Transgender youth health care would be nearly banned everywhere under new rules : Shots

Access to gender-affirming care for transgender youth would be sharply limited by the Trump administration under new proposals from the Department of Health and Human Services.

NPR received draft text proposed rule it would prohibit federal Medicaid reimbursement for health care provided to transgender patients under 18 years of age. It also prohibits reimbursement through the Children's Health Insurance Program, or CHIP, for patients under age 19.

An additional proposed rule would go further by blocking all Medicaid and Medicare funding for any hospital services that provide pediatric gender-affirming care.

The rules are being prepared for public release in early November, according to a Centers for Medicare and Medicaid Services official. The employee asked NPR not to use his name because he feared professional retribution for speaking to the media without permission. An HHS spokesman did not respond to a request for comment on the planned timing of publication of the proposed rules.

Almost banned in all states

Both supporters and opponents of transgender rights agree that, taken together, the upcoming rules could make access to pediatric gender-affirming care across the country extremely difficult, if not impossible. Grooming is already prohibited in 27 states.

“These rules would be a significant escalation of the Trump administration's attacks on transgender people's access to health care,” he says. Katie KeithDirector of the Center for Health Policy and Law at Georgetown University.

“I think it’s really important to note that nothing changes overnight,” she explains. “These will be proposals that will be put out for public comment, the Trump administration will take months to come up with a final rule, and then, if past is prologue, we will see litigation over the final rules.”

Administration goals

In his first days in office, President Trump signed decree stating that the United States “will not fund, sponsor, promote, assist or support the so-called 'transition' of a child from one gender to another.”

Months later, H.H.S. published a report is critical of research supporting access to this care. Federal Suicide Prevention Lifeline specifically for transgender youth was canceledas it was hundreds of millions dollars to fund LGBTQ-related research. Federal health officials warned State Medicaid Director proceed with caution, and the Ministry of Justice issued subpoenas some children's hospitals and threatening providers with an accusation.

“I think these restrictions are very good,” Terry Schilling says of the upcoming rules. Schilling – President American Principles Projectconservative advocacy group. “This will change the entire transgender industry and deprive it of many sources of funding.”

He points to public opinion poll since the spring, which showed 66% of the public opposed Medicaid coverage of this type of care for young people.

“They believe that if you want to undergo any kind of sex modification procedure, you have to pay for it,” Schilling says. “The American people fully support these efforts.”

New dramatic expansion of power

The proposal to condition hospital participation in Medicaid and Medicare on ending gender-affirming care for youth represents an “unprecedented” use of the executive branch's power to control what health care is available at hospitals, Keith says.

“Because Medicare is a significant portion of many hospitals' revenues,” she explains, the rule would essentially force hospitals to stop providing gender-specific care. programs for transgender youth. This would mean that all patients in these programs—regardless of whether they have Medicaid or private insurance—would lose access.

The federal government doesn't typically use these types of rules, Keith said. She served in the Biden administration on the Gender Policy Council and worked on several projects.conditions of participation“Medicare and Medicaid regulations,” she says. “They are so simple that you should have a crash cart.” [with] there is enough medicine to help a pregnant woman in crisis.”

Instead of health and safety standards, the proposal would direct hospitals to “completely stop offering a certain type of care to a certain group of patients,” she says.

Professor of Law Kathy Ayer from Rutgers University doubts whether such a rule will stand up to legal challenge. “But if it had been successful, I shudder to think what this administration would have done with such a tool in its hands,” she says. That could open the door for any White House to withhold all federal funding to hospitals for care it doesn't like.

“The writing was on the wall that this would happen,” says Lindsey Dawsondirector of LGBTQ health policy at KFF, a nonpartisan health research organization.

However, the release timing has remained a mystery for several months. Notice of both proposed rules (though not the rules themselves) appeared in the state registry over the summer, and it's still unclear why they haven't been published yet, Dawson says.

“Obsessive Focus”

The administration's efforts on transgender issues extend far beyond health care and youth policies. The Federal Trade Commission recently conducted a seminar “on unfair or deceptive trade practices in the “gender affirming care” industry for minors.” The military forced out transgender military personnel. Universities have been told their federal funding is limited. contingent about adopting anti-transgender policies on issues such as toilet access.

Even the looming cessation of food assistance (SNAP) funding is linked to Democratic support for “gender mutilation procedures,” according to a banner on the SNAP website. Ministry of Agriculture website.

“It’s endless,” Ayer says. “It really was an intrusive focus that was pervasive throughout the administration.”

Warning letters, grant cancellations, and more have had a significant chilling effect. In states where grooming is still legal, many clinics and hospitals have completed their gender-affirming care programs. If these rules were to go into effect, other programs would likely follow suit.

“There are real people behind this,” says Ayer, who is also the parent of a transgender child. “People are really scared and suffering as a result of the attacks on the trans community.”

It's still legal, although access is declining.

Gender-affirming care for youth, including puberty-blocking drugs, hormones and, in rare cases, surgery, does not actually violate federal law, Eyer notes. And despite the recent political pressureNo major US medical organization has changed its clinical guidelines confirming the feasibility and safety of these treatments.

Approximately 3% of youth in the US identify as transgender or non-binary, although not all seek treatment related to their identity.

It is noteworthy that in Utah government analysis The evidence recently came to a conclusion opposite to the Trump administration's conclusions about transgender people. Researchers at the University of Utah found that there is sufficient evidence of the benefits and safety of these treatments and wrote that policy restrictions on this care for youth “cannot be justified by the quantity or quality of scientific research or concerns about potential future regrets.”

The draft text of the proposed federal law obtained by NPR does not mention the Utah analysis and does not cite the American Academy of Pediatrics, whose recommendations I also support access to care.

Iyer said making the rules public would give them an opportunity to challenge them in court.

“It will depend on “arbitrary and capricious” review“This is actually preferable to what we have had so far, which is coercion without law.”

Diane Webber edited this article.