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'It Will Kill People': HHS Proposal Targeting Transgender Healthcare Could Cause Even More Hospitals to Close
One advocate said the proposed rule would force hospitals "to choose between providing lifesaving care for trans people or maintaining the ability to serve patients through Medicare and Medicaid."
Oct 30, 2025
A pair of extreme new Trump administration rules aimed at functionally banning gender-affirming healthcare for transgender youth could force even more hospitals to close down.
NPR reported Thursday that the Department of Health and Human Services (HHS) drafted a proposed rule that would prohibit federal Medicaid reimbursement for medical care provided to transgender patients younger than 18 and prohibit the same from the Children's Health Insurance Program (CHIP) for patients under 19.
Another proposed rule goes even further, blocking all Medicaid and Medicare funding to hospitals that provide gender-affirming care to youth.
As Erin Reed, an independent journalist who reports on LGBTQ+ rights, explained, this "would effectively eliminate access to such care nationwide, except at the few private clinics able to forgo Medicaid entirely, a rarity in transgender youth medicine."
The policies are of a piece with the Trump administration and the broader Republican Party's efforts to eliminate transgender healthcare for youth across the country.
Bans on gender-affirming care for those under 18 have already been passed in 27 states, despite evidence that early access to treatments like puberty blockers and hormones can save lives.
As Reed pointed out, a Cornell University review of more than 51 studies shows that access to such care dramatically reduces the risk of suicide and the rates of anxiety and depression among transgender adolescents.
The new HHS rules are being prepared for public release in November and would not be finalized for several more months.
But if passed, the ramifications could extend far beyond transgender people, impacting the entire healthcare system, for which federal funding from Medicare and Medicaid is a load-bearing piece. According to a report last year from the American Hospital Association, 96% of hospitals in the US have more than half their inpatient days paid for by Medicare and Medicaid.
It is already becoming apparent what happens when even some of that funding is taken away. As a result of the massive GOP budget law passed in July, an estimated $1 trillion is expected to be cut from Medicaid over the next decade. According to an analysis released Thursday by Protect Our Care, which maintains a Hospital Crisis Watch database, more than 500 healthcare providers across the country are already at risk of shutting down due to the budget cuts.
Tyler Hack, the executive director of the Christopher Street Project, a transgender rights organization, said that the newly proposed HHS rule would be "forcing hospitals to choose between providing lifesaving care for trans people or maintaining the ability to serve patients through Medicare and Medicaid."
"Today’s news marks a dangerous overreach by the executive branch, pitting trans people, low-income families, disabled people, and seniors against each other and making hospitals choose which vulnerable populations to serve," Hack said. "If these rules become law, it will kill people."
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Small Social Security Boost Won't Do Much for Seniors as Trump Policies Jack Up Living Costs
"Seniors on fixed incomes are rightly concerned that the Social Security COLA is not keeping pace with the true impact of inflation on their living costs," said one advocate.
Oct 24, 2025
The Social Security Administration on Friday announced a 2.8% cost-of-living adjustment for beneficiaries, a small increase that advocates said would be mostly or entirely offset by surging healthcare premiums and other price hikes fueled by President Donald Trump's erratic tariff policies and Republican legislation passed earlier this year.
The 2.8% raise—the second-smallest since 2021—will amount to just over $50 extra per month for the average Social Security recipient. The projected 11.6% increase in Medicare Part B premiums next year would wipe out around 40% of the COLA increase for seniors.
Nancy Altman, president of the progressive advocacy group Social Security Works, noted in a statement Friday that "the situation is even worse" for Social Security recipients who buy health insurance on the Affordable Care Act (ACA) marketplace because they are not yet eligible for Medicare. The federal government is currently shut down because congressional Republicans are refusing to extend ACA subsidies that are set to expire at the end of 2025, sending premiums soaring.
"ACA premiums are projected to skyrocket next year, with those over 50 hit hardest," Altman said. "For many of these beneficiaries, the COLA increase won't come close to covering their increased healthcare premiums."
Another factor that could eat into the Social Security COLA is the impact of Trump's tariffs on prescription drug prices, which are already far higher in the US than in other wealthy nations. Overall, as KFF Health News reported last month, "Medicare enrollees who buy the optional Part D drug benefit may see substantial premium price hikes—potentially up to $50 a month—when they shop for next year's coverage."
"Seniors on fixed incomes are rightly concerned that the Social Security COLA is not keeping pace with the true impact of inflation on their living costs—especially in areas where prices are soaring," said Max Richtman, president and CEO of the National Committee to Preserve Social Security and Medicare. "Medical, housing, and grocery costs are outstripping the COLA."
