On Tuesday, a coalition of 19 states and the District of Columbia filed a lawsuit against the U.S. Department of Health and Human Services (HHS), its Secretary, Robert F. Kennedy Jr., and its inspector general. The lawsuit was in response to a declaration that could potentially complicate access to gender-affirming care for young people. This declaration is the latest in a series of policy moves that have led to clashes between the administration and advocates for transgender healthcare.
The declaration in question was issued the previous Thursday, and it labeled treatments like puberty blockers, hormone therapy, and surgeries as unsafe and ineffective for children and adolescents experiencing gender dysphoria, or the distress caused when one’s gender expression doesn’t align with the sex they were assigned at birth. Additionally, the declaration warned doctors that they risked being excluded from federal health programs such as Medicare and Medicaid if they chose to provide these types of care.
Simultaneously, HHS announced proposed rules intended to further limit gender-affirming care for young people. However, these proposed rules were not addressed in the lawsuit as they have not yet been finalized.
The lawsuit was filed in U.S. District Court in Eugene, Oregon. In it, the coalition alleges that the declaration is both inaccurate and unlawful, and it requests that the court block its enforcement. The lawsuit is the most recent development in an ongoing conflict between an administration that argues that transgender healthcare for children can be harmful and advocates who argue that the care is medically necessary and should not be inhibited.
These clashes escalated after President Trump, upon taking office in January, signed an executive order aimed at reducing federal support for specific types of gender-affirming care for individuals under the age of 19. The lawsuit argues that HHS’s declaration seeks to pressure providers into ceasing the provision of gender-affirming care and to circumvent legal requirements for policy changes. Furthermore, the suit claims that federal law requires the public to be given notice and an opportunity to comment before substantive changes to health policy are made; neither requirement, the suit alleges, was fulfilled before the declaration was issued.
A representative for HHS declined to comment on the matter. The department’s declaration was based on conclusions drawn from a peer-reviewed report conducted earlier this year that recommended a greater reliance on behavioral therapy over extensive gender-affirming care for youth with gender dysphoria. The report questioned standards for the treatment of transgender youth issued by the World Professional Association for Transgender Health and expressed concerns that adolescents may be too young to give consent to life-altering treatments that could result in future infertility.
However, the report has been sharply criticized by major medical groups and those who treat transgender young people. The criticisms label the report as inaccurate, and most major U.S. medical organizations, including the American Medical Association, continue to oppose restrictions on transgender care and services for young people.
This declaration was part of a broader effort to limit gender-affirming health care for children and teenagers. It builds on other Trump administration efforts to target the rights of transgender people nationwide. As part of these efforts, HHS also unveiled two proposed federal rules on the same day the declaration was announced. One proposed rule aims to cut federal Medicaid and Medicare funding from hospitals providing gender-affirming care to children, while the other seeks to prevent federal Medicaid dollars from being used for such procedures.
These proposals are not yet final or legally binding and must undergo a lengthy rulemaking process and public comment before becoming permanent. Despite this, they are likely to further discourage healthcare providers from offering gender-affirming care to children. Several major medical providers have already pulled back on gender-affirming care for young patients since Mr. Trump returned to office, even in states where such care is legal and protected by state law.
Medicaid programs in slightly fewer than half of all states currently cover gender-affirming care. In contrast, at least 27 states have implemented laws that restrict or ban the care. A recent 6-3 decision by the Supreme Court upholding a ban in Tennessee means most other state laws of this nature are likely to remain in place. The case, U.S. v. Skrmetti, marked the first time the Supreme Court had dealt with the issue of healthcare for transgender youth.
Tennessee’s law bans medical treatments such as puberty blockers or hormone therapy for transgender adolescents under the age of 18. The state defended the law, arguing that it has a “compelling interest in encouraging minors to appreciate their sex, particularly as they undergo puberty,” and in barring treatments that “might encourage minors to become disdainful of their sex.”
In his majority opinion, Chief Justice John Roberts stated that the Court’s role was not “to judge the wisdom, fairness, or logic” of the law but rather to ensure that it does not violate the equal protection guarantee of the Fourteenth Amendment. He concluded that the law does not violate this guarantee and left questions regarding its policy to the people, their elected representatives, and the democratic process.
Democratic attorneys general from California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Wisconsin, Washington, and the District of Columbia joined New York Attorney General Letitia James in the lawsuit. Pennsylvania’s Democratic governor also joined. In a statement released on Tuesday, James said, “Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary healthcare because their federal government tried to interfere in decisions that belong in doctors’ offices.”
