Trump crackdown on gender‑affirming care fuels alarm across U.S.

The Trump administration's crackdown on gender-affirming care is expanding rapidly as officials investigate hospitals, cut off benefits for federal workers and their dependents, and pick new fights with blue states.Why it matters: The latest moves could put hospitals and other providers in the middle of a showdown between federal power and patient privacy protections — or even force health providers to break their own state laws.The actions have also created an atmosphere of fear for transgender individuals, their families, and health providers who say they're providing medically necessary care and haven't violated any laws.What they're saying: "As of this month, we have really seen escalation," said Kellan Baker, senior adviser for health policy at the Movement Advancement Project, a policy think tank."I think there's this gallop to cause as much damage as possible in as short a time as possible, before the political repercussions ... manifest." Driving the news: Federal court filings made public last week revealed the Justice Department has subpoenaed hospitals for extensive data surrounding transition-related care for individuals under 19 provided since the beginning of 2020.The demands included the Social Security numbers of patients who were prescribed puberty blockers or hormone therapy. The Justice Department's subpoenas to children's hospitals potentially set up a collision with the Health Insurance Portability and Accountability Act, the landmark privacy law that protects sensitive patient information, said Lisa Pierce Reisz, a lawyer at the firm Epstein Becker Green."These kinds of subpoenas, I think, are an effort to test the legal limits of what they can get," said Don Bell, policy counsel at the Project on Government Oversight.Also last week, the Office of Personnel Management stripped coverage of gender-affirming care for minors and adults for federal workers beginning next year, other than mental health treatment and certain ongoing hormonal treatment.Last Monday, the FBI announced that Missouri Attorney General Andrew Bailey would come on as co-deputy director. Bailey launched several initiatives, with varying success, in Missouri to limit gender-affirming care for kids and adults. And Health and Human Services said on Thursday that it's pulling a $5.8 million annual grant from a California program aimed at preventing teen pregnancy and sexually transmitted infections in adolescents because the state refused to scrub mentions of what officials called "gender ideology."The California Department of Public Health told Axios in a statement that the program's curriculum is medically accurate and age-appropriate, and previously approved by HHS. The other side: "Putting an end to child mutilation, protecting girls' sports, and reasserting the reality of biology have been Day One priorities for the Trump administration, which continues to build on the executive actions that President Trump signed on these matters on his first day back in the White House," White House deputy press secretary Kush Desai said in an email. Friction point: The actions advance executive orders on gender that President Trump issued during his first weeks in office. But critics say the multipronged campaign is testing the boundaries of executive powers and could undercut federal and state protections.Last month, Children's Hospital of Philadelphia asked the U.S. District Court for the Eastern District of Pennsylvania to prevent it from having to supply the Justice Department with patient identification, diagnosis information and parental consent records. The court will decide whether the hospital must hand over the information, and will have to weigh the Justice Department's concerns over patient privacy rights, said Reisz of Epstein Becker Green.Between the lines: The federal government establishes basic health safety standards and regulates public insurance coverage. But the practice of medicine is governed by states. 25 states have prohibited youth access to gender-affirming care, and the Supreme Court in June upheld Tennessee's ban, allowing others to follow suit.But attorneys general of 16 states where gender-affirming care for kids is legal sued the federal government earlier this month for what they see as a coordinated attack on the services for people under 19.The suit alleges the federal government is intimidating health providers and forcing them to violate state anti-discrimination laws.While the legal battles play out, the administration's power over federal spending already is having a chilling effect on the availability of care in blue states.Health systems — including the Children's Hospital of Los Angeles, Children's National Hospital in D.C. and UPMC in Pittsburgh — are pulling back on services even where they remain legal.Reality check: Gender-affirming care for kids with gender dysphoria is considered safe and appropriate by major medical organizations, including the American Medical Association.Drugs like puberty blockers are temporary and reversible, and are also used for non-trans youth who experience early-onset puberty. Surgeries for transgender children are rare.A broad medical evidence review published by the University of Utah in May at the request of the state's legislature found that gender-affirming hormone treatments are safe, and effective for promoting mental health.What we're watching: The Trump administration is pursuing more restrictions on transition-related care.The Federal Trade Commission is investigating whether providers are making false or unsupported claims about the care.And a forthcoming Medicaid rule could prevent states from using federal funding to cover gender-affirming care for kids.

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