How is Gender Affirming Care at Risk?
Over the past few months, access to gender-affirming care in the United States has faced significant challenges due to new federal directives and state-level legislation. Here's an overview of the recent developments:
Federal Actions Impacting Gender-Affirming Care
Executive Order 14187: On January 28, 2025, President Trump signed Executive Order 14187, titled "Protecting Children from Chemical and Surgical Mutilation." This order prohibits federal funding and support for gender-affirming care for individuals under 19, including surgeries, hormone therapies, and puberty blockers. It also directs federal agencies to ensure that institutions receiving federal grants are not performing gender-related procedures.
Legal Challenges: In response to the executive order, multiple lawsuits have been filed. Notably, a federal judge issued a temporary restraining order preventing the withholding of federal funds from hospitals providing gender-affirming care to minors. Another judge blocked the order in four states—Washington, Oregon, Minnesota, and Colorado—pending further legal proceedings.
State-Level Legislative Developments
Kansas: In February 2025, Kansas lawmakers overrode the governor's veto to enact a law banning gender-affirming care for minors, making it the 27th state to implement such restrictions. The law prohibits the use of puberty blockers, hormone therapies, and surgeries for minors' gender transitions. AP News
Ohio: Contrastingly, in March 2025, the Ohio 10th District Court of Appeals overturned a state ban on gender-affirming care for transgender minors, declaring the law unconstitutional and restoring access to treatments like puberty blockers and hormone therapy. Washington Post
Kentucky: In March 2025, Kentucky's Republican lawmakers passed a bill protecting conversion therapy for LGBTQ+ youths and prohibiting the use of Medicaid funds for gender-affirming health care for transgender residents. This legislation reversed a previous executive order banning tax dollar spending on conversion therapy for minors. AP News
Healthcare Providers' Responses
Service Suspensions: Following the federal executive order, several hospitals, including Children's National Hospital in Washington, D.C., and NYU Langone Health, paused or canceled gender-affirming care services for minors to assess compliance with the new regulations.
Resumptions and Legal Support: Some institutions resumed services after legal interventions. For instance, Children's Hospital Colorado and Denver Health reinstated gender-affirming care for minors after the Colorado Attorney General joined a lawsuit challenging the executive order.
Implications for Access to Care
Insurance Coverage: The executive order directs the Department of Health and Human Services to review and potentially end insurance coverage for certain gender-affirming care under Medicare, Medicaid, and the Affordable Care Act. This could lead to increased out-of-pocket costs and reduced access for those relying on these programs.
Interstate Care Challenges: As more states enact restrictions, individuals seeking gender-affirming care may need to travel across state lines, facing additional financial and logistical barriers. Some states have pledged to protect access to such care, but the patchwork of laws creates uncertainty for patients and providers alike.
