Lawmakers in the Maine House narrowly approved a bill Friday that would require MaineCare to cover gender-affirming care.

Gov. Janet Mills four years ago added coverage of gender-affirming care, including mental health counseling, surgery and hormone treatments under the state’s Medicaid program.

But L.D. 1040, sponsored by Rep. Matt Moonen, D-Portland, would codify that rule into law, in large part so that a future administration could not easily eliminate the coverage. Fifteen states already restrict gender-affirming care for people under 18, and 18 other states, including New Hampshire and New Jersey, are considering bans on gender-affirming care for minors, according to Human Rights Watch.

That comes even as age-appropriate, gender-affirming care has been endorsed by major medical associations across the country, including the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics and the American Public Health Association.

Moonen said the fact that many Republican-led states are working to restrict gender-affirming care is all the more reason for Maine to act.

The House voted 75-65 in a party-line vote. The bill now goes to the Senate.

Prior to Friday’s action, one House member compared gender-affirming care to “choosing Satan’s will,” a comment that later drew condemnation from a fellow Republican.

Rep. Michael Lemelin, R-Chelsea, spoke at length about his opposition to the bill and repeated arguments that have been made here and elsewhere that dehumanize transgender individuals.

He said providing gender-affirming care, “insults our god,” and went on to say that, “Gender is not a choice. It was given to us as a gift from god.”

Lemelin further complained about Christians like him being persecuted for their beliefs, at which point other members objected. He closed his remarks by saying he opposed the bill “because of love not hate.”

When Lemelin finished, Rep. David Boyer, R-Poland, rose to criticize his colleague’s remarks.

“I have a trans loved one and I know (others). It hurts my heart to think if they are listening right now, or in this chamber, being told they are evil. This issue is more nuanced.”

Boyer said while he has concerns about the bill and others related to trans care, he urged lawmakers to “speak with a little more compassion and empathy.”

Rep. Michele Meyer, D-Eliot, said the rule that has been in place since 2019 “has helped hundreds if not thousands of our constituents to live fuller more rewarding lives in which they can truly be themselves.”

Rep. Jane Pringle, D-Windham, who is a physician, fact-checked some of Lemelin’s false assertions, including that gender is binary. She also encouraged her colleagues to read the book “Becoming Nicole,” by Amy Ellis Nutt, which tells the story of Maine native and transgender actor and activist Nicole Maines.

Another bill related to gender-affirming care has yet to be voted on in the House or Senate.

L.D. 535, sponsored by Rep. Erin Sheehan, D-Biddeford, would allow a minor who is at least 16 years old to receive gender-affirming hormone therapy without parental consent. That bill narrowly won passage in committee last month.

Although it would allow care for older teens without their parents’ consent, there are certain conditions that would have to be met.

First, they must be diagnosed with gender dysphoria, a term for when a person’s biological sex and gender identity do not align. Second, they must be experiencing or are expected to experience harm from not receiving gender-affirming hormone therapy. And third, the minor must receive certain detailed information and counseling from a health care professional prior to providing written consent.

Lawmakers approved a bill this week, L.D. 1507, that allows married individuals to apply to the state’s Registrar of Vital Statistics for a new marriage certificate reflecting a change of gender.