A new Tennessee bill poses an interstate health care nightmare. If an insurance provider covers gender-affirming care in another state—like hormone therapy in New York, or breast reduction surgery in Illinois—that provider could be cut off from the 1.7 million Tennesseans who use the state’s Medicaid program.

The bill, HB1215, is just one of several recent efforts by lawmakers that target insurance, when used for gender-affirming care. In Florida, Wyoming, Kentucky, and Arkansas, proposed legislation would hit doctors, employers, and patients, who rely on longstanding insurance programs.

“This attempt to try to limit health insurance, particularly for providers and health insurance from companies is just going to [cost] more money and delay more things in court, because we’ve known for well over a decade that health insurance has explicitly said gender-affirming care is included in health care,” Shelby Chestnut, executive director of the Transgender Law Center told The Daily Beast.

Tennessee’s HB1215 was introduced in early February. Under the bill, Tennessee’s Medicaid program, TennCare, will no longer contract with health providers that cover gender-affirming care, even if the treatment takes place out of state.

“We’re also seeing lots of bills that would prevent any kinds of public funds like Medicaid or public facilities including doctors and hospitals from being able to be used to provide gender affirming care,” Cathryn Oakley, the Kentucky legislative director for the Human Rights Campaign told the Associated Press shortly after the bill’s unveiling.

One week before the Tennessee bill’s introduction, Wyoming’s Senate introduced its own bill that would block doctors from providing minors with gender-affirming care, including temporary treatments like hormone blockers. If enacted, the bill would suspend or revoke licenses of doctors who provided those treatments. It would also prohibit insurance companies from covering any gender-affirming procedures for minors.

The Tennessee and Wyoming bills come amid a maelstrom of anti-LGBTQ legislation. More than 300 such bills have been introduced in statehouses this year, according to the Human Rights Campaign; about 150 of those bills would curtail rights for transgender people.

Medical experts overwhelmingly recommend gender-affirming care for transgender youth. A 2020 study of 11,914 transgender and nonbinary people in their teens and early 20s found a significant drop in depression and suicide attempts among young people who received gender-affirming care, especially when those people were supported by their parents.

Nevertheless, lawmakers have used concerns about transgender youth as part of a larger broadside against gender-affirming care for people of all ages.

“I think it’s a blanket fear-mongering tactic,” Chestnut said. “It is concerning the lengths lawmakers are going to criminalize not only young people and their parents and their health care providers.”

One new bill, introduced in Kentucky on Tuesday, is nominally about blocking young people from gender-affirming health care and mental health care. It requires teachers to alert parents if kids use new pronouns but it also lays the groundwork for a wider attack on insurance for transgender people in the state.

The bill would “establish liability provisions if an insurer elects to cover gender transition services” and amend Kentucky law “to prohibit a fully insured benefit plan or self-insured plan for public employees from covering gender transition services for a person under the age of 18 years.”

Health-care providers would also be required to report anyone who provides gender-affirming care to minors, or face criminal charges. The bill is being fast-tracked through the Kentucky legislature, the Louisville Courier Journal reported.

The Kentucky bill’s language about liability comes amid an interstate effort to make gender-affirming care risky for doctors who provide it. A new Arkansas bill would allow people who received gender-affirming care as minors to sue doctors for malpractice up until age 48. The bill would greatly increase doctors’ liability, making it difficult for them to obtain their own insurance, the Associated Press reported.

In Florida, meanwhile, lawmakers have penned legislation that would make employers liable for costly disputes over gender-affirming care. On Monday, Florida’s Senate introduced a bill that would require employers who pay for gender-affirming care to pay for “treatment that reverses gender dysphoria treatment,” if the patient wants it later, regardless of whether the patient is still an employee.

“Woke businesses need to be held accountable when offering to pay for gender affirming surgeries in other states, such as California, because they are nothing more than political decisions masquerading as health care and human resource decisions,” the bill’s sponsor, Sen. Blaise Ingoglia announced in a statement.

Florida banned state Medicaid coverage for gender-affirming care in 2022.

“The healthcare field, as a whole, is bursting at its seams right now,” Chestnut said, citing the strain that COVID-19 placed on doctors. “Add in the increased discrimination you’re seeing across the country: the criminalization of transgender people, and parents, and medical providers—now they’re trying to come for insurance.

“It’s just going to greatly lessen people’s safety in going to the doctor.”