Following through on an executive order signed in January, the Trump administration on Dec. 18 issued multiple proposed rules intended to comprehensively ban gender-affirming care for youth.
The Department of Health and Human Services (HHS) announced that the Centers for Medicare and Medicaid Services would require hospitals participating in Medicare and Medicaid programs to bar what the administration describes as “sex-rejecting procedures” — or gender-affirming care — on individuals under the age of 18. A press release issued by HHS on Dec. 18 said the Centers for Medicare and Medicaid Services would also issue a proposed rule banning federal Medicaid funding for gender-affirming care for minors. The same ban, according to the administration, would apply to federal Children’s Health Insurance Program (CHIP) funding for gender-affirming care procedures on individuals under age 19.
Furthermore, the Food and Drug Administration (FDA) is delivering warnings to a dozen manufacturers and retailers, accusing them of illegally marketing breast binders for youth to treat gender dysphoria.
“Breast binders are Class 1 medical devices used for purposes such as assistance in recovery from cancer-related mastectomy,” the press release notes. “The warning letters will formally notify the companies of their significant regulatory violations and how they should take prompt corrective action.”
HHS Secretary Robert F. Kennedy, Jr., described his agency’s actions as an effort to stop “unsafe, irreversible practices.”
The administration’s attacks on gender-affirming care come nearly a year after President Donald Trump signed an executive order entitled “Protecting Children from Chemical and Surgical Mutilation,” which called to ban federal funding for gender-affirming care for individuals under the age of 19 and direct the Health and Human Services (HHS) secretary to “take all appropriate actions to end” gender-affirming care, “including regulatory and sub-regulatory actions.”
The latest proposed rules also come one day after the GOP-led House of Representatives passed a bill banning gender-affirming care for youth, though that legislation is destined to fail in the Senate.
In a video address to transgender New Yorkers, New York Attorney General Letitia James acknowledged that the administration’s latest effort to restrict gender-affirming care for youth is “frightening.” James has aggressively defended gender-affirming care throughout the year, beginning in February when she warned New York-based providers that withholding such care is against New York anti-discrimination law.
“As of now, nothing has changed,” James said in the video on Dec. 18. “Your healthcare is still legal and protected. And your doctors cannot cut off your access to gender-affirming care based on the administration’s reckless proposal.”
In a separate written statement, James said Trump “would rather target young people than lower costs or expand access to health care” and called it “reprehensible” that the federal government is attacking young people who the government should be protecting.
Legal groups, including the American Civil Liberties Union (ACLU), vowed to challenge the administration’s attacks on trans care.
“We have seen the devastating consequences of similar policies at the state level, and we have fought them every step of the way,” Chase Strangio, co-director of the ACLU’s LGBTQ & HIV Rights Project, said in a written statement. “Let us be clear: If this administration moves forward with this attempt to enact a national ban on our medical care through coercion, the ACLU will see them in court. We will not rest until the rights of transgender youth to live authentically and access the care they need are fully protected.”
Jennifer Levi, senior director of transgender and queer rights at GLBTQ Legal Advocates & Defenders (GLAD Law), said parents of trans youth want the same thing other parents want: to see their kids thrive with the medical care they need.
“But this Administration is putting the government between patients and their doctors. Parents witness every day how their children benefit from this care—care backed by decades of research and endorsed by major medical associations across the country. These proposed rules are not based on medical science. They are based on politics. And if allowed to take effect will serve only to drive up medical costs, harm vulnerable children, and deny families the care their doctors say they need. These rules elevate politics over children—and that is profoundly unAmerican.”
The National Center for LGBTQ Rights’ (NCLR) legal director, Shannon Minter, said NCLR stands with the parents and families impacted by the administration’s actions.
“We stand with parents and families against Trump administration efforts to dictate personal medical decisions,” Minter said. “These rules wage an attack on the lowest income Americans’ ability to access health care and cruelly seek to cut off health care for all transgender youth. Starting tomorrow, members of the public will have 60 days to submit comments raising concerns or issues with the proposed rules. NCLR urges families, advocates, medical professionals, health experts and others to submit comments opposing these dangerous rules.”
All proposed rules go through a standard commenting process to allow the public to offer suggestions. Lambda Legal, a national LGBTQ legal group, called on the public to make their voices heard.
“It is important to remember that these rules are not in effect today,” Sasha Buchert, director of the Non-Binary and Transgender Rights Project at Lambda Legal, said in a written statement. “They are merely proposals with a notice and comment process ahead, so we don’t even know what their final form will take. We encourage all to use the comment portals provided to let HHS know just how dangerous and cruel these proposed regulations are, and how unconscionable it is for this administration to hold affordable critical healthcare hostage — all in service of this Administration’s campaign to erase transgender people from existence.”
New York City Health + Hospitals, the largest municipal health care system in the US, did not immediately respond to a request for comment for this story.
