Over the last 24 hours, the Trump administration has marshaled extraordinary federal power to restrict health care for transgender youth, a population that makes up well under 1 percent of Americans, while leaving untouched a looming crisis that threatens millions more: the scheduled January expiration of Affordable Care Act tax credits that keep health insurance affordable on the Obamacare exchanges.
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Late Wednesday, the House passed the most extreme anti-transgender health care bill ever to clear Congress, legislation sponsored by Republican Rep. Marjorie Taylor Greene of Georgia that would criminalize parents and doctors for providing best-practice medical care to transgender young people. Three Democrats joined nearly all Republicans in passing the bill.
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By Thursday morning, the Trump administration went further.
At an 11 a.m. press event filled with pseudoscience and misinformation at the Hubert H. Humphrey Building, Health and Human Services Secretary Robert F. Kennedy Jr. announced a slate of proposed federal rules that would sharply limit access to gender-affirming care for minors nationwide. Onstage with Kennedy were the heads of HHS’s major health agencies — Centers for Medicare & Medicaid Services Administrator Mehmet Oz, Food and Drug Administration Commissioner Marty Makary, National Institutes of Health Director Jay Bhattacharya, and Assistant Secretary for Health and U.S. Public Health Service Commissioned Corps head Adm. Brian Christine — as well as 20-year-old Chloe Cole, an anti-trans activist who regretted receiving gender-affirming care as a teenager. Republican Louisiana U.S. Sen. Bill Cassidy, Tennessee U.S. Sen. Marsha Blackburn, and Texas Attorney General Ken Paxton were in attendance.
CMS administrator Mehmet Oz speaks at HHS headquarters in Washington, D.C., as detransitioner Chloe Cole looks on. Alex Wong/Getty Images
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If finalized, the proposals would bar hospitals that provide gender-affirming care to minors from participating in Medicare and Medicaid, prohibit federal Medicaid and Children’s Health Insurance Program funds from covering such care nationwide, and roll back transgender-inclusive civil rights protections by excluding gender dysphoria from Section 504 of the Rehabilitation Act.
“Under my leadership, and answering President Trump’s call to action, the federal government will do everything in its power to stop unsafe, irreversible practices that put our children at risk,” Kennedy said, endorsing a declaration asserting that gender-affirming care for minors does not meet professionally recognized standards of health care.
Oz echoed that position, calling the interventions “experimental” and arguing that hospitals participating in federal health programs should not provide them. Makary announced that the FDA has issued warning letters to manufacturers and retailers accused of illegally marketing chest binders to minors. Bhattacharya described gender-affirming care as a failure of scientific rigor, while Christine urged providers to refuse such treatments, calling the evidence base weak.
In January, President Donald Trump ordered federal agencies to put a stop to gender-affirming care for minors through an executive order. Kennedy and Oz took victory laps, thanking Trump for putting the restrictions in motion.
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Medical organizations sharply dispute the administration’s claims. Groups including the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society maintain that gender-affirming care is evidence-based, medically necessary for some patients, and provided following careful clinical evaluation. They warn that denying such care increases risks to transgender youth’s mental health and well-being.
Can the Trump administration ban gender-affirming care this way?
Health policy experts say the administration is asserting authority it does not have.
“They are trying to do something that CMS simply isn’t empowered to do,” a former senior Centers for Medicare & Medicaid Services official from the Biden administration told The Advocate on Thursday afternoon. “CMS is prohibited by statute from regulating the practice of medicine, and that is exactly what this is. The authority that they are citing for these actions does not exist.”
The former official said CMS has historically deferred to states to define what constitutes medically necessary care and has never used its Medicaid authority to prohibit an entire category of treatment nationwide. “They are trying to transform CMS into a medical board,” the official said. “This is unprecedented, and they know it.”
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Adrian Shanker, a former Biden administration deputy assistant secretary for health policy and now principal of Shanker Strategies, said the speed and scope of the last day’s actions underscore the administration’s priorities.
“The last 12 hours have been traumatic for the legal and health rights of trans Americans,” Shanker told The Advocate. “Last night, the House passed the most extreme anti-trans bill to date — a bill that, if signed into law, would jail parents and doctors for providing best-practice medical care for trans youth. The worst part: three Democrats voted with almost all Republicans to let this bill pass.”
“Today, the Trump administration went even further by proposing three more anti-trans rules,” he added. “Combined, this is a dreary and scary moment for trans health. This administration is obsessed with denying them that basic right at every step.”
How have states and LGBTQ+ groups responded to the HHS proposals?
Some states moved quickly to signal resistance.
In a statement released Thursday afternoon, Maryland Department of Health Secretary Dr. Meena Seshamani said the state would continue to support gender-affirming care and follow established medical guidance, despite the Trump administration’s announcement.
“Maryland wholeheartedly supports the care needs of Maryland’s transgender and gender-expansive people,” Seshamani said. “We will continue to follow evidence-based clinical guidance from leading medical organizations around comprehensive gender-affirming care while engaging with our transgender and gender-diverse youth with compassion, positivity, and hope.”
Seshamani added that, for now, state policy remains unchanged. “Gender-affirming coverage under Medicaid remains unchanged,” she said.
Attorneys for the National Center for LGBTQ+ Rights and GLAD Law were highly critical of the Trump administration’s move.
“Parents of transgender children want what all parents want: to see their kids thrive and get the medical care they need. But this Administration is putting the government between patients and their doctors," Jennifer Levi, a senior director of transgender and queer rights at GLAD Law, said in a statement. “Parents witness every day how their children benefit from this care -- care backed by decades of research and endorsed by major medical associations across the country. These proposed rules are not based on medical science. They are based on politics. And if allowed to take effect will serve only to drive up medical costs, harm vulnerable children, and deny families the care their doctors say they need. These rules elevate politics over children -- and that is profoundly unAmerican.”
Shanon Minter, NCLR's legal director, also criticized the policy proposal sharply.
“We stand with parents and families against Trump administration efforts to dictate personal medical decisions," Minter said in a statement. “These rules wage an attack on the lowest-income Americans’ ability to access health care and cruelly seek to cut off health care for all transgender youth."
He urged people to respond to the comment period. “Starting tomorrow, members of the public will have 60 days to submit comments raising concerns or issues with the proposed rules. NCLR urges families, advocates, medical professionals, health experts, and others to submit comments opposing these dangerous rules,” Minter said.
Advocacy groups say the administration’s focus reflects a fixation wildly out of proportion to the population affected.
“The Trump administration is relentless in denying health care to this country, and especially the transgender community,” said Kelley Robinson, president of the Human Rights Campaign. “These proposed actions would put Donald Trump and RFK Jr. in those doctors’ offices, ripping health care decisions from the hands of families and putting it in the grips of the anti-LGBTQ+ fringe.”
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Mental health experts warn the stakes are life-and-death. Rodrigo Heng-Lehtinen, senior vice president of public engagement campaigns at The Trevor Project, said restricting care “risks the lives of transgender and nonbinary youth,” citing research linking access to gender-affirming care with lower rates of depression and suicide risk.
All of this unfolded as enhanced ACA tax credits, relied on by millions of Americans, remain set to expire in January, a deadline health policy analysts say could sharply raise premiums and push people out of coverage altogether. The administration has offered no proposal to extend them.
The proposed HHS rules are not binding law and are subject to a 60-day public comment period. Legal challenges are widely expected. But for critics, the broader picture is already clear: in the span of a single day, the Trump administration chose to test the outer limits of federal power to take health care away from a tiny, politically vulnerable population — while leaving a far larger affordability crisis unresolved for millions of Americans.
CMS administrator Mehmet Oz speaks at HHS headquarters in Washington, D.C., as detransitioner Chloe Cole looks on. Alex Wong/Getty Images
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