Trump's road map for defunding gender-affirming care

Driving the news: President Trump on Monday signed a series of executive orders, including one the White House said was aimed at eliminating "gender radicalism" from the military.

• That follows a flurry of actions last week that included a declaration that the government would only recognize "two sexes, male and female."
• Included in that order was a ban on federal funding for gender-affirming care by the Bureau of Prisons.

What they're saying: The goal "appears to be laying out a plan to erase transgender people from existing under the law ... as part of an attempt to push them out of society," Harper Seldin, staff attorney for the ACLU's LGBTQ & HIV Project, told Axios.

• "The anti-abortion playbook is one that we are increasingly seeing used to regulate and control transgender people's lives, so I think [further funding cutoffs] is something we're preparing for," Naomi Goldberg, executive director of the Movement Advancement Project, told Axios.

Between the lines: Advocates see a multi-pronged effort by the administration and Republican Congress to tie the awarding of federal funding to recognizing a person's sex assigned at birth.

• The administration froze U.S. foreign assistance funding through USAID — an agency cited in Project 2025, which called for an incoming administration to "deradicalize USAID's programs" and to end its "gender ideology" and "bullying LGBTQ+ agenda."
• Last month, Congress cleared the annual defense policy bill, which mandated that government insurance not cover gender-affirming surgeries for soldiers and nearly all gender-affirming care for their children under 18, including hormones and puberty blockers.
• Republicans in the last Congress proposed restricting schools that receive federal funding from changing a child's gender designation without parental consent and cutting funding to hospitals that provide gender transition care. They are expected to revive efforts to pare transgender protections this session, the 19th reported.

Catch up quick: Anti-abortion forces similarly used federal funding as a wedge in the 1970s to enact the Hyde Amendment, which bars the use of federal funds in Medicaid and other federal health programs for abortions except in cases of rape, incest or in cases where the pregnant person's life is in danger.

• The amendment was renewed multiple times by Congress, even when Democrats controlled the House. And similar policies were extended to other federal health programs, including coverage for federal employees and their families, military personnel and inmates in federal prisons, per Planned Parenthood.

What to watch: Advocates are ready to use the courts to push back against the latest gender policies.

• Several cases brought on behalf of transgender people in both federal prisons and various state prisons have found access to this care is "medically necessary" and must be provided under both the Constitution and various statutes, Goldberg pointed out.
• Further, it would take Congress to make similar restrictions for Medicaid and Medicare coverage of gender-affirming care. These will be the basis for legal challenges, Goldberg said.
• "This administration will make every argument that such care is not necessary, and I think continuing to look to the science and medical expertise is going to be really important," Goldberg said.

The bottom line: The early moves by the Trump administration are widely seen as an opening salvo to more sweeping moves to curb access.

• "We're going to have to see ways in which the agencies at the directive of the executive order try to change policy," Goldberg said.