The U.S. Department of Health and Human Services on Thursday announced a series of regulatory actions aimed at effectively banning gender-affirming care for minors, building on the Trump administration's sweeping restrictions on transgender Americans.
The sweeping proposals (the administration's most significant steps to date to limit puberty blockers, hormone therapy, and surgical interventions for transgender children) include cutting off federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to children and prohibiting the use of federal Medicaid funds to fund such procedures.
“This is not medical care. This is medical malpractice,” Secretary of Health Robert F. Kennedy Jr. said at a Thursday press conference regarding gender affirmation procedures for children.
“Gender-denial treatment robs children of their future.”
Thursday's announcement would jeopardize access in about two dozen states where drug treatments and surgeries remain legal and are funded by Medicaid, which includes federal and state funds.
This proposal goes against the recommendations of most major U.S. medical organizations. Advocates for transgender children also strongly disputed the administration's claims about gender-affirming care, saying Thursday's action would put lives at risk.
“The numerous efforts by Congress to deprive transgender and non-binary youth of necessary health care are deeply disturbing,” said Rodrigo Hen-Lehtinen of the Trevor Project, a nonprofit suicide prevention organization for LBGTQ+ youth, calling the changes a “uniform mandate from the federal government” regarding decisions that should be made between doctors and patients.
Proposed rules would pose a threat in states where gender-affirming care for youth remains legal
Currently, Medicaid programs cover gender-affirming care in just under half of states. At least 27 states have adopted laws that limit or prohibit this care. The Supreme Court's recent decision upholding Tennessee's ban means most other state laws are likely to remain in place.
The proposals announced by Kennedy and his representatives are not final or legally binding. The federal government must go through a lengthy rulemaking process, including a period of public comment and rewriting, before the restrictions become permanent. They are also likely to face legal problems.
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However, the proposed rule would likely further intimidate health care providers from providing gender-affirming care to children, and many hospitals have already discontinued such care in anticipation of federal action.
Nearly all hospitals in the United States participate in the Medicare and Medicaid programs, the federal government's largest health care programs for elderly, disabled, and low-income Americans. Losing access to these payments would put most hospitals and health care providers in the United States at risk.
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A federal notice posted Thursday morning says similar funding restrictions apply to the State Children's Health Insurance Program, a smaller health care program, when it comes to caring for people under 19.
President Kennedy also announced Thursday that the HHS Office of Civil Rights will propose a rule that would exclude gender dysphoria from the definition of disability.
In this regard, the Food and Drug Administration has issued warning letters to more than a dozen companies that sell chest vests and other devices used by people with gender dysphoria. Manufacturers include GenderBender LLC of Carson, Calif., and TomboyX of Seattle.
The FDA's letter states that breast binders can only be legally sold for FDA-approved medical uses, such as recovery after mastectomy surgery.
The move goes against advice from medical institutions and transgender advocacy groups.
Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services, on Thursday called transgender treatment “a Band-Aid for a deeper medical condition” and suggested that children with gender dysphoria are “confused, lost and in need of help.”
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Polls show that many Americans agree with the administration's position on this issue. An Associated Press-NORC Center for Public Affairs Research poll conducted in May found that about half of American adults support President Trump's handling of transgender issues.
Chloe Cole, a conservative activist known for speaking out about gender reversal, expressed her gratitude at a press conference. She said the cries for help for herself and others in the same situation were “finally being heard.”
But this approach contradicts the recommendations of most major U.S. medical organizations, including the American Medical Association, which urges states not to restrict treatment for gender dysphoria.
“The Trump administration is forcing health systems to choose between providing life-saving care to LGBTQ+ youth or accepting critical federal funding as part of an effort to increase hospitals' participation in the government's anti-LGBTQ policies,” Dr. Jamila Perritt, a Washington-based obstetrician-gynecologist and president and CEO of Physicians for Reproductive Health, Inc., said in a statement.
“This is a lose-or-lose situation where lives are at stake.”
Actions build on larger efforts to limit transgender rights
The announcement follows a series of actions by President Donald Trump, his administration, and Republicans in Congress targeting the rights of transgender people across the country.
On his first day in office, President Trump signed an executive order declaring that the federal government recognizes only male and female as permanent genders. He also signed an order aimed at ending federal support for gender transition for people under 19 and banning transgender athletes from participating in girls' and women's sports.
On Wednesday, the United States passed a bill that would make transgender health care providers subject to prison terms if they treat people under 18.
It goes to the House of Representatives and then to the Senate. Another bill being considered in the House Thursday would ban Medicaid coverage of gender-affirming care for children.
Young people who permanently identify with a gender other than the one assigned at birth are first evaluated by a team of experts.
Some may attempt social transitions, such as changing their hairstyle or pronouns. Later, some people are given hormone blockers to delay puberty, followed by testosterone or estrogen to bring about the desired physical changes in the patient. Minors rarely undergo surgery.
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