On Gender-Affirming Care
The methods being used to restrict gender-affirming care set an alarming precedent that should concern us all.
My views and opinions are my own.
This year, on July 15, Rush University System for Health confirmed that it will stop providing gender-affirming care to new pediatric patients. Just three days later, University of Chicago Medicine followed suit – ending this care for all pediatric patients, new and existing.
These are two of the most respected health systems in the country. And they didn’t make these decisions based on new medical consensus — they did it to survive.
I’m not here to convince you one way or another on transgender healthcare. If you support it, I appreciate your perspective. If you oppose it, I understand your concerns.
But what’s happening right now goes beyond the issue of care itself — it’s about what happens when politics hijacks the medical process behind closed doors, with no vote and no accountability.
This should concern you, no matter where you stand.
Hospitals aren’t abandoning gender-affirming care because of new or irrefutable medical evidence. They’re doing it to avoid financial collapse.
In January, the Trump administration issued Executive Order 14187, which directs Health and Human Services (HHS) to end gender-affirming care for minors using a bureaucratic backdoor: the Medicare and Medicaid Conditions of Participation (CoPs).
CoPs are rules that enforce basic safety standards like patient rights, emergency preparedness, and staffing requirements. Healthcare organizations must follow them to receive federal reimbursement for treating Medicare and Medicaid patients.
If HHS enacts this rule, hospitals that provide pediatric gender-affirming care would no longer be eligible for Medicare and Medicaid reimbursement. In FY24, the federal government spent $865 billion on Medicare and $618 billion on Medicaid. Few (if any) hospitals can risk losing out on such a vast revenue stream.
The CoPs have never before been used to ban a particular type of care. This represents an unprecedented shift in healthcare regulation.
This won’t be like previous restrictions on gender-affirming care or abortion, where states and governors could shield patients and providers. If implemented, this rule ends pediatric gender-affirming care in the United States.
But it does more than that — it opens the door to weaponizing healthcare regulations against any service a given administration disapproves without democratic oversight. Tomorrow, they could target medication abortion. Or fertility treatments. Or HIV prevention.
This is a drastic expansion of executive authority. The decision to adjust the treatment for hundreds of thousands of children deserves, at minimum, a vote.
In many cases, this care will be scaled back immediately — with no transition plan in place. I know parents of trans children that have been left to fend for themselves, scrambling to ensure continuity of care while fearing the worst for their child’s health.
Puberty blockers are often administered via a subcutaneous implant. What doctors will risk removing those implants? What’s the plan? Does a plan even exist?
Those questions are about to be answered: On July 17, National Review reported that HHS will soon begin formal rulemaking to change the Conditions of Participation.
This is not a theoretical threat.
This is the new reality.
And it will be up to frightened, vulnerable kids to plead with the courts.
Next time, it may be up to you.
The medical centers and hospitals that have been delivering gender-affirming care aren’t fringe clinics or rogue providers. These are world-class institutions.
The same institutions where babies take their first breath.
Where patients ring the bell after chemo.
Where families embrace one another and await life-changing news.
These are institutions we trust with our lives. And they’re being forced to choose between honoring medical judgement and keeping their doors open.
Whether or not you support gender-affirming care, this new policy sets a dangerous precedent: medicine by mandate. If you believe healthcare decisions should be made transparently — by doctors, patients, and elected representatives — this matters. Speak up. Because the next target might be care that you or your loved ones rely on.