The Implications of the Latest Federal Regulations on Transgender Health Care

The United States Department of Health and Human Services recently unveiled a series of new regulations designed to prohibit transgender youth from accessing gender-affirming care. Since Trump stepped into office, a wave of reforms regarding transgender care had already been carried out, including cancelling a federal suicide prevention lifeline for transgender youth and threatening providers of gender-affirming care with prosecution. Furthermore, the House just passed a bill that would subject providers of gender-affirming care to up to 10 years in federal prison and another measure to bar Medicaid payments for gender-related treatments for minors. However, the newest regulations carry the most significant implications. 

The sweeping proposals would cut federal Medicaid and Medicare funding from hospitals that provide gender-affirming care to minors, alongside prohibiting Medicaid funds from being used to fund those procedures. This type of rule is called a condition of participation, a rule typically used to establish the bare minimum of standards for health and safety in hospitals. However, the Trump Administration has used it to cherry-pick one area of medicine to prohibit and withdraw necessary funding for other groups of people if hospitals fail to comply. Currently, at least 27 states have already restricted or banned transgender care, but nearly two dozen states, which allow transgender care to remain legal, would be affected. Additionally, around 45% of hospital spending comes from Medicare and Medicaid, meaning if the proposals were to pass, hospitals that fail to comply would be in danger of shutting down. 

Gender-related treatments for minors, such as hormone therapies and puberty blockers, are still supported by major medical organizations in the US. The American Medical Association has urged states not to restrict their transgender medical services, and the American Academy of Pediatrics condemned the new rules, saying “children and families will bear the consequences.” Many of these groups do not endorse surgery as part of care, which is the aspect the Trump Administration is most worried about, and research shows that surgery is still rare among transgender teens. Yet, the polls show that about half of US adults approve of how Trump is handling transgender care. 

Many families of transgender children find gender-affirming care at children’s hospitals to be a good route, because these hospitals provide interdisciplinary treatment with a team of therapists and psychiatrists to ensure individuals get the full spectrum of care. Thus, these new regulations leave many children in a vulnerable state and may interfere with the private patient-physician relationship. 

A 60-day public comment period will follow, and the new proposals are subject to legal challenges, as the American Civil Liberties Union has already threatened to sue. Law experts at Washington and Lee University stated that the legal challenges will most likely hinge on the first provision of the Medicare statute, which outlines that the federal government “shall not interfere with the practice of medicine.” Even though these rules are only proposals for now, they have already discouraged healthcare providers from offering gender-affirming care to children, and many hospitals ceased these treatments altogether in anticipation of federal action.

Ultimately, these actions reflect the latest signal from the Trump Administration that the government does not recognize the legitimacy of transgender individuals, a stance that could now have detrimental consequences to our nation’s hospitals and patients. Whether the new regulations are deemed to actually protect the “health and safety” of patients will be left to the courts. 

Read more here: 

•  Ali Swenson, Matthew Perrone, and Devi Shastri, AP News

• Selena Simmons-Duffin, NPR

• Stephanie Sy and Same Lane, PBS

• Azeen Ghorayshi, Amy Harmon and Reed Abelson, New York Times