Protesters gathered outside Children’s Hospital Los Angeles in February after President Trump issued an executive order to cut off federal funding for hospitals that provide gender-affirming care to children.
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The Trump administration would dramatically limit access to gender-affirming treatment for transgender youth under a new proposal from the Department of Health and Human Services.
NPR obtained the draft text. proposed rule This would prohibit federal Medicaid reimbursement for medical care provided to transgender patients under the age of 18. It also prohibits reimbursement through the Children’s Health Insurance Program, or CHIP, for patients under 19 years of age.
not Additional Proposed Rules It would go further and block all Medicaid and Medicare funding for all services at hospitals providing pediatric gender-affirming care.
The rule is expected to be released in early November, according to officials at the Centers for Medicare and Medicaid Services. The employee asked that NPR not use his name because he fears professional retaliation for speaking to the press without permission. An HHS spokeswoman did not respond to a request for comment on the timing of the proposed rule.
Almost banned in every state
Transgender rights supporters and opponents alike agree that the upcoming regulations could make access to pediatric gender-affirming care extremely difficult, if not impossible, across the country. Care is already prohibited. 27 states.
“These rules would significantly escalate the Trump administration’s attacks on transgender health care,” it says. katie kissDirector of the Center for Health Policy and Law at Georgetown University.
“I think it’s really important to note that nothing changes instantly,” she explains. “These proposals will be subject to public comment, and it will take several months for the Trump administration to issue a final rule. And if past is prologue, we will likely see litigation no matter what the final rule is.”
management goals
President Trump signed the document on his first day in office. executive order The United States declared that it would not fund, sponsor, encourage, subsidize or support “so-called gender transition of children.”
In the months that followed, HHS published a report Is critical of research supporting access to this treatment. A federal suicide prevention lifeline specifically for transgender youth was canceled. hundreds of millions Funding LGBTQ-related scientific research. Federal health officials warn State Medicaid Director We must tread carefully, and the Department of Justice Subpoena Announcement Some children’s hospitals suppliers under threat With prosecution.
“I think these restrictions are very good,” Terry Schilling said of the upcoming rules. Schilling is chairman. American Principles ProjectConservative advocacy group. “This will change the entire transgender industry and take away a lot of its funding stream.”
He points to opinion poll It found that 66% of the public opposes Medicaid coverage of this type of care for adolescents.
“They believe that if you want to have any kind of sex characteristic modification procedure, you have to pay for it,” Schilling says. “The American people fully support these efforts.”
dramatic new expansion of power
The proposal to condition hospitals’ participation in Medicaid and Medicare on ending gender-affirming treatment for youth would be an “unprecedented” use of the executive branch’s power to control the health care services provided in hospitals, Keith says.
“Because Medicare accounts for a significant portion of many hospitals’ revenue, this rule would essentially force hospitals to discontinue gender care,” she explains. Program for transgender youth. This means it is inaccessible to all patients in that program, regardless of whether they have Medicaid or private insurance.
This is not how the federal government typically uses these types of rules, Keith says. She served in the Biden administration on the Gender Policy Council and “Participation conditions“The rules for Medicare and Medicaid are very basic, like having emergency carts with enough medications to help pregnant women in crisis.”
Instead of health and safety standards, the proposal would direct hospitals to “completely stop providing certain types of care to certain patient populations,” she says.
law professor katie yer A Rutgers University professor questions whether such a rule would survive a court challenge. “If it were successful, I shudder to think what this government would do with such a tool in their hands,” she says. This could open the door for the White House to withhold all federal funding from hospitals for providing care they do not favor.
“The writing was on the wall that this was going to happen,” he says. Lindsey DawsonShe is director of LGBTQ health policy at KFF, a nonpartisan health research organization.
However, the timing of its release has been a mystery for months. Notices of two proposed rules, though not the rules themselves, appeared in government registers over the summer, and it’s unclear why they haven’t been published yet, Dawson says.
‘Obsessive concentration’
The administration’s commitment to transgender issues extends far beyond health policy and youth. The Federal Trade Commission recently Hosted a workshop “Regarding unfair or deceptive trade practices relating to ‘gender-affirming care’ for minors.” The military forcibly expelled transgender soldiers. Universities have been told that federal funding is contingent on adopting anti-transgender policies on issues such as bathroom access.
Even the impending defunding of food assistance (SNAP) is tied to Democrats’ support of “sex mutilation procedures,” the banner says. Department of Agriculture website.
“It’s endless,” says Eyer. “That has been an obsessive focus that has been deployed throughout the administration.”
Warning letters and cancellation of subsidies had a significant chilling effect. In states where the treatment is still legal Many clinics and hospitals I ended my gender reassignment treatment program. If these rules apply, the rest of the program is likely to follow suit.
“There are real people behind all of this,” says Iyer, who is also the parent of a transgender child. “People are truly scared and suffering as a result of the onslaught on the transgender community.”
Although access is decreasing, it is still legal.
Gender confirmation treatments for adolescents, including puberty-blocking drugs, hormones and, in rare cases, surgery, don’t actually violate federal law, Eyer points out. And despite the recent political pressureHowever, no major medical organization in the United States has changed its clinical guidelines supporting these treatments as appropriate and safe.
approximately 3% of American youth Although they identify as transgender or non-binary, not all of them seek treatment related to their identity.
Especially in Utah National commissioned analysis There is evidence that contradicts the Trump administration’s recent transgender report. University of Utah researchers found that there was sufficient evidence for the benefits and safety of these treatments, and wrote that policy restrictions on these treatments for adolescents “cannot be justified on the basis of the quantity or quality of medical research results or concerns about potential future regret.”
The draft text of the proposed federal rule obtained by NPR does not mention the Utah analysis, nor does it cite guidance from the American Academy of Pediatrics. Also support Access to care.
In Eyer’s view, if these rules become public, it will provide an opportunity to challenge them legally.
“It will depend on ‘Arbitrary and capricious’ reviewAnd the courts will probably look closely at the factual basis on which it is based,” she says. “That is actually preferable to what we have been doing so far, which is force without law.”
Diane Webber edited this story.
