Gov. Tim Walz issued an executive order Wednesday protecting access to gender-affirming health care for transgender Minnesotans, a direct response to recent legislative action in states such as Iowa and South Dakota to ban that care for children and their families.

"It's being led by bullies, and I say this as a teacher, we cannot stand bullies," the DFL governor said during a signing ceremony for the order. "Nothing to gain for themselves, not following any factual data, and essentially using the state apparatus to bring cruelty."

The order aims to make Minnesota a refuge for people seeking health care designed to affirm their gender identity by protecting patients and providers from extradition orders and keeping their data private. State agencies will communicate with health care systems about the requirements under the order.

Its aim is similar to proposals introduced in the DFL-controlled Legislature, but supporters said the recent proposals in other states prompted the need for an emergency action as the bills make their way through the process.

"This situation is escalating too rapidly in the United States against trans and gender- expansive people to not use every tool we have to protect people," said Rep. Leigh Finke, DFL-St. Paul, Minnesota's first transgender legislator, who is sponsoring the measure.

On Tuesday, the Iowa Senate passed a proposal to ban doctors in the state from performing gender-affirming surgeries, as well as from providing hormone therapy and puberty blockers to someone younger than 18. Eight states have passed laws or policies banning gender-affirming care, led by Republican lawmakers who argue the policies protect children and families from permanent changes they could regret later.

"So-called 'gender-affirming health care' is in reality a way in which the medical establishment victimizes vulnerable young people, often with lifelong negative health effects," said John Helmberger, CEO of the Minnesota Family Council, a Christian advocacy group.

The American Medical Association recently sent a letter to the National Governors Association urging state leaders to oppose proposals dictating care between physicians and patients, calling gender-affirming care "medically necessary" for transgender people "who face increased risk of anxiety, stress, substance use disorder and suicide."

Dr. Kelsey Leonardsmith, who provides gender-affirming care at the FamilyTree Clinic in Minneapolis, said they've seen desperate families relocating to Minnesota to prevent disruptions in their children's care.

"Our staff, many of whom are themselves transgender people, are fielding heartbreaking calls from families ... who are terrified," she said. "It's just horrifying that in 2023, families are being made refugees within the United States of America."

Minnesota was the first state to spell out protections for transgender individuals in the human rights act three decades ago.

Under the governor's executive order, the state will investigate and take administrative actions in cases where someone was denied gender-affirming health care services, and state agencies will issue a joint bulletin to health plans on health insurance coverage and benefits for gender-affirming health care services. The order is effective 15 days after being signed.

Hao Nguyen came to the Capitol on Wednesday with his 6-year-old daughter Asher, who is transgender. She clutched an oversized teddy bear throughout the news conference and grinned for the cameras. It's her spring break this week, he said, so she asked: "Do I have to see the governor today?"

"All she wants is to be loved; all she wants is to be cared for," said Nguyen, who added that he's feared having to move away if Minnesota banned gender-affirming care. "All she wants is that protection, to be happy, to be carefree, to have the gall to say, 'I'm not seeing the governor today.' "