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Attacks on Transgender Americans Are Attacks on Health Care
This is not difficult: Gender-affirming care is health care, period, and decisions about that care belong to patients and their health care providers (and families in the case of minors), not politicians on an ideological crusade.
Mar 21, 2026
For some time now, right-wing forces have been attacking gender-affirming health care for transgender individuals, and especially for trans youth. Those attacks ratcheted up seriously in December, when the Trump administration proposed rules designed to ban gender-affirming care for young people, with HHS Secretary Robert F. Kennedy Jr. flatly calling such care “malpractice.”
The medical community promptly and unequivocally disagreed, with American Academy of Pediatrics President Dr. Susan J. Kressly telling NPR, "These policies and proposals misconstrue the current medical consensus and fail to reflect the realities of pediatric care and the needs of children and families." AAP’s view represents the overwhelming consensus among medical, nursing and psychiatric organizations, but that has had no impact on the crusade by the administration as well as right-wing state officials to erase trans people and eliminate and even criminalize their health care.
The Trump administration’s push to erase trans people began early last year with a presidential executive order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” The order declared, “Efforts to eradicate the biological reality of sex fundamentally attack women by depriving them of their dignity, safety, and well-being.” Trump’s order oddly failed to acknowledge the existence of transgender men but effectively declared all transgender humans to be nonpersons according to the U.S. government. “It is the policy of the United States,” it read, “to recognize two sexes, male and female. These sexes are not changeable and are grounded in fundamental and incontrovertible reality.”
That’s not a scientific statement but an ideological one. In fact, as Nathan Lents, a molecular evolutionary biologist at the John Jay College of Criminal Justice in New York City explained to a reporter after the executive order was issued, “Biology doesn’t operate in binaries very often … Reducing sex to a binary really doesn’t make a lot of sense for how we actually live.”
Many cultures around the world, particularly indigenous cultures, have long recognized gender diversity. In Hawaii, where I live, native Hawaiian culture understood and respected māhū, the Hawaiian word for a person of dual male and female spirit. What administration officials and other right-wingers dismiss as “radical gender ideology” is in fact a factual, science-based understanding of a facet of human diversity that has been recognized by different cultures around the globe for millennia, starting long before either modern science or modern politics entered the picture.
Nevertheless, the president’s order and subsequent messages from the Department of Health and Human Services put intense pressure on hospitals and health care providers, many of whom responded by curtailing gender-affirming care, especially for minors. Those pausing or such care included major hospital systems such as Kaiser Permanente with its 40 hospitals. By late August, news outlets had counted at least 17 major hospital systems in at least nine states and the District of Columbia that had paused, discontinued, canceled or ended gender-affirming care for pediatric patients.
States—generally Republican-leaning states—have also piled on restrictions. Late last year, KFF reported that 27 states had passed laws limiting access to gender-affirming care for minors. Roughly half of the nation’s trans or nonbinary youth are estimated to live in these states. Half a dozen states, including Florida, Alabama and Idaho, have made it a felony to provide gender-affirming care for young people under 18. Though the Supreme Court upheld such bans last year, some of these state laws face legal challenges in state courts based on individual state constitutions.
On the other hand, a number of states—generally “blue states,” including New York and California—have passed laws protecting gender-affirming care, while a few others have such policies via executive orders. Recently, New York Attorney General Letitia James informed a major Manhattan hospital that its actions to curb gender-affirming care under federal pressure violated New York State law. Hospitals and other providers may find themselves more and more caught between conflicting state and federal requirements.
It’s important to remember that for those under 18, gender-affirming care almost never involves surgery, but typically focuses on social and psychological support. Medical interventions such as puberty blockers are sometimes used after puberty begins. Puberty blockers, which are entirely reversible (and which a White House executive order has dishonestly branded as “chemical mutilation”) pause puberty in order to buy the young person time to mature and consider their options before major and complex-to-reverse physical changes set in.
Opponents of gender-affirming care sometimes focus on a handful of patients who later changed their minds and regretted having this care. Nearly any medical procedure results in a few patients wishing they hadn’t done it, but research consistently shows that regret rates for gender-affirming care are quite low. For example, a 2024 review of 55 articles that looked at regret rates after various types of plastic surgery found that gender-affirming surgery had far lower regret rates than other surgeries, including breast augmentation or reconstruction, not to mention other major life decisions such as having children or getting a tattoo.
