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AMY GOODMAN: The Trump administration has announced new measures that could effectively ban gender-affirming care for transgender youth. On Thursday, Health Secretary Robert F. Kennedy Jr. and Dr. Mehmet Oz, who leads Medicaid and Medicare, unveiled a series of new rules targeting hospitals and doctors that provide care to trans youth. One rule would strip Medicaid and Medicare funding for any hospital that provides pediatric gender-affirming care.
Kennedy spoke Thursday.
HEALTH SECRETARY ROBERT F. KENNEDY JR.: So-called gender-affirming care has inflicted lasting physical and psychological damage on vulnerable young people. This is not medicine. It is malpractice. We’re done with junk science driven by ideological pursuits, not the well-being of children.
AMY GOODMAN: Dr. Susan Kressly, president of the American Academy of Pediatrics, criticized the new rules, saying, quote, “Allowing the government to determine which patient groups deserve care sets a dangerous precedent, and children and families will bear the consequences,” unquote.
The new rules were announced a day after the House narrowly approved a bill that aims to criminalize providing gender-affirming medical care for any transgender person under the age of 18 and subject providers to hefty fines and up to 10 years in prison.
This is Democratic Representative Sarah McBride, the first openly transgender member of Congress, speaking to reporters before the anti-trans bill vote Wednesday.
REP. SARAH McBRIDE: We are two legislative days away from the Affordable Care Act tax credits expiring, when millions of people will see their healthcare premiums skyrocket. And GOP leadership, with that deadline fast approaching, has decided to schedule two votes on anti-trans bills and precisely zero votes on extending the Affordable Care Act tax credits. They would rather have us focus in and debate a misunderstood and vulnerable 1% of the population, instead of focusing in on the fact that they are raiding everyone’s healthcare in order to pay for tax breaks for the wealthiest 1%.
All Republican politicians care about is making the rich richer and attacking trans people. They are obsessed with trans people. I actually think they think more about trans people than trans people think about trans people. They are consumed with this, and they are extreme on it. They are bringing forward a bill that would put parents and providers at risk of being jailed, literally jailed, for affirming their transgender child and following medical best practices.
AMY GOODMAN: We’re joined now by two guests. Jeffrey Birnbaum is a pediatrician and adolescent medicine specialist who works with transgender youth here in New York City. And we’re joined by Chase Strangio, the co-director of the American Civil Liberties Union’s LGBTQ & HIV Project. Last year, he became the first openly trans lawyer to argue in front of the Supreme Court when he presented oral arguments in United States v. Skrmetti.
We welcome you both to Democracy Now! Chase, let’s begin with you. If you can explain what RFK Jr., the health secretary, has announced and what the House passed?
CHASE STRANGIO: Yeah, so, Amy, I just want to take a step back and echo what Representative McBride said, because before we get into the details, we have to understand what’s happening here, which is that healthcare costs for Americans are about to skyrocket, and you have two branches of government, the legislative and the executive, deciding to instead focus on usurping the decisions of parents and doctors to try to, in the case of the House bill, criminalize this care and, in the case of the actions from HHS, coerce hospitals into stopping providing care for transgender adolescents.
This is a drastic departure from any concern about science, concern about parents and their rights. And frankly, it’s really rich to hear the secretary, RFK Jr., talking about junk science, when what we have here is medical care supported by every major medical association in the United States. Meanwhile, this is an administration that is so anti-science that I think we can see that all of our health is under threat. And trans people now and our families are facing terror from this administration, because they are, in essence, saying, “We will do whatever it takes to take away your healthcare.” And that’s what we’re seeing right now.
AMY GOODMAN: So, we’re talking about removing Medicare and Medicaid from hospitals where transgender care is performed on young people, and doctors being criminalized. If they dare to engage in transgender care, they could go to prison?
CHASE STRANGIO: Exactly. So, with respect to that, to the bill that passed the House, that is threatening doctors with 10 years in prison. This would be a felony for following evidence-based medicine. And then, on the HHS side, it is a — it is a proposed rule. And I think it’s important so that people aren’t terrified right now: Neither of these things is the law yet. But what we have from HHS is a proposed rule, in essence, saying to hospitals across the country, including in states where this care is legal, “We will take away the vast majority of your funding if you continue to provide this care to transgender adolescents,” regardless of whether federal money is being used to provide the care. So, it’s telling hospitals that they have to stop providing the care, if they are, in essence, going to continue to operate.
AMY GOODMAN: Have hospitals responded?
CHASE STRANGIO: What we’re seeing from hospitals since January of this year, since the inauguration, is that they are, in some cases, capitulating to the threats of the administration, and, in some cases, continuing to take a stand to defend their patients. Obviously, right now this is a significant escalation. And if these regulations are in fact finalized in the way that they have been proposed, hospitals will not really have a choice, because they cannot afford to lose 50% or more of their operating money. So, it is putting hospitals in an impossible situation, and just another example of this administration undermining and threatening all of our health and welfare.
AMY GOODMAN: I want to go back to the Democratic Congressmember Sarah McBride. She is the first openly transgender member of Congress.
REP. SARAH McBRIDE: I get it’s hard to understand what it feels like to be trans. I get that it is hard to understand what it feels like to be me. I get that it’s hard to understand this care and understand the need for it. But one of the things that gets so lost in this conversation is that the transgender adults of today were kids once. I was a kid once. I didn’t have the courage to come out until I was 21, but it’s a fact I have known about myself for my entire life. I didn’t have the courage to come out until I was 21, and that means 21 years of pain, 21 years of unwavering homesickness that only went away when I was able to get the care that I needed. And my biggest regret in life is that I never had a childhood without that pain.
AMY GOODMAN: That’s Sarah McBride, the first openly trans member of Congress. Dr. Jeffrey Birnbaum, you’re a pediatrician and adolescent medicine specialist who works with transgender youth in New York City. If you can expand on what Congressmember McBride is saying? And talk about what this means for you. Do you continue your care? You could face 10 years in prison.
DR. JEFFREY BIRNBAUM: Yeah, well, Congresswoman McBride’s words really resonated with me. As soon as the show is over this morning, I’m going to spend the morning in my clinic working with these young people that — of the type that she talks about, not just her, but everyone who has that sort of experience as young people. I work with these young people and their parents, their families, every single day, and they are terrified right now.
I have to tell you the number of suicide attempts we’ve averted, the amount of depression we’ve treated, the number of kids that we’ve kept in school, keeping their school performance up, helping them reach their life goals. This is what transgender treatment for young people results in: improved outcomes.
If these laws go forward, I don’t know how my facility is going to respond, but I refuse to stop providing this care, knowing that I could potentially face 10 years in prison and a felony charge. I’m willing to go down that route, if necessary.
AMY GOODMAN: Can you compare suicide rates of children who are trans and children who are not?
DR. JEFFREY BIRNBAUM: I don’t have the exact information in front of me in terms of rates, but LGBT youth in general have higher suicide rates than the non-LGBT youth overall. That’s inclusive of all LGBT youth. And transgender youth probably have much higher rates, because they are that much more marginalized. I would say the one thing that is best in prevention of these horrible outcomes is access to care and a supportive family.
AMY GOODMAN: What does it mean to interrupt transgender care, Dr. Birnbaum?
DR. JEFFREY