The Trump administration is backing off an attempt to force hospitals across the country – even those in blue states – to stop providing gender-affirming care to trans minors in a victory for trans rights and for the medical associations that opposed the proposed rule.
In December, the Centers for Medicare and Medicaid Services (CMS), which is directed by political appointee Mehmet Oz, announced a proposed rule to ban any hospital in the United States from getting funding through Medicare and Medicaid if they provide transgender health care to minors.
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Medicaid and Medicare account for about 45% of hospital revenue in the U.S., and one expert said that losing that funding would be a ” death sentence” for any hospital. If the rule were implemented and enforced, hospitals would likely stop providing gender-affirming care to trans youth.
But an official document obtained by NPR this week shows the administration backing off the new rule. It’s “a victory for people who are defending the rights and interests of trans people,” former Department of Health and Human Services (HHS) general counsel Sam Bagenstos told NPR. “But I don’t think it indicates a more general retreat from the aggressive posture of the Trump administration.”
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The proposed rule received over 30,000 public comments in the past seven months, including comments from the American Medical Association and the Children’s Hospital Association pressing CMS to drop the rule. Major medical associations back gender-affirming care for trans youth as the standard of care for gender dysphoria, as it has been shown through research to be life-saving and effective.
CMS refused to comment on the withdrawal of the proposed rule, saying it “does not comment on future rulemaking or speculate on potential actions.”
“The Trump Administration rejects ideologically driven surgical interventions on vulnerable children,” the agency’s statement continued. While surgery is rarely a part of gender-affirming care for trans minors – only some older teens who meet stringent requirements can at times access surgery – Republicans tend to focus on it and say that children as young as 5 years old are getting operated on. The point is to spread misinformation in order to drum up public opposition to such health care.
The federal government often uses the threat of losing Medicare and Medicaid funding to enforce policy measures on hospitals and states. But Bagenstos, who is now a professor of law at the University of Michigan, pointed out that these “conditions of participation” have historically been limited to basic health and safety standards, not imposing ideological policies. The proposed rule would have changed that, since it was focused on banning certain types of people from accessing certain medical interventions that would still be available to others in an attempt to impose the president’s view of what sex and gender are.
“It violates the Medicare Act, which says that Medicare and Medicaid can’t be used to control the practice of medicine within the state — states get to regulate the practice of medicine,” Bagenstos said. Nevertheless, the Supreme Court has issued several anti-trans rulings in the past few years, including a ruling against trans youth health care access in U.S. v. Skrmetti. SCOTUS has overall been very deferential to the Trump administration.
Trans people often experience gender dysphoria, or distress caused by one’s body not aligning with one’s gender identity. Going through the wrong puberty (e.g., getting breasts as a boy or wide shoulders and a deep voice as a girl) can affect a teen’s mental health. Conservatives argue that they want trans youth to wait until they’re adults – and sometimes well into adulthood – before making any “permanent changes” to their bodies, but the permanent changes that come with puberty start well before legal adulthood.
Alexa, a trans woman from Indiana, described “how uncomfortable I felt in my own skin” when she was in high school and knew that she was transgender. She said that her gender dysphoria led to an attempt to take her own life.
“In the weeks before I came out, I laid awake at night begging God to kill me because I was afraid I wouldn’t be accepted or loved for who and what I am,” she said. But she was supported by her family after she told them that she’s trans, and she was able to access gender-affirming care, which involved hormone therapy.
“Since I had started gender affirming hormone therapy, my mental health improved,” she said. “My struggles with suicidal ideation started to disappear into the background like a sunset on the beach. I wanted to live. I wanted to go on… I finally could envision myself growing old.”
“The hormones didn’t change my brain, they changed my body to finally match my brain. And, the more I saw the real me in the mirror, the more my anguish faded. Gender affirming health care literally saved my life.”
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