A later study of 150 youthful individuals (median age 18.6 years) who had had gender-affirming hormone therapy and/or surgery found that the most common emotions associated with these treatments “were satisfaction (88.0%) and confidence (86.7%).” Only one of the 150 wished they hadn’t had the treatments, leading the authors to conclude, “Individuals who accessed [gender-affirming care] as adolescents are largely satisfied with this care. Care-related satisfaction and regret are more nuanced than sometimes portrayed and should not be used to limit access.”
State attacks on transgender residents don’t stop with medical care. Kansas, for example, just summarily invalidated all driver’s licenses in which the driver had legally changed their gender to match their lived identity. Such policies can impact the health of those affected, both by adding new layers of stress and by interfering with their ability to drive to obtain care or just make a living.
All of these policies are based on a myth: That transgender identity is the product of some new, “woke,” “radical gender ideology” and that trans people are simply confused and have been propagandized into believing that they can change their gender.
Trans people know better. Take “Perry” (a pseudonym), a young friend of mine whom I wrote about last October for Defend Public Health. Perry, 17 when I met him and now turning 21, knew something was amiss from early in his childhood. “I always felt uncomfortable,” he told me. “I rebelled against every single authority most of my childhood.” His feelings clarified when he was about twelve. As he explained it, “I always felt like I wasn’t myself, like I was playing a role” -- the role assigned to the female anatomy he was born with.
Despite some parental unease, he eventually began living as a boy and instantly felt more comfortable and like his authentic self. Trans people like Perry know who they are and don’t need politicians dictating what care they can and can’t obtain.
Happily for Perry, he lives in Hawaii, a state that has not restricted gender-affirming care and is unlikely to. But Hawaii doesn’t yet have a shield law to protect providers (such a bill is now up for consideration in the state legislature), and can certainly be impacted by misguided federal policies, so he’s not completely out of danger.
This is not difficult: Gender-affirming care is health care, period, and decisions about that care belong to patients and their health care providers (and families in the case of minors), not politicians on an ideological crusade. We must fight back against these attacks and push our politicians to defend the rights of all, including transgender people, to get the care they need.
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Millions of Americans Joining the Ranks of the Uninsured Thanks to Trump-GOP Cuts in 2025
New data released by KFF underscores how "universal, seamless coverage throughout the life course remains an urgent prerogative for the nation," said one physician and advocate.
Mar 20, 2026
About 24.3 million Americans were enrolled in healthcare plans within the Affordable Care Act marketplace last year, but a survey released Thursday by KFF found that about 1 in 10 of those people had no choice but to make a difficult and risky calculation at the end of 2025 when ACA subsidies expired due to Republicans' refusal to support an extension.
According to the research, 9% of people enrolled in plans under the marketplace last year are now uninsured, having dropped their coverage—and costs were a deciding factor for the vast majority of those who left the marketplace.
The expiration of the enhanced tax credits sent premiums skyrocketing by an average of 114%, according to KFF.
The decision was unavoidable for one 54-year-old man in Texas, who told KFF simply, "Without the subsidy, I cannot afford the premium payments.”
A 56-year-old woman in Illinois said her income was too high last year to qualify for subsidies, but the increase in cost this year was "so high even for those without subsidies."
"I simply cannot afford to pay $1,200 a month for insurance," she said. "It used to be high premiums meant low deductibles and copays, but not anymore. This is ridiculous. $1,200 for a healthy person, and an $8,000 deductible. Really?”
A Florida resident named Kelly Rose told The Wall Street Journal that the $1,700 monthly premium she was quoted for an ACA plan would have been more than her mortgage. She missed the enrollment window for health coverage through her job at a bank—assuming her ACA plan would cost less—and is now uninsured and relying on a Canadian pharmacy to get her asthma medication, which would cost $800 per month without insurance in the US.
Cynthia Cox, a senior vice president at KFF, told the Journal that the survey results were “about on target” what the health policy research group had expected last year when the subsidy expiration was looming and Democrats were demanding that the GOP vote with them to extend the tax credits.
“Not only is there significant coverage loss, but there could be more to come,” Cox said.
An estimated 25 million Americans are uninsured, said Harvard Medical School professor and former Physicians for a National Health Plan president Adam Gaffney—a fact he called "abhorrent" as he suggested the new data makes the latest case for "universal, seamless coverage throughout the life course," or an expansion of the Medicare program to the entire US population.
