HHS Proposes New Rules Restricting Youth Gender-Affirming Care, Prompting Lawsuit and Widespread Opposition
The U.S. Department of Health and Human Services (HHS) has announced a declaration and proposed new rules aimed at restricting gender-affirming care for individuals under 18 years old. These actions, which include potentially cutting federal funding for hospitals providing such care, have prompted a lawsuit from a coalition of 19 states and the District of Columbia, as well as significant opposition from major medical organizations. Concurrently, the House of Representatives has advanced legislative bills that would further limit access to this care.
Federal Administrative Actions and Rationale
Last Thursday, federal health officials, including Health Secretary Robert F. Kennedy Jr., announced measures to restrict gender-affirming care for transgender youth. These actions were stated to be based on science and evidence, referencing an HHS report that concluded clinicians providing medical care for youth transitions had "failed their patients," while emphasizing psychotherapy as an alternative.
During the announcement, officials made statements questioning the concept of transgender identity.
Acting CDC Director Jim O'Neill stated, "Men are men. Men can never become women. Women are women. Women can never become men," and referred to "the blurring of the lines between sexes" as "a hatred for nature as God designed it."
Health Secretary Kennedy Jr. stated that doctors and medical groups had "peddled the lie" regarding the benefits of these treatments for children, asserting that youth were "conditioned to believe that sex can be changed."
The internal HHS report also scrutinized treatment standards from the World Professional Association for Transgender Health (WPATH) and raised concerns regarding adolescents' capacity to consent to treatments that may have irreversible effects, including potential infertility.
Among the proposed rules, announced by Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services (CMS), are:
- Prohibiting federal Medicaid reimbursement for medical care provided to transgender patients under 18 years of age.
- Blocking all Medicaid and Medicare funding for any services at hospitals that provide pediatric gender-affirming care.
These proposed rules are subject to a 60-day public comment period and are not immediately implemented. Further announcements related to healthcare for transgender young people were also anticipated from Dr. Marty Makary, head of the Food and Drug Administration (FDA), and Dr. Jay Bhattacharya, head of the National Institutes of Health (NIH).
Other federal actions have included an executive order by President Trump to not fund or promote "the 'transition' of a child from one sex to another," and the Department of Justice initiating subpoenas of some children's hospitals.
Legislative Efforts in Congress
These administrative actions coincide with recent legislative activity in the House of Representatives:
- On Wednesday, the House passed a bill introduced by Rep. Marjorie Taylor Greene (R-Ga.) that proposes to criminalize the provision of gender-affirming care to transgender minors, with potential penalties including fines or up to 10 years in prison.
- A bill introduced by Rep. Dan Crenshaw (R-Texas), which seeks to prohibit Medicaid reimbursement for gender-affirming care for youth, was scheduled for a vote on Thursday.
Both legislative bills would require Senate approval to become law.
Legal Challenges
On Tuesday, a coalition of 19 states and the District of Columbia filed a lawsuit in U.S. District Court in Eugene, Oregon, against the U.S. Department of Health and Human Services (HHS), its Secretary, and its Inspector General. The lawsuit challenges the HHS declaration regarding gender-affirming care for young people.
The lawsuit, led by New York Attorney General Letitia James, contends that the HHS declaration is inaccurate and unlawful, seeking a court order to prevent its enforcement. Plaintiffs allege that the declaration aims to compel providers to cease offering gender-affirming care and circumvents established legal procedures for policy modifications, claiming federal law mandates public notice and a comment period before significant changes to health policy are enacted, which they assert did not occur.
Attorney General James stated that the HHS Secretary lacks authority to unilaterally alter medical standards and that individuals should not lose access to medically necessary healthcare due to federal government intervention.
Attorneys general in New York and California, along with the ACLU, have also indicated intentions to challenge these federal rules.
Medical Community Response
Major medical organizations have challenged the administration's stance and the HHS report. The American Academy of Pediatrics (AAP), American Medical Association (AMA), American Psychological Association (APA), and the Endocrine Society are among groups that have expressed opposition to restrictions on gender-affirming care for minors.
- The AAP, representing 67,000 pediatricians, stated that the policies "misconstrue the current medical consensus and fail to reflect the realities of pediatric care and the needs of children and families." The AAP's official position, shared by the AMA and Endocrine Society, is that gender-affirming care is safe and effective for appropriate young patients.
- The APA expressed concern that recent federal actions challenge the scientific understanding of gender identity and could affect the human rights, psychological health, and well-being of transgender and nonbinary individuals.
- The AMA clarified its support for evidence-based treatment, including gender-affirming care, and stated that surgical interventions in minors should generally be deferred until adulthood, noting this as a clarification of an existing position, not a reversal or endorsement of other groups' positions.
- The American Society of Plastic Surgeons (ASPS) released a statement recommending delaying gender-related surgery until a patient is at least 19 years old, citing current evidence and legal/regulatory environments. The ASPS noted ethical considerations for gender-affirming surgery in adolescents, including its irreversible nature and the potential for lifelong harms given evolving preferences and identities.
Matthew Cook, CEO of the Children's Hospital Association, stated that if finalized, the proposed rules could establish a precedent allowing "all kinds of specialized health care treatments to be withheld based on government-mandated rules," potentially affecting "millions of families."
Dr. Kade Goepferd, founder of Children's Minnesota Gender Health Program, noted the "deep moral distress" experienced by healthcare professionals when restricted from providing care they believe improves health outcomes.
Hospital and Healthcare Provider Adjustments
Following the federal announcements, some healthcare systems have adjusted their services. Children's Wisconsin and UW Health, two of Wisconsin's largest pediatric hospitals, ceased providing gender-affirming pharmacologic care to minors, citing "escalating legal and federal regulatory risk" and "recent federal actions." Both institutions stated they would continue to offer mental health services and affirmed their commitment to providing compassionate care to LGBTQ+ patients.
Kaiser Permanente health system also ceased providing gender-affirming surgery to youth in California. The proposed federal rule has been cited by some hospitals as a factor in the closure of gender clinics across the country.
Broader Context and Demographics
According to a CDC survey, approximately 3% of teenagers aged 13-17, totaling around 700,000 individuals, identify as transgender. For minors, common medical options include puberty blockers and hormones, with surgery being rare. One study found an average of 800 top surgeries per year in patients aged 18 or younger between 2016 and 2020.
More than half of U.S. states, with at least 27 states, have already enacted laws restricting or prohibiting gender-affirming care for young people since 2021. The Supreme Court's decision to uphold Tennessee's ban on specific gender-affirming care has been noted as potentially impacting the legal stability of similar state-level restrictions. Currently, Medicaid programs in approximately half of U.S. states include coverage for gender-affirming care.
Observers familiar with transgender rights issues anticipate that the combination of the proposed hospital rules and legislative efforts could significantly limit access to pediatric gender-affirming care nationwide.