By Ian Lopez. Originally published in Bloomberg Law on January 21, 2025.
Transgender federal health protections are likely to be overhauled under executive actions issued by President Donald Trump during his first day in office.
Trump on Monday issued an executive order requiring federal agencies use the term sex rather than gender and ensure official documents reflect sex accurately, giving a view into how the new administration is going to approach gender protections former President Joe Biden’s health agency had prioritized.
“The President’s executive order affirming that there are only two genders will likely lead to a reversal of any mandates to provide sex transition surgery,” said Josh Blackman, a professor at South Texas College of Law Houston.
Trump on Monday didn’t take many other sweeping health policy actions, though he did rescind some Biden administration executive orders on health, touching on prescription drug costs, the Affordable Care Act, and the Covid-19 pandemic.
Under Biden, the US Department of Health and Human Services issued a rule on Section 1557 of the Affordable Care Act enforcing the view that civil rights protections cover sexual orientation and gender identity. That rule has been challenged and is currently paused by federal courts.
Trump’s move indicates “the priority for a really drastic shift of HHS policy and the way that people are going to be able to access gender affirming care,” said Carmel Shachar of the Center for Health Law and Policy Innovation at Harvard Law School.
According to the National Institutes of Health, about 53% of states had policies protecting gender affirming care under Medicaid as of 2022. Now, “it’s possible with this change of policy that we’ll see HHS try to prevent states from offering coverage of these services,” Shachar said.
“This is an administration that is trying to move very swiftly that had a clear sense of what they wanted to do going in,” Shachar said. “They have a very strong sense of where they want to steer the ship, and a lot of interest in doing so relatively quickly.”
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