On Tuesday, a coalition of 19 states along with 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 over a declaration that could hinder access to gender-affirming care for young individuals. The legal action was initiated in U.S. District Court in Eugene, Oregon, following a contentious declaration made by HHS last Thursday.
The controversial declaration labeled treatments such as puberty blockers, hormone therapy, and surgeries as unsafe and ineffective for children and adolescents facing gender dysphoria, which is defined as the distress experienced when a person's gender identity does not align with the sex assigned to them at birth. The notice issued by HHS warned health care professionals that they could face exclusion from federal health programs, like Medicare and Medicaid, if they continued to provide such care.
Accompanying the declaration were proposed rules from HHS aimed at implementing further restrictions on gender-affirming care for minors. However, these proposals have not yet become final, and thus, they were not part of the lawsuit filed by the coalition of states. The states assert that the declaration is not only inaccurate but also unlawful, urging the court to block its enforcement.
New York Attorney General Letitia James, who is spearheading the lawsuit, stated, "Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary health care because their federal government tried to interfere in decisions that belong in doctors' offices." The lawsuit highlights that the declaration coerces health care providers into discontinuing gender-affirming care, thereby bypassing legal protocols that mandate public notice and the opportunity for comment prior to modifying health policies.
The declaration's conclusions were based on a peer-reviewed report conducted earlier this year by HHS, which advocated for a greater focus on behavioral therapy over broader gender-affirming care for youth suffering from gender dysphoria. The report raised questions regarding the established treatment standards for transgender youth, specifically those issued by the World Professional Association for Transgender Health, and expressed concerns that adolescents might be too young to consent to irreversible treatments that could lead to future infertility.
Prominent medical associations and professionals specialize in treating transgender youth, have criticized the HHS report as misleading. Most major U.S. medical organizations, including the American Medical Association, continue to oppose any restrictions on transgender care and services provided to young people. This declaration is part of a broader initiative to limit gender-affirming health care for children and teens, building on previous efforts initiated during the Trump administration aimed at marginalizing the rights of transgender individuals across the country.
Alongside the declaration, HHS introduced two proposed federal rules: the first aims to cut federal Medicaid and Medicare funding for hospitals offering gender-affirming care to minors, and the second seeks to prohibit the use of federal Medicaid funds for such procedures. Although these proposals are not yet enacted and must undergo an extensive rulemaking and public comment process, they are expected to deter health care providers from offering gender-affirming care to minors.
Since Trump's recent return to office, several major medical providers have already scaled back on offering gender-affirming care for young patients, even in states where such care remains legal and protected by state law. Presently, Medicaid programs in nearly half of the states cover gender-affirming care, while at least 27 states have passed laws restricting or banning such treatments. The Supreme Court's recent upholding of Tennessee's ban on gender-affirming care has set a precedent that suggests many other state laws will remain in force.
Along with James, the lawsuit includes Democratic attorneys general from various states, including 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, as well as the Democratic governor of Pennsylvania, highlighting a substantial political coalition against the recent actions taken by HHS.
