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SB163: The Most Explosive Bill of 2023 Nevada Legislature, Part III

(Chuck Muth) – OK, with the stage set from Part 1 and Part 2 of this series, let’s get into the meat of Senate Bill 163; an act “requiring certain health insurance to include coverage for the treatment of conditions relating to gender dysphoria and gender incongruence…”

What makes this bill so difficult to analyze objectively – especially for me and the average Nevada voter – is that it’s not just a policy bill.

There are also significant medical, legal, and political aspects to consider – and the language used in the bill makes it even harder for anyone who’s not a doctor or a lawyer to comprehend.

Indeed, what the heck is “gender dysphoria” and “gender incongruence,” right? And then there’s the legalese in the bill language itself; written by lawyers, for lawyers.

Seriously, I could tell you to read the bill; however, after three days of doing that myself, my head still hurts from trying to make sense of it. But lemme give it my best shot…

As best as I can determine, understanding this bill rests on understanding three terms: “gender dysphoria,” “medically necessary,” and “cosmetic surgery.”

Gender dysphoria is defined in the bill as…

“Distress or impairment in social, occupational or other areas of functioning caused by a marked difference between the gender identity or expression of a person and the sex assigned to the person at birth…”

So right away, we know this is BS.  As noted in Part 1, people aren’t “assigned” their gender at birth.  You’re either born a boy or a girl.  Period.

And let’s face it, some people are born morons – you know, like Jon Ralston.  They’re not “assigned” stupidity at birth.  That defect came with the package.

So does that mean we invent an “intelligence dysphoria” medical condition and cover stupidity in health insurance policies?  Gimme a break.

But I digress.

The bill goes on to define gender dysphoria as “a strong desire to be rid of primary or secondary sex characteristics because of a marked difference between such sex characteristics…”

It also includes “a strong desire for the primary or secondary sex characteristics of the gender opposite from the sex assigned at birth.”

This used to be called, in layman’s terms, “penis envy.”  Which reminds me of an old joke…

A boy and girl played a little “you show me yours; I’ll show you mine” behind the barn. 

The little boy looked at the little girl and said, “Ha-ha, I have one of these and you don’t.”

To which the little girl replied, “So what?  With one of these I can get all of those I want.”

But I digress.

SB163 goes on to require that “medically necessary” treatments of “gender dysphoria” be covered by health insurance policies, which includes “psychological and surgical intervention and any other medically necessary treatments” provided by, among others, social workers, psychiatrists, psychologists and…speech-language pathologists?

What the heck?

So what does “medically necessary” mean according to SB163?

It means “health care services that a prudent provider of health care would provide to a patient to prevent, diagnose or treat an illness, injury or disease, or any symptom thereof, that are necessary” and is “required to improve a specific health condition” and “not provided for the convenience of the patient.”


Being a man who wants to be a woman, or vice-versa, doesn’t seem to me to be an illness, injury, or a disease.  But then again, I’m not a doctor, lawyer, or liberal trans-radical activist like Ralston.

The bill goes on to stipulate that insurance companies are not required to cover “cosmetic surgery performed by a plastic surgeon that is not medically necessary.”

Cosmetic surgery is defined as a surgical procedure that “does not meaningfully promote the proper function of the body; does not treat illness or disease; and is primarily directed at improving the appearance of a person.”

In other words, to people like you and me, a sex change operation isn’t “medically necessary,” but a “cosmetic” surgical procedure.

After all, a sex change operation isn’t done to “promote the proper function of the body” – all the body parts are already working as designed – does not treat an illness or disease, and is clearly done to change – in their minds, improve – their appearance.

In other, other words, whether or not health insurance companies will be required to provide coverage for sex change operations in this bill will come down to whether or not the courts construe such procedures as “medically necessary” or “cosmetic.”

I think you know where this is going.  But I’ll get to that in the fourth and final installment of this series tomorrow.


“You have a perfect right to believe in unprovable essences that may or may not match the sexed body, but the rest of us have a right to disagree, and to refuse to adopt your jargon.” – Harry Potter author, J.K. Rowling

Mr. Muth is president of Citizen Outreach, publisher of Nevada News & Views, and founder of You can sign up for his conservative, Nevada-focused e-newsletter at  His views are his own.


This blog/website is written and paid for by…me, Chuck Muth, a United States citizen. I publish my opinions under the rights afforded me by the Creator and the First Amendment to the United States Constitution as adopted by our Founding Fathers on September 17, 1787 at the Constitutional Convention in Philadelphia, Pennsylvania without registering with any government agency or filling out any freaking reports. And anyone who doesn’t like it can take it up with George Washington, Thomas Jefferson, Ben Franklin and John Adams the next time you run into each other.

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