That proposal, which has been introduced in Congress numerous times by lawmakers including Sen. Bernie Sanders (I-Vt.) and Rep. Pramila Jayapal (D-Wash.), would put the US in line with the healthcare systems of other wealthy nations, improve healthcare outcomes, and save an estimated $650 billion per year.
A poll released late last year by Data for Progress found that 65% of likely US voters supported "creating a national health insurance program, sometimes called ‘Medicare for All,’ that would cover all Americans and replace most private health insurance plans."
The fact that millions of Americans have chosen to opt out of the country's for-profit health insurance system—putting their health and finances at risk—is representative of "a profound hollowing-out and weakening of America," said writer and markets researcher Ben Hunt.
The economic justice campaign Unrig Our Economy emphasized that Republicans' cuts to healthcare last year—via the expiration of the subsidies and slashes to Medicaid—put an estimated 15 million Americans at risk of losing health coverage.
“Republicans knew that healthcare tax credits were critical to helping millions of Americans afford their health insurance, but they chose to get rid of them to fund more tax breaks for their billionaire buddies,” said Unrig Our Economy campaign director Leor Tal. “Costs are higher, millions are without insurance, and working Americans are having to make sacrifices just to afford basic healthcare—and they know that Republicans are to blame. It’s time Republicans finally started listening to their constituents and fixing the healthcare crisis they created.”
KFF's polling also found that among people who still have health insurance under the ACA, higher premiums and deductibles have left a majority concerned that they wouldn't be able to afford emergency care even with their coverage. Nearly half of respondents said they were worried that even routine medical care will be unaffordable this year with their ACA plans.
Due to Republican attacks, the cost of coverage offered by the program is now forcing 55% of people using the ACA to cut back on spending money on food, household items, and clothing in order to afford it. Forty-three percent said they are trying to find another job or extra income to afford healthcare payments, and nearly a quarter said they are skipping or delaying payments on other bills to afford their health coverage.
More than half of people polled by KFF said they blame Republicans in Congress for their rising healthcare costs.
"Americans are blaming them because it’s true," said Unrig Our Economy. "Congressional Republicans’ massive cuts to health care have put a projected 15 million Americans at risk of losing health insurance and left millions more struggling to keep up with rising costs. Republicans made these cuts all so they could give more tax breaks to billionaires and corporations."
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'People Can't Afford Healthcare': Sanders Rips Pentagon Request for Another $200 Billion
"People can't afford childcare," said Sen. Bernie Sanders. "And this guy, in addition to giving tax breaks to billionaires, now wants to spend another $200 billion on a war that should never have been fought."
Mar 20, 2026
US Sen. Bernie Sanders said Thursday that it is absurd for the Trump administration to demand another $200 billion from Congress for an illegal war on Iran after lawmakers already approved $1 trillion in military spending for the year—and while millions of people across the nation are struggling to afford basic necessities.
"You got people all over this country, 20% of households, spending 50% of their income on housing," Sanders (I-Vt.) said in an appearance on MS NOW. "People can't afford healthcare. People can't afford childcare. And this guy, in addition to giving tax breaks to billionaires, now wants to spend another $200 billion on a war that should never have been fought."
The senator's remarks came as President Donald Trump, who has not yet formally requested the funds from Congress, suggested another $200 billion would be a "small price to pay" as the US-Israeli war on Iran heads toward its fourth week with no end in sight.
"I think the Trump people are in a bit of panic," Sanders said Thursday. "They're losing ground. Gas prices are soaring. There is massive discontent against this war. It's got to end, and we've got to make sure that Trump is neutered in 2026."
With the Trump administration considering a plan to deploy thousands of additional troops to the Middle East amid widespread fears of a ground invasion of Iran—which would explode the price tag of an already costly war—the National Priorities Project (NPP) released an analysis highlighting where the $200 billion requested by the Pentagon could be better spent.
The group estimated that $200 billion would be enough for all of the following this year:
- Medicaid for the 17 million people who will lose it due to budget cuts and other policies;
- Food stamps for the 22 million people who will go hungry due to Trump's budget cuts;
- Medical care for the 1.8 million veterans of the last forever war who still live with disabilities; and
- Tripling the number of kids in Head Start, from just over 700,000 to 1.4 million kids.
"Pete Hegseth would rather the US bomb Iranian families than feed American families," wrote NPP's Lindsay Koshgarian, referring to the Pentagon secretary. "We should remember the lies that led us into war in Iraq a generation ago. That war ultimately cost nearly $3 trillion. We must not go down that path again. Our tax dollars should be helping struggling Americans, not feeding new forever wars."
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