Some states – including both North and South Carolina – have moved to ban gender-affirming healthcare for trans youth under 18, which has drawn criticism from LGBTQ+ folks and allies alike. Now, under the direction of Donald Trump and fellow Republicans, the federal government is moving to ban that same care on a national level.
Health Secretary Robert F. Kennedy Jr. and Dr. Mehmet Oz, who leads Medicaid and Medicare, announced several moves to limit, restrict and effectively ban gender-affirming healthcare for trans minors a week before Christmas – including states where it is still legal.
“So-called gender affirming care has inflicted lasting physical and psychological damage on vulnerable young people,” Kennedy said. “This is not medicine. It is malpractice.”
There are two components to the proposed policy from Oz and Kennedy. The first measure prevents physicians and medical centers from being paid by Medicaid for gender-affirming treatments given to patients under 18. Medicaid is the public health insurance program for people with low income.
The second policy cuts off both Medicaid and Medicare payments to any hospital that offers gender-affirming care to children. Nearly all U.S. hospitals participate in Medicare, which provides coverage for seniors and people with disabilities. Since hospitals depend heavily on Medicare funding, this policy would affect a large portion of the health care system.
These actions come as Republicans in the House of Representatives passed a myriad of health care bills not extending subsidies for people who buy health insurance in Affordable Care Act plans. The set of measures taken up by Congress in the week leading up to the holiday break featured a proposal – sponsored by Rep. Marjorie Taylor Greene of Georgia – criminalizing gender-affirming medical treatment to transgender youth, carrying penalties and including fines or sentences of up to 10 years in prison. The bill was approved on Wednesday, Dec. 17.
The very next day, Rep. Dan Crenshaw (R-Texas) introduced a bill prohibiting Medicaid reimbursement for gender-affirming care for folks under 18. Dr. Marty Makary, who heads the Food and Drug Administration, also announced that same day the FDA would be sending warning letters to businesses manufacturing chest binders and aiming the sales of them to young people.
The American Academy of Pediatrics (AAP) has continued to push back against HHS and the legislative branch’s actions.
“These policies and proposals misconstrue the current medical consensus and fail to reflect the realities of pediatric care and the needs of children and families,” said AAP President Dr. Susan J. Kressly.
Kressly also noted in an interview with NPR these new measures don’t help with minimizing health care costs and instead, “unfairly stigmatize a population of young people.”
“These rules are a baseless intrusion into the patient-physician relationship,” Kressly said. “Patients, their families, and their physicians – not politicians or government officials – should be the ones to make decisions together about what care is best for them.”
The American Civil Liberties Union has come forward and stated they would be suing the government in response to these proposed policies. The organization argues the administration’s proposal seeks to block the provision of evidence-based, medically necessary care for transgender people under 18 – care that is supported by every major medical association in the United States, including the American Medical Association and the AAP.
“By attempting to strip away essential healthcare, the administration is not ‘protecting’ anyone; it is weaponizing the federal government to target a vulnerable population for political gain,” said Chase Strangio, Co-Director of the ACLU’s LGBTQ & HIV Rights Project. “Healthcare decisions belong to families and their doctors, not politicians. The latest proposals from the administration would force doctors to choose between their ethical obligations to their patients and the threat of losing federal funding. It would uproot families who have already fled state-level bans, leaving them with nowhere to turn for the care they need to survive and thrive.
“We have seen the devastating consequences of similar policies at the state level, and we have fought them every step of the way. Let us be clear: If this administration moves forward with this attempt to enact a national ban on our medical care through coercion, the ACLU will see them in court. We will not rest until the rights of transgender youth to live authentically and access the care they need are fully protected.”
The UCLA Williams Institute completed a study in January 2025 examining the impact of gender-affirming care bans in states where they’re already implemented, and the results were telling. There are approximately 300,100 transgender youth aged 13 to 17 living in the U.S. Currently, over 180,000 of those youth live in states where access to gender-affirming care is permitted, most of whom – 149,100 – are in states with “shield” laws that protect access to gender affirming care in various ways, and an additional 8,000 live in states where surgery is banned for minors but other gender-affirming treatments remain available.
An additional 110,300 transgender youth live in one of 24 states with an existing ban on gender-affirming hormone therapy and surgeries. Many transgender youth living in these states are currently prohibited from accessing these forms of gender-affirming care.
“President Trump has directed federal agencies to prohibit access to gender-affirming care for transgender youth and take additional steps to discourage access to the care. Some aspects of this executive order will have an immediate impact, such as the rescission of President Biden’s support for gender-affirming care and possible early enforcement attempts from the Department of Justice. However, other aspects of this order will likely take time to implement, and the president will need to go through formal channels, such as the formal rule making process,” the Williams Institute concluded in its January 2025 study.
“A long-term ban on gender-affirming care, if it requires a statutory change, would have to go through Congress. Furthermore, the extensive landscape of state laws and court precedent surrounding gender-affirming care means that most of the actions outlined in the executive order will likely have to contend with immediate and potentially long-lasting litigation.”
The first steps to barring the essential healthcare transgender Americans require launched when Trump passed executive orders on his first day in office, condemning gender-affirming care for trans youth. Now, congressional representatives are taking the steps to codify these orders.
While the ACLU and other activism organizations have announced they will step up to the fight, it’s up to every American to stand up for the rights of their brothers, sisters and gender-nonconforming loved ones.