(Washington) The US Department of Health and Human Services on Thursday unveiled a series of regulatory measures aimed at de facto banning gender-affirming care for minors, continuing the broader restrictions imposed by the Trump administration on trans people.
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These sweeping proposals – the most significant steps taken yet by this administration to limit the use of puberty blockers, hormone therapy and surgical procedures for trans children – include eliminating federal Medicaid and Medicare funding for hospitals providing gender-affirming care to children, as well as banning the use of federal Medicaid funds for such interventions.
More than half of U.S. states already ban or restrict gender-affirming care. However, Thursday’s announcement jeopardizes access to this care in nearly two dozen states where drug treatments and surgical procedures remain legal and funded by Medicaid, which includes federal and state funds.
These proposals, to be announced by Secretary Robert F. Kennedy Jr. and his deputies, are neither final nor legally binding.
PHOTO ANDREW CABALLERO-REYNOLDS, AGENCE FRANCE-PRESSE ARCHIVES
U.S. Health Secretary Robert F. Kennedy Jr.
The federal government must go through a lengthy rulemaking process, including periods of public comment and rewriting of documents, before restrictions become permanent. These measures also risk being subject to legal challenges.
However, the proposed rules risk further intimidating health professionals and deterring them from providing gender-affirming care to children.
Many hospitals have already stopped caring for these patients in anticipation of federal intervention.
Nearly all U.S. hospitals participate in the Medicare and Medicaid programs, the federal government’s largest health insurance plans, which cover the elderly, people with disabilities, and low-income Americans. Losing access to this funding would put most U.S. hospitals and healthcare professionals at risk.
The same funding restrictions would apply to a smaller health program, the State Children’s Health Insurance Program, according to a federal notice released Thursday morning.
This approach contradicts recommendations from most major U.S. medical organizations, including the American Medical Association, which has urged states not to restrict care for people with gender dysphoria.
Young people who persistently identify with a gender different from the one they were assigned at birth are first assessed by a team of professionals. Some may undertake a social transition, involving a change in hairstyle or pronouns.
Patients may subsequently be given hormone-blocking medications to delay puberty, followed by testosterone or estrogen to induce the desired physical changes. Surgery is rare in minors.
Medicaid programs currently cover gender-affirming care in just under half of U.S. states. At least 27 states have passed laws restricting or banning this care. Federal judges struck down the bans in Arkansas and Montana, ruling them unconstitutional. Legal battles continue in these states.
Rodrigo Heng-Lehtinen, vice-president of The Trevor Project, called the changes “a uniform directive imposed by the federal government” to a decision that should be a dialogue between doctor and patient.
“The multitude of efforts by federal lawmakers to deprive trans and non-binary youth of the health care they need is deeply disturbing,” he argued.
