Trump administration moves to restrict gender-affirming care for minors nationwide

Amna Nawaz:

The Trump administration today took its most significant moves yet in a wide-ranging effort to restrict gender-affirming medical care for minors.

Geoff Bennett:

The Department of Health and Human Services unveiled a series of actions meant to effectively ban transition-related medical treatments nationwide for those under the age of 18.

Stephanie Sy has more.

Stephanie Sy:

Geoff and Amna, the moves announced today include cutting off federal Medicare and Medicaid funding from hospitals that provide those treatments and prohibiting Medicaid funding from paying for such care.

Here's what Secretary Kennedy had to say.

Robert F. Kennedy Jr., U.S. Health and Human Services Secretary: This morning, I signed a declaration. Sex-rejecting procedures are neither safe nor effective treatment for children with gender dysphoria. These procedures fail to me professionally recognize standards of care. Medical professionals or entities providing sex-rejecting procedures to children are out of compliance with these standards of health care.

Stephanie Sy:

We will delve into those controversial assertions in a moment, but we should say that, before these policies are enacted, there's a lengthy rulemaking process that has to take place and groups such as the ACLU are already threatening lawsuits.

To break some of this down, I'm joined now by Selena Simmons-Duffin, who covers health policy for NPR and was at today's announcement.

Selena, thank you so much for joining us.

We know that about 45 percent of hospital spending comes from Medicare and Medicaid, so threatening to cut that off would be existential, I imagine, for most hospitals. Even though these are only proposed rule changes now, are we going to see widespread stoppage in this care? What might the impact be?

Selena Simmons-Duffin, NPR:

Yes, I mean, children's hospitals have been pioneers in this treatment for transgender young people, which can include puberty blockers, hormone therapy. Very rarely, it can include surgery.

But part of the reason why children's hospitals are attractive to parents, children who are considering this treatment, is because they're interdisciplinary and they have really high-quality teams, that you can talk to therapists, you can talk to psychiatrists, you can really get that full spectrum of care.

And I think that if these rules are enacted, this care will no longer happen at hospitals across the country. And that includes in places where it is legal, even though there are 25-plus states that have banned the care at the state level.

Stephanie Sy:

Help us understand how unprecedented it is to have the government tell hospitals they won't have access to federal funding if they provide a certain kind of medical care.

Selena Simmons-Duffin:

It is extremely unprecedented.

This type of rule is called the condition of participation. And it's used to create kind of a bare minimum of standards for health and safety in hospitals normally, so rules such as you must have a crash cart available if you're providing care for people in emergencies, you must have a certain number of staff-to-patient ratio, those kinds of things, very, very, very basic, kind of the floor of health and safety.

And you could imagine that the same approach, using conditions of participation, as you say, this kind of existential tool to — over hospital budgets, you could use it for any variety of care that any health secretary now or in the future disfavors.

And we're talking about Robert F. Kennedy Jr., the current health secretary, who has talked skeptically about a host of medical care that is regarded as the standard of care and regarded as safe and effective, from antidepressants to vaccines. So it really opens up an enormous can of worms if this — these rules take effect and are allowed to stand through the legal challenges that will for sure be coming.

Stephanie Sy:

For all the talk of gold standard science at the announcement today, there were a few nonscientists who made declarative statements dismissing gender dysphoria altogether.

I want to play what Jim O'Neill, deputy secretary at HHS, who has no medical degree, had to say.

Jim O'Neill, U.S. Health and Human Services Deputy Secretary: Men are men. Men can never become women. Women are women. Women can never become men.

(Applause)

Jim O’Neill:

At the root of the evils we face, such as the blurring of the lines between sexes and radical social agendas, is a hatred for nature as God designed it.

Stephanie Sy:

Both sides, Selena, of the treatment debate claim to have science on their side and accuse the other side of acting ideologically, in a way that harms children. How are we to separate the science from ideology? Is anything definitively known about safe and effective treatment?

Selena Simmons-Duffin:

Well, I think you can really hear ideology at play in those statements from Jim O'Neill.

I mean, he did not say that evidence doesn't support the use of threat treatments among the pediatric patients because they have these side effects, et cetera, et cetera. No, he was saying men cannot become women, women cannot become men. He's speaking about adults.

And that is kind of the foundation of understanding what it means to be transgender. So there was that thread throughout the whole event today that transgender people don't exist in the world view that you were hearing from the health officials in this Trump administration.

What you see in the materials from this HHS is kind of a rejection of the premise that there are people for whom there might be benefit from this care. And so I don't think that there — this is really a good-faith debate about whether the care works or not or what the protocol should be. It's really kind of more of a bigger picture conversation, like Jim O'Neill said, about God and about gender and about sex and what's changeable and what's not.

And so I do think that it is striking that, even under immense pressure, the American Academy of Pediatrics, the American Medical Association, the Endocrine Society, all of these organizations that are composed of doctors that actually see these patients and engage with this care don't agree and really roundly reject this characterization and the way that this administration and this health department have been presenting the evidence.

Stephanie Sy:

That is Selena Simmons-Duffin with NPR joining us.

Thank you.

Selena Simmons-Duffin:

You're welcome.