Election could move the fight over trans care from the states to the District of Columbia

While the legislative fight over transgender care has so far largely been limited to the states, a flurry of campaign ads from Republicans and concerned transgender advocates indicates that could change if Republicans take control of Congress and the White House.

Even as Republican presidential candidate Donald Trump concentrated, Particularly in the final weeks of his re-election campaign focused on restricting gender-affirming care for transgender people, leading Republican senators began investigating the legality of using puberty blockers on minors.

And in December the Supreme Court will hear arguments landmark case this may determine the fate of access to gender-affirming child care.

Democrats, lawyers and LGBTQ+ rights groups say the federal government’s focus on transgender care is a marked shift from the past, when most policies affecting transgender people were approved at the state level.

Twenty six states passed legislation banning gender-affirming care for minors under 18, according to the Human Rights Campaign. However, there is no such ban at the federal level. republicans tried Provisions limiting transgender people’s access to health care have been added to major spending bills in recent years, but Democrats have blocked them.

A GOP-led Congress in 2025 could change that.

“We will see efforts to influence transgender people’s ability to access health care at both the federal and state levels in the future,” Olivia Hunt, policy director for Advocates for Transgender Equality, said of a potential GOP Congress and White House. in the future. 2025.

Ahead of the election, the Trump campaign covers the southern half of the US on NFL Sundays with ads claiming: “Kamala for them/them, Trump for you.” The ad also claims that Harris supports taxpayer-funded gender reassignment surgeries for transgender inmates, a policy that was actually included in budget documents since the first Trump administration.

The transgender community makes up less than 1 percent of the U.S. population, and polls indicate that voters are not particularly interested or motivated by the issue.

More than 60 percent of voters, including 41 percent of Republicans, called the use of political attack ads against transgender people “disgraceful.” according to survey from the left group “Data for Progress”.

“Republicans have been using abortion for years (as a political appeal), and right now it’s backfiring,” said Sasha Buchert, senior attorney at Lambda Legal, an organization that aims to protect LGBTQ+ people. “So they took this issue, this partisan issue, to go after the 1 percent of the population.”

Congress’s view

Capitol Hill Republicans are showing increased interest in transgender health care policy as the 118th Congress comes to an end, a likely hint of what could happen to the GOP majority next year.

Sen. Bill Cassidy, R-Louisiana, could lead the Senate Health, Education, Labor and Pensions Committee if the GOP takes control of the chamber. Earlier this month he launched investigation of medical organizations that recommend the use of puberty blockers or gender confirmation surgery for minors.

Cassidy’s investigation was inspired 2020 research For most young people, medical intervention may not be the best way to cope with gender dysphoria, according to Britain’s National Health Service.

The study, often called the Cass Review, led to a ban in the United Kingdom on the prescription of puberty blockers to people under 18, with some exceptions. The report was criticized by international health agencies as well as doctors’ groups in the US, Canada, Australia and Japan for weak evidence.

Cassidy describes his investigation as a fact-finding mission for Americans to ensure that “treatment recommendations are based on and supported by science and not influenced by extreme ideology.” But advocates worry it could have ripple effects on access to health care.

Groups such as the American Academy of Pediatrics and the World Health Organization recommend puberty blockers as a treatment for gender dysphoria in minors. Surgery is extremely rare for transgender children. recent study Researchers at the Harvard School of Public Health found that only 2.1 out of 100,000 diagnosed transgender adolescents ages 15 to 17 undergo any gender-related surgery. The rate among adults aged 18 and older is 5.3 surgeries per 100,000 people diagnosed as transgender.

In addition, Florida Republican Senator Marco Rubio is calling on the National Institutes of Health to investigate whether its own researchers are manipulating data on puberty blockers for minors.

Rubio disagrees with the unpublished results of a federally funded study analyzing the effects of puberty blockers. Study lead physician Joanna Olsen-Kennedy recently told The New York Times said it did not immediately publish the study’s findings due to the tense political climate surrounding the topic. Her study did not find that puberty blockers improved the mental health of transgender youth; rather, mental health remained constant.

On Oct. 28, Rubio sent a letter to NIH Director Monica Bertagnolli accusing Olson-Kennedy of “abusing her position of trust to disguise a political ideology” and calling on the research agency to investigate the matter.

Rep. Mark Pocan, D-Wis., chairman of the Congressional Equality Caucus, said the Senate’s efforts should not be surprising given the goals of Prop 2025. Although Trump has disavowed the document, many Democrats fear the list’s proposals under a Republican administration could serve guidance document for legislators.

Lawmakers on Capitol Hill have repeatedly tried to tie policies banning access to puberty blockers for minors or gender-affirming care for military personnel and their families to major spending bills in recent years. But they failed to implement such a policy.

Democrats say they plan to do everything they can to block such policies in the new administration.

“Fortunately, Democrats were able to stop their efforts to limit access to health care from becoming law—and we will not stop defending transgender rights in the future,” Pocan said in a statement.

Executive Branch Policy and Supreme Court Consequences

On December 4, the Supreme Court is scheduled to hear United States v. Skrmetti, which will consider whether Tennessee law Banning medical treatments for transgender youth, including puberty blockers and hormone therapy, violates the Equal Protection Clause of the 14th Amendment.

This case could shape the future of health care for transgender youth across the country, no matter who wins the White House.

But if Trump wins, his administration could take other steps to restrict access to health care.

Project 2025 calls gender-affirming care for minors “child abuse.” Likewise, the 2024 GOP platform promises to “ban taxpayer funding of gender reassignment surgeries and prevent taxpayer-funded schools from promoting gender transition.”

Trump officials took a number of steps to limit transgender people’s access to health care during his first administration.

For example, the Department of Health and Human Services has proposed rules that would eliminate protections for transgender people and others who are discriminated against in health care settings or by insurers who deny coverage.

Trump’s Justice Department filed a brief with the Supreme Court arguing that federal law “does not prohibit discrimination against transgender people on the basis of their transgender status.”

The nondiscrimination provision of the 2010 health care law, known as Section 1557, is likely the most vulnerable target, said Maayan Anafi, senior counsel for equity and health equity at the National Women’s Law Center. Repealing this law could impact gender-affirming care as well as access to reproductive technologies.

Anafi and several other lawyers noted that the new Trump administration could try to use the mifepristone regimen for hormone therapy, and also try to use the Food and Drug Administration to restrict the off-label use of hormone therapy for transgender people.

“It’s all about finding ways to use the tools we have as weapons,” Hunt said.

Sandhya Raman contributed to this story.