Pediatricians and legal experts in the state expressed outrage Thursday at a new federal effort to effectively ban gender-affirming care for minors nationwide, reminding Washingtonians that these medical services remain protected here.
The U.S. Department of Health and Human Services early in the day revealed proposed rules that would bar hospitals and other medical providers from receiving Medicare or Medicaid funds for any services if they also offer gender-affirming care to youth.
The proposals aim to prevent government insurers, like Medicaid and TRICARE, from paying for gender-affirming medication and procedures for trans and gender-diverse minors in the nearly two dozen states, like Washington, where such care is legal. These proposals are not final.
“This is not about protecting kids,” Rebekah Gardea, co-executive director of community advocacy and outreach at the QLaw Foundation of Washington, wrote in an email. “It is about using trans children as political pawns and will have devastating consequences for families who are simply trying to keep their kids healthy and alive.”
Federal health agencies should expect to face strong pushback and legal challenges from advocacy organizations, families and providers in Washington, Gardea added. The QLaw Foundation is a Seattle-based legal association that provides services to LGBTQ+ communities in the state.
Gardea pointed to existing work on this front from state Attorney General Nick Brown’s office, including an ongoing lawsuit filed in February against the Trump administration over an executive order that sought to halt federal funding for pediatric gender-affirming care. Later that month, a federal judge in Seattle found the executive order to be discriminatory and issued a preliminary injunction that blocks the order while the case proceeds.
A federal judge in Maryland has issued a similar pause on the executive order in a separate lawsuit.
Brown’s office said in a post on social media Thursday afternoon that the proposed HHS rules are “cruel and unnecessary.”
“Under the law in Washington, necessary healthcare for transgender people is lawful and legally protected,” the post said. “Proposed rules are not the law — nothing has changed in Washington.”
Asked whether Brown might file a lawsuit over this latest threat to gender-affirming care for minors, a spokesperson said the attorney general’s office was “discussing our options.”
Despite the legal protections, Gardea said trans youth and their families already have experienced “chilling effects.” While there are private practices that continue to offer gender-affirming care for minors in Washington, several children’s hospitals have chosen to narrow their gender care services or shutter gender clinics altogether.
Seattle Children’s and Mary Bridge Children’s hospitals both provide some gender-affirming medical care, though Mary Bridge does not perform any gender-affirming surgeries for patients under 18 and, in August, cut its gender clinic waitlist. Children’s no longer lists surgeries on its gender clinic website; the hospital’s media relations office has declined to answer questions regarding the current status of care.
In statements Thursday, both hospitals said they were reviewing federal proposals to determine next steps.
“We remain committed to providing high-quality care to patients, their families, and the communities we serve,” a Mary Bridge spokesperson said. A Children’s spokesperson said the hospital would “continue to comply with all applicable laws” but didn’t respond to questions about which laws.
Kaiser Permanente, which also offers gender-affirming medication and mental health care to patients under 19, did not respond to a request for comment.
Other pediatric health experts in the state were quick to express horror at the news, though some said these federal steps were not unexpected.
Major medical associations in the U.S. — including the American Medical Association, the American Psychological Association and the American Academy of Pediatrics — recommend gender-affirming care to treat gender dysphoria, including for trans minors whose health providers deem hormone treatment and puberty blockers to be medically necessary. Gender-affirming surgeries are extremely rare for trans people under 18.
Dr. Lelach Rave, executive director of the Washington chapter of the American Academy of Pediatrics, said the Thursday announcement was “shocking, but also not surprising” — though she “wants us to continue to be shocked because normalizing this is not good for anyone.”
“We are concerned about the well-being of the teenagers we care for and their families,” Rave continued. “We know that when children are struggling with these issues, being able to have centers of excellence … where they can turn and get expert care and advice, is really important for their well-being — and sometimes for their very lives.”
The Thursday news comes a day after a divided House of Representatives approved legislation that would criminalize gender-affirming treatments for minors. On Wednesday, The Washington Post also reported HHS canceled several American Academy of Pediatrics grants aimed at reducing sudden infant deaths, prenatal substance exposure, birth defects and teen mental health problems.
Rave, a Seattle-area pediatrician, wondered if federal health officials unveiled the gender care proposals as a “technique to flood the field” and distract people from cuts happening to other pediatric care, she said.
“There’s so many horrible things going on at once,” Rave said. “I’m very saddened that health care for children has yet again been politicized.”
Editor’s note: Due to the sensitivity of the topics covered in this article, the comment thread has been removed.
Elise Takahama: 206-464-2241 or etakahama@seattletimes.com. Elise Takahama is a health reporter at The Seattle Times, where she writes about public health issues, the business of health care, medical research and health equity gaps in Washington.