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A coalition of blue states has come together to file a lawsuit against the Trump administration challenging its plan to strip federal funds from gender-affirming care for minors. The lawsuit alleges that the administration is overstepping its authority by trying to dictate what medical procedures can and can’t be covered by federal funding.
“[The Department of Health and Human Services (HHS)] has disregarded the law and its own policy precedent in another attempt to restrict transgender individuals’ access to crucial care,” California Attorney General Rob Bonta said in a statement. “We will not stand by as the Trump administration oversteps its authority and twists the facts to justify its bad-faith agenda against transgender Americans. We will continue to fight to secure access to medically necessary care and protect transgender individuals’ abilities to prosper as their authentic selves.”
The lawsuit targets Robert F. Kennedy Jr. as the head of HHS, as well as Dr. Mehmet Oz in his role as administrator of the Centers for Medicare & Medicaid Services (CMS). Last month, the departments finalized a plan to prevent federal Medicare and Medicaid plans from covering gender-affirming care for anyone under the age of 18, and to bar plans under the federal Children’s Health Insurance Program (CHIP) from covering the care for anyone under 19.
The plan spent months in a public comment period during which is received nearly 35,000 comments, over 90% of which opposed the plan. Despite this, the rule is set to go into effect on October 13 with little change to the text of the final document.
The lawsuit wastes no time highlighting to the US District Court for the District of Massachusetts that the administration’s new plan is not about healthcare, but an attack on trans people.
The introduction states, “The Administration seeks such broad and unprecedented powers in part to advance its social policy agenda, a key component of which involves relentless attacks on a small and vulnerable population—transgender individuals—whose very existence the President scapegoats to stoke national division.”
The lawsuit makes a case that the proposed rule oversteps states’ rights by regulating the practice of medicine, a responsibility that both Congress and existing legal precedent have made clear is reserved for the states themselves. The suing states also say that HHS has cherry-picked its evidence and failed to make a case for its ban on gender-affirming care funding, and that the plan change violates the Social Security Act and HHS precedent by excluding care that has been deemed medically necessary by the states.
The lawsuit also highlights that Congress left the decision for what should be covered by Medicare and CHIP to the states, and therefore the federal government cannot simply impose a rule to prevent the states from exercising their own will.
“The federal government does not have the authority to dictate what medically necessary care New York provides to its residents,” said New York Attorney General Letitia James in a statement. “This unlawful rule threatens access to health care for transgender young people and undermines states’ ability to administer our own Medicaid programs. New York will continue to stand up for patients and defend our authority to provide the care they need.”
The lawsuit additionally includes a nod towards a longstanding argument that banning gender-affirming care is discrimination based on sex, as under the proposed rule cis patients will still be able to receive coverage for the same treatment and care that is being denied to trans patients.
In his statement, Attorney General Bonta was keen to highlight that this proposed rule does not stop anyone from practicing gender-affirming care in any state where it is still legal (which includes California). The only restriction is on the use of federal funds, and the rule explicitly still allows for state funds to be used for the care.
An earlier HHS attempt saw the department pushing a rule that would have barred hospitals and clinics that provided gender-affirming care from receiving any form of federal funding at all. However, a judge struck that rule down in April and the Trump administration seemed to back off from trying to appeal that ruling in July.
Trans journalist Erin Reed called the states’ lawsuit “the next major step in the fight to protect transgender healthcare,” since the removal of federal funding would be ” a virtual death sentence for any hospital system.”
Reed noted that over “40 hospitals and health systems have stopped or paused their programs in capitulation” to the administration despite there being no federal law against the care. Some of these institutions have stopped providing the care in violation of state or local laws that explicitly protect transgender people from healthcare discrimination.
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