by one of my mentors that this patient needs her HIV treated, her blood pressure managed. I’m like, okay, I got that. And refill her hormones while you’re at it. And so when I asked her, don’t I have to send her to endocrine for that? She gave me this very British look of disappointment that I had seen more than once from her. Handed me the guidelines and said, read this and go take care of her. Trusting me to be open-minded and welcoming. I went to get additional training starting in 2015. And I’ve since gotten over 100 hours of CME specific to trans care as well as helping to teach others So I’ve made a very focused effort to get good at this
Jane Coaston: Nebraska’s ban restricted some of the care that you helped provide. How are you negotiating treating your patients?
Dr. Alex Dworak: Well, I’m still able to treat them, which is a significant reason why I’m still here in Nebraska. For the first time I thought about leaving Nebraska when the ban was being debated and it’s something that restricts care and has a mandate for 40 hours of therapy. I already was asking for a letter of support from a qualified mental health professional and was never just treating anybody without full informed consent. I have had families where one parent is supportive and the other parent is not and I can’t treat those kids and I don’t. I mean I talk to them, I talk the parents, I answer questions, I allay fears, I also say, that’s a logical fear when they’re worried about how their kids might have to move through the world. Nebraska also requires a waiting period and requires that all hormone injections be administered in the physician’s office for safety, unless the kid isn’t queer, and that it is fine to give them at home, or unless the kids is being given a much more dangerous hormone, which is insulin. You cannot kill somebody with estrogen or testosterone. Insulin can and does kill people if it’s drawn up wrong or if something else happens. So, I see those uh contradictions and I see that only the queer kids are targeted and that just says it all for me.
Jane Coaston: And speaking of the kids you work with, how are your patients feeling? Have any of your patients left the state since the ban went into effect?
Dr. Alex Dworak: Yes, several adults left the state, even though the ban was aimed at children. One family moved to a sanctuary state along with our other kids. Even before the raft of legislation that started in other states, families had bolt plans. They’re thinking about where they’re going to go, you know, how would we get there and what would our lives look like. Many adults leave because of politics, and they tell me that specifically. They say, we don’t feel safe and we don’t feel welcome here. I dedicated my life to the care of the underserved. I put my mental health and my physical health on the line and my life on the line during COVID when I knew people were dying. And the state relied on my expertise and my professionalism and my sacrifices and what I asked of my family because I didn’t want to kill one of my patients by getting sick. I asked my family to isolate hard too and they did. You know, to do all that and then to be told, well, your expertise and your sacrifices don’t really count for anything. And people who have no medical training are going to ignore the people they’re talking about, the expert clinicians, it really made me reconsider Nebraska as my home. I’ve decided to stay and fight for my patients who can’t leave and won’t leave, but it still hurts to be treated that way by the state that I have dedicated my life to.
Jane Coaston: Nebraska Governor Jim Pillin celebrated the ban when it was enacted last year, saying that we need to protect children from, quote, “potentially irreversible and regrettable decisions, decisions for which they may not completely understand the consequences.” Now, this is a very common argument we hear from Republicans against gender affirming care. It’s an argument that drives me, personally, absolutely crazy. This entire argument assumes that being trans is bad. And that you don’t want to be trans, and no one should let you be trans and that if you are trans, it’s going to be a mistake that you regret. But I am just an angry person with a podcast. You are an actual healthcare professional. So what’s your response to that repeated claim that we keep hearing from Republicans?
Dr. Alex Dworak: Well, I’m an angry health professional who doesn’t have a podcast, but it makes me extremely frustrated. Regret rates are extremely low and they’re much higher for some other types of procedures like many other–
Jane Coaston: Knee surgery.
