In a significant announcement on Thursday morning, Health Secretary Robert F. Kennedy Jr. revealed proposed new rules that could lead to the closure of hospitals failing to comply with federal mandates. These rules, if finalized, would have far-reaching implications for the healthcare system, particularly regarding Medicare and Medicaid, which collectively account for nearly 45 percent of spending on hospital care, according to the Kaiser Family Foundation (KFF), a prominent nonprofit health policy research organization.
These new regulations come on the heels of a divided House of Representatives vote to approve legislation aimed at criminalizing gender transition treatments for minors. Under this legislation, healthcare providers could face up to 10 years in federal prison for offering such services. Additionally, the House is expected to pass another bill that would prohibit Medicaid payments for gender-related treatments for minors. While these bills are unlikely to pass in the Senate, they highlight the ultraconservative Republican majority's commitment to fulfilling President Trump’s campaign promises to restrict such medical treatments.
The proposed rules extend beyond mere legislative measures; they aim to prohibit hospitals nationwide from providing gender-related treatments altogether. Caroline Farrell, a former lawyer with the Centers for Medicare and Medicaid Services (CMS), emphasized that the proposed regulations could be a “death sentence” for hospitals, which already operate on razor-thin margins. She stated, “The proposed rule means just forcing them to stop the care.”
Gender-related treatments for minors, including puberty-blocking drugs, hormone therapies, and, in rare instances, surgeries, have been subjects of intense debate globally. However, these treatments receive endorsement from a majority of medical groups in the United States. The announcement from Health Secretary Kennedy also included further actions, such as a CMS rule that would bar Medicaid from funding these treatments for minors.
In response to the proposed regulations, Kelley Robinson, president of the Human Rights Campaign, reminded the public that these rules are still proposals and not yet binding law. She urged community members, healthcare providers, and allies to voice their concerns about the devastating effects these proposals could have on families and the broader healthcare community.
These developments follow a clear path laid out by President Trump through executive orders issued early in his administration, which denied the existence of transgender individuals. The president's directive stated, “It is the policy of the United States to recognize two sexes, male and female,” and mandated the Department of Health and Human Services to review the evidence supporting gender transition treatments. A report produced as a result of this review highlighted uncertainties surrounding the benefits of medical interventions while noting potential risks, such as loss of fertility.
This report, which has been criticized by both sides of the political spectrum, has become central to the new rules. Secretary Kennedy cited its conclusions to argue that gender-related treatments do not adhere to recognized standards of medical care, thus violating federal funding conditions. Such a determination is considered “unprecedented” by legal experts.
The proposed rules pose an existential threat to hospitals that accept any federal funding, regardless of whether those funds are allocated for gender-related treatments. Questions surrounding the effectiveness and safety of medical interventions for minors have fueled global debates, leading several countries to impose restrictions on such treatments. However, none have adopted the sweeping measures seen in the United States, where nearly half the states have enacted bans, and criminal charges are being considered against healthcare providers.
The new regulations are likely to spark a 60-day public comment period, and legal challenges are anticipated before any final implementation. As these developments unfold, it remains clear that the landscape of gender-related healthcare is shifting dramatically, raising significant concerns among healthcare providers, patients, and advocacy groups alike. The future of healthcare for transgender minors hangs in the balance as the nation grapples with these contentious issues.