"If billionaires and the wealthiest 1% pay their fair share, we can boost benefits for everyone and guarantee the program’s solvency for future generations."
Social Security lifts more people out of poverty than any other US government program, but experts and advocates have long argued that its benefits should be expanded and the COLA formula reformed to combat the growing financial struggles of older Americans. The senior poverty rate in the US rose to 15% last year, according to US Census Bureau data.
Richard Fiesta, executive director of the Alliance for Retired Americans, said Friday that "strengthening and expanding Social Security must be a national priority."
"If billionaires and the wealthiest 1% pay their fair share, we can boost benefits for everyone and guarantee the program's solvency for future generations," said Fiesta. "Instead of working to protect Social Security, too many members of Congress and Trump administration officials are pushing to raise the retirement age, cut benefits, and even privatize the program. Older Americans have earned these benefits through a lifetime of work; they should not have to fight to keep them."
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CNBC Host Doesn't Know How to Fix Runaway Healthcare Costs. Ro Khanna Says: Medicare for All
As health insurance companies rake in billions in profits, the California Democrat argues that a single-payer system would help US businesses and cut costs.
Oct 23, 2025
With the second-longest federal government shutdown dragging on and Americans concerned about soaring health insurance premiums and coverage losses, Congressman Ro Khanna on Thursday again made the case for Medicare for All.
On CNBC's "Squawk Box," co-host Joe Kernen made clear he doesn't support Medicare for All but expressed concern about rising premiums. He also admitted, "I don't know what the answer is."
Khanna (D-Calif.), meanwhile, reiterated his support for a single-payer system, in part by highlighting how private health insurance companies are raking in billions of dollars in profits each year, at the expense of patients.
If the United States extended eligibility for Medicare, which is now only available to Americans ages 65 and older, "it would help private business," the congressman argued. "It would lower healthcare costs."
A 2020 analysis from the Economic Policy Institute found that Medicare for All would benefit companies and workers by supporting self-employment and small business development, boosting wages, increasing job quality, and lessening the stress and economic shock of losing or changing employment. That same year, the Congressional Budget Office (CBO) estimated that shifting to Medicare for All could save $650 billion annually.
Khanna on Thursday pushed back against claims that under Medicare for All, Americans wouldn't be able to get the healthcare they need, saying: "I don't think Medicare is rationing more than the private industry. [If] you are on private insurance, that's where you get rationed. You have to get your pre-authorization. You have things denied. Medicare, actually, doesn't do that."
Although Medicare can deny coverage, KFF found in 2023 that people with employer-sponsored health insurance were twice as likely as those on Medicare for Medicaid—which covers people with low incomes and disabilities—to have a claim denied.
"Traditional Medicare, also known as Original Medicare, has historically required little in the way of pre-authorization for beneficiaries seeking services; pre-authorization was typically the domain of Medicare Advantage," or plans administered by private insurance companies, Kiplinger reported this summer. "But that's about to change."
Under President Donald Trump's "profoundly unqualified" pick to lead the Centers for Medicare and Medicaid Services, Dr. Mehmet Oz, CMS will require prior authorization for 17 services it claims "are vulnerable to fraud, waste, and abuse" in six states next year.
Beginning in January, Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington will serve as testing grounds "to provide an improved and expedited prior authorization process relative to Original Medicare's existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars," CMS said in a June statement.
Julie Alderman Boudreau, who has worked as a researcher at various organizations, warned at the time that "this is a Medicare cut by another name. This will cause seniors to delay care or forgo it altogether."
The CMS announcement came just days before Trump signed Republicans' One Big Beautiful Bill Act, which contained cuts to Medicaid and did not extend expiring Affordable Care Act premium tax credits. The current government shutdown, which began on October 1, stems from Democrats' fight to undo the GOP attacks on Medicaid and ACA subsidies.
The CBO estimates that 10 million Americans could be booted off Medicaid because of cuts. Additionally, more than 20 million Americans who buy insurance via ACA marketplaces are expected to see their premiums spike next year, and some of them may not be able to afford any plans. Multiple polls released this week show that US voters are concerned about premium hikes.
One of those surveys, released Monday by Data for Progress and Groundwork Collaborative, also shows that voters want Democrats in Congress to keep fighting for a fix to the looming healthcare crisis, even if it means the shutdown continues.
Khanna—one of several Democrats considered a potential 2028 presidential candidate—noted on social media earlier this week that KFF polling shows that "78% of Americans favor extending ACA credits."
"Republicans are once again trying to reward the ultrawealthy at the expense of regular folks," he added. "It's time to pass Medicare for All and solidify Americans' right to affordable healthcare."
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