Dr. Alex Dworak: Yes, knee surgery is a big one and lots of other cosmetic procedures and things that we are not restricting. I think it’s implied that there’s a lot of big business in this and for me that’s absolutely not the case. I’m a primary care doctor. I work taking care of the underserved, a lot of uninsured people. If I’m making money off of this, somebody tell me where the checks are going. When this is attacked, my autonomy as a physician and, again, all the hard work and study I put in is also attacked. Parents have their freedom taken away. The youth and the adults who are saying, this is who I am and this is what I need to be healthy, they’re being ignored. The consensus of the literature is being ignored, the level of scientific understanding that I hear from politicians who, as a general rule, don’t practice medicine. I think there may be a few physicians in Congress. I don’t usually hear them talking as much about this. That perspective of, well, you might regret this. It doesn’t talk about the harm. Doing nothing isn’t neutral. This is actively denying. And one of the points that jumps out for me with that is the Trevor Project’s 2024 report, where having accepting schools and families is a big factor in suicide prevention. Even more than access to medical care. And so when your society is rejecting you that way, it’s going to make more people hurt themselves, which as a doctor, that’s the opposite of what I’m here to do.
Jane Coaston: I’m from a red state, the state of Ohio, which keeps getting redder. Um. You are working in a red State and there are tons and tons of LGBTQ people in red states. President Trump has signed a ton of anti-LGBTQ policies since taking office. What is your message to other people in red States or people around the country in general who feel hopeless in this moment where the only response is just move to somewhere else, but somewhere else might not be better.
Dr. Alex Dworak: Mm hmm. No, I think that my response is you’re not alone. There are many, many other people who are here standing up alongside you and with you, and I’m one of them. I have hundreds of medical colleagues who share my view that I just personally know that people should be allowed to access this care. And I think a hopeful sign is that I have had so, so, so many young medical students, resident physicians, PA students, NP students, early career physicians who want to learn more about this care, who want be welcoming, who want to make sure that they’re doing this care properly and add it to their skill set.
Jane Coaston: Alex, thank you so much for being here.
Dr. Alex Dworak: Thank you.
Jane Coaston: That was my conversation with Dr. Alex Dworak, Associate Medical Director of Family Medicine at One World Community Health Centers in Omaha, Nebraska. We’ll get to more of the news in a moment, but if you like the show, make sure to subscribe, leave a five-star review on Apple Podcasts, watch us on YouTube, and share with your friends. More to come after some ads. [music break]
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Jane Coaston: Here’s what else we’re following today.
[sung] Headlines.
[clip of Karoline Leavitt] The White House and the President are adamant that this bill is passed and that this bill makes its way to his desk. Republicans need to stay tough and unified during the home stretch and we are counting on them to get the job done.
Jane Coaston: That’s White House Press Secretary Karoline Leavitt, who is very normal and very calm, pushing Republicans to pass Trump’s so-called big, beautiful bill. As of our recording Monday evening Pacific Time, the seemingly endless marathon of voting on proposed amendments was ongoing. Republicans are racing to get the mega-bill of tax breaks for billionaires and Medicaid cuts to Trump’s desk before the fireworks start popping off on Independence Day, which is now just three days away. Democratic Senate Minority Leader Chuck Schumer of New York had a message for his colleagues Monday.
[clip of Chuck Schumer] Senate Republicans have to decide. Choose the American people or bow down to Donald Trump and his coterie of billionaires.
Jane Coaston: And Republican Senate Majority Leader John Thune of South Dakota put his own spin on the bill.
[clip of John Thune] What we are doing here is extending tax relief for the American people, keeping their rates low, making sure they don’t have their child tax credit cut in half, their standard deduction cut in half, including new provisions that provide more relief for working Americans.
Jane Coaston: Ah yes, I can hear working Americans across the country sighing with relief that their health care is now at risk. But there’s still Republican infighting over issues like gutting Medicaid, clean energy, and raising the debt limit by trillions of dollars.
[clip of Majed Bamya] A different reality is possible for Palestine, for Israel, and for the region, a reality of shared peace, security, and prosperity. It starts with ending the genocide, releasing hostages and prisoners, delivering humanitarian aid, and the full Israeli withdrawal from Gaza.
Jane Coaston: Ambassadors from Israel and Palestine engaged in a tense back and forth during a United Nations hearing on the ongoing conflicts in the Middle East on Monday. Deputy Permanent Observer of Palestine to the UN Majed Bamya repeatedly called for a ceasefire and accused Israel of violating UN resolutions. Israel’s Ambassador to the U.N., Danny Danon, responded to Bamya by asking him to disavow Hamas before any talks could move forward.
[clip of Danny Danon] So if you claim that you represent the Palestinian people, be responsible, be brave, and agree with me today that the future of Gaza will not include Hamas.
Jane Coaston: But then Bamya accused Danon of using Hamas as a pretext to avoid a ceasefire with Palestine.
[clip of Majed Bamya] Your systematic killing of Palestinian civilians can never be justified. We are not lesser human beings.
Jane Coaston: Meanwhile, Israeli attacks on Gaza killed at least 60 people on Monday.
[clip of Karoline Leavitt] President Trump will travel to the great state of Florida to attend the opening of a new illegal alien detention center located at Dade Collier Training and Transition Airport alongside Secretary Kristi Noem, Governor Ron DeSantis, Congressman Byron Donalds and other state and local leaders. We hope to see many of you there. The facility is in the heart of the Everglades and will be informally known as Alligator Alcatraz.
Jane Coaston: That’s right. Today, President Trump will personally attend the official opening of Alligator Alcatraz, a brand new institution as preposterously cartoonish as it is cruel. White House Press Secretary Leavitt used some of the administration’s favorite buzzwords during a press conference Monday.
[clip of Karoline Leavitt] The facility will have up to 5,000 beds to house, process, and deport criminal, illegal aliens. This is an efficient and low-cost way to help carry out the largest mass deportation campaign in American history.
Jane Coaston: She sounds so excited, doesn’t she? Florida Republican Governor Ron DeSantis also said he thinks housing migrants in the middle of America’s largest remaining subtropical wilderness is a great idea.
[clip of Ron DeSantis] What will happen is you bring people in there. They ain’t going anywhere once they’re there unless you want them to go somewhere because good luck getting to civilization.
Jane Coaston: Eew. The Trump administration seems to think this is hilarious. Over the weekend, the Department of Homeland Security posted to its Twitter account a photo of alligators wearing immigration and customs enforcement hats with the caption, coming soon. You know, like a serious government agency. The visit comes as CBS News released its analysis of DHS data that found that detentions of immigrants without criminal histories have increased significantly, reporting, quote, “From the first week of May to the first week of June, new ICE detentions of people facing only civil immigration charges, such as entering the country without authorization, rose by over 250%. So to recap, Trump plans to hold migrants without criminal histories in a facility that was built like, a week ago, that is basically intended to be a forever prison guarded by alligators. Sure. The Trump administration accused Harvard University of being in, quote, “violent violation of the Civil Rights Act over its treatment of Jewish and Israeli students.” The accusation came in a letter from the joint task force to combat anti-Semitism Monday. Their note also included a threat to cut off all federal funding to the university unless changes are made. And no, they didn’t say exactly what those changes are supposed to be. A Harvard spokesperson said the university takes anti-semitism seriously and strongly disagrees with the task force findings. This is just the latest escalation in Trump’s months-long battle with the oldest, richest university in America. The administration has already pulled more than $2 billion in federal funding from Harvard, threatened to revoke its tax-exempt status, and attempted to stop international students from enrolling. And that’s the news. [music break]
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Jane Coaston: That’s all for today. If you like the show, make sure you subscribe, leave a review, seriously. Tell your friends, family, neighbors, lovers, haters, and strangers on the street just how bad the big beautiful bill is, and tell your friends to listen. And if you’re into reading, and not just about how despite the Republican spending bill wreaking havoc on health care and food assistance to the benefit of the wealthy, just 48% of Americans have heard anything about it, and just 8% know it would cut Medicaid by billions, like me. What a Day is also a nightly newsletter. Check it out and subscribe at Crooked.com/subscribe. I’m Jane Coaston and folks, you are part of the 48% who know just how ugly this bill is. And if you live in a Republican district, you can make sure they know all about it. [music break] What a Day is a production of Crooked Media. It’s recorded and mixed by Desmond Taylor. Our associate producer is Emily Fohr. Our producer is Michell Eloy. Our video editor is Joseph Dutra. Our video producer is Johanna Case. We had production help today from Greg Walters, Matt Berg, Sean Ali, Tyler Hill, and Laura Newcomb. Our senior producer is Erica Morrison, and our senior vice president of news and politics is Adriene Hill. Our theme music is by Colin Gilliard and Kashaka. Our production staff is proudly unionized with the Writers Guild of America East. [music break]
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