President Donald Trump’s administration has proposed a new set of rules that would prohibit hospitals across the country from providing gender-affirming medical care to transgender youth under 18.
On Thursday, the Centers for Medicare and Medicaid Services (CMS) announced that one of its proposed rules would block hospitals and clinics from accessing the program if they choose to continue providing gender-affirming care.
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The second rule would prohibit federal Medicaid funds from providing gender-affirming procedures.
Medicare and Medicaid are both types of government-provided health insurance that are offered to vulnerable groups. Medicaid primarily covers low-income households, and Medicare provides coverage for older Americans and people with disabilities.
The Trump administration noted in a statement that the vast majority of health care providers work with Medicare and Medicaid to provide health insurance to patients. Therefore, the proposed rule would amount to a de facto ban on gender-affirming care.
“Nearly all U.S. hospitals participate in Medicare and Medicaid,” the CMS statement said.
“This action is designed to ensure that the U.S. government does not do business with organizations that intentionally or unintentionally cause permanent harm to children.”
In addition to the two proposed rules, Health and Human Services Secretary Robert F. Kennedy Jr. signed a proclamation Thursday rejecting gender-affirming care as harmful to youth.
Under his order, the Food and Drug Administration also issued notices to 12 manufacturers of breast binders, warning them that marketing to transgender youth would be considered illegal under the current administration.
Deviation from medical consensus
The series of statements marks the Trump administration’s latest broadside against transgender medical care, despite repeated warnings from top medical groups that banning transgender care could have devastating and lifelong consequences.
But at a news conference Thursday, Kennedy, who has no formal medical training, slammed some of the country’s leading medical organizations for violating their professional obligations.
“The American Medical Association and the American Academy of Pediatrics have perpetuated the lie that chemical and surgical gender-denial treatments can be effective for children suffering from gender dysphoria,” Kennedy said.
“They have betrayed the Hippocratic oath to do no harm. So-called gender-affirming care has caused lasting physical and psychological damage to vulnerable young people. This is not medicine. It is medical malpractice.”
CMS Director Mehmet Oz similarly accused health care providers of abusing patients’ trust by prescribing gender-affirming treatments. He suggested that the motive was not the patient’s health, but rather profit.
“Doctors can’t look them in the eye and treat them like children who are confused and lost and need help. They become an opportunity. They end up being a victim,” Oz said.
“Reasonable, evidence-based objections, even common sense, that children’s confusion may resolve over time have been ignored.”
The Trump administration has taken a hard line against the transgender community, denying that such identities even exist.
Instead, upon taking office on January 20, President Trump issued an executive order announcing that the federal government would recognize only the concept of biological sex, not gender identity, and that people would be classified as male or female according to their birth certificate.
The executive order also rejected transgender identity as a “false” concept.
“Problems that don’t exist in reality”
Eight days later, on January 28, President Trump followed up on that executive order by calling on the Department of Health and Human Services (HHS) to end what the agency called the “chemical and surgical mutilation of children.”
The order was cited as the basis for Thursday’s proposed rules and proclamation to limit gender-affirming care.
However, there is broad consensus within the medical community that gender-affirming care can improve the health of transgender youth, including reducing the incidence of suicide, anxiety, self-harm, and depression.
Gender-affirming care takes many forms, from surgery to puberty blockers, which are safe and reversible treatments for children who want to delay the onset of puberty.
Such treatments are only recommended after thorough consultation with a trusted medical professional, and surgeries are extremely rare among transgender youth.
A 2024 Harvard University study found that for every 100,000 adolescents ages 15 to 17, an average of 2.1 adolescents sought gender reassignment surgery based on 2019 medical insurance claims.
For teens ages 13 to 14, the average dropped to 0.1, and no cases were reported for anyone under 12.
Danny Dye, one of the study’s authors, said in a news release that the results suggest that “laws that block gender-affirming care for TGD youth are not designed to protect children and are rooted in bias and prejudice.”
Dye added that these government actions are aimed at “addressing a perceived problem that doesn’t actually exist.”
Immediately after Thursday’s announcement, groups such as the Human Rights Campaign called on the public to voice their concerns about the new rules proposed by the Trump administration.
“These rules currently have a 60-day ‘comment period’ during which you can express your views,” the Human Rights Campaign wrote on social media.
“Many comments can delay work, force changes, or lay the groundwork for future litigation. Your comments start it.”
Congressional action underway
Already, 27 states, including major population centers such as Texas, Ohio and Florida, have banned gender-affirming care for minors.
As a result, the Human Rights Campaign estimates that nearly 40 percent of the 300,000 transgender youth in the United States live without access to the medical care they need.
These state actions have been supported by actions at the federal level. In June, the Supreme Court’s conservative majority voted 6-3 to uphold Tennessee’s ban on gender-affirming care for minors.
Just this Wednesday, the U.S. House of Representatives passed a bill that would make it a crime to provide gender-affirming care to patients under the age of 18. A total of 216 senators, including several Democrats, voted to send the bill to the Senate, where its passage is uncertain.
Another House bill aimed at ending Medicaid benefits for transgender youth seeking gender-affirming care is scheduled for a vote Thursday.
Advocates worry that young people will make medical decisions they later regret, but stress that some gender-affirming treatments, including puberty blockers, are reversible and can protect teens from physical and psychological harm.
Rep. Sarah McBride, the first openly transgender member of Congress, stood on the steps of Congress and said she believed there was a gap in the public’s understanding of gender-affirming treatment.
“I understand that it’s difficult to understand this care and understand the need for it,” McBride told reporters. “But one of the things that is so forgotten in this conversation is that today’s transgender adults were once children. I was once a child, too.”
“My biggest regret in life is not having that pain-free childhood,” she continued.
Ms McBride voted against the bill, saying she felt it was motivated by “hate.” “Politicians should never interfere in the personal medical decisions of patients, parents, and health care providers. That includes trans Americans,” she later wrote on social media.
Meanwhile, President Kennedy told reporters that he expected lawsuits would be filed against the Trump administration’s proposed changes.
“I think it will happen. I can’t even count the number of lawsuits that have my name mentioned right now,” he said.
He added that the Trump administration is confident it will prevail in any case. “It’s shameful for the medical establishment to have let this go for so long.”
