Trump admin moves to cut hospital payments over trans care

The Trump administration on Thursday moved to cut off federal health payments to hospitals that offer transition-related care to youths, setting the stage for another legal battle over transgender rights.

Why it matters: Stopping Medicare and Medicaid payments would strike at a key component of hospitals' finances and escalate a series of administration moves to curtail medical services for transgender kids.

• Virtually every hospital in the country participates in Medicare and Medicaid, and the programs pay for at least half of inpatient stays at 96% of facilities, per the American Hospital Association.
• The policy does not take effect immediately and hospitals providing gender-affirming care can continue participating in Medicare and Medicaid for the time being.

If the policy is finalized, it is certain to be challenged in court.

• New York Attorney General Letitia James (D) called the administration move "reprehensible," adding, "I will use every tool at my disposal to fight this proposal and protect transgender Americans and their families."

Trump administration efforts to restrict transition-related care for youths have already led more than 20 facilities to stop prescribing puberty blockers and hormone therapy to transgender patients or announce plans to end services, including Children's Hospital Los Angeles and Children's Hospital of Philadelphia.

What they're saying: "So-called gender-affirming care has inflicted lasting physical and psychological damage on vulnerable young people," Health Secretary Robert F. Kennedy Jr. said at an event announcing the policy. "This is not medicine. It is malpractice."

• "We're done with junk science driven by ideological pursuits."

Transition-related care for kids is considered safe and appropriate by major medical organizations, including the American Medical Association.

• Puberty blockers are also used for non-trans youth who experience early-onset puberty. Surgeries for transgender children are rare. Transgender teens who get gender-affirming care report high levels of satisfaction.

The other side: "These rules aim to completely cut off medically necessary care from children no matter where in this country they live," said Kelley Robinson, president of the Human Rights Campaign.

• "It's the Trump administration dictating who gets their prescription filled and who has their next appointment canceled altogether."

The American Hospital Association said in a statement that it's reviewing the proposal and will provide comments to the agency.

Where it stands: The administration is proposing to stipulate that hospitals cannot receive payments from Medicare or Medicaid for any medical services or procedures if they perform gender-affirming care for youth.

• The care in question would include prescribing puberty blockers, hormone therapies and surgical procedures, which the administration calls "sex-rejecting procedures."
• Exceptions under the new policy would include treatment for kids with "medically verifiable" sexual development disorder, or for unrelated medical purposes.

Between the lines: The Centers for Medicare and Medicaid Services notes that it is legally prohibited from controlling the practice of medicine. But it contends that gender-affirming care "is not health care and hence are not subsumed under the term of 'the practice of medicine.'"

• The policy change is open for public comment for the next 60 days.

Zoom out: A separate proposal released Thursday would prevent state Medicaid plans from covering gender-affirming care for minors. Medicaid covers more than half of kids in the U.S.

Flashback: The rules follow a January executive order from President Trump directing the Department of Health and Human Services to stop youth gender-affirming care in the country.

• The order explicitly suggests using conditions of participation in Medicare and Medicaid to enforce the policy.
• Advocacy groups and states have filed lawsuits challenging the executive order and other Trump administration efforts to stop gender-affirming care for kids. A federal judge has temporarily stayed the executive order.

This story has been updated with further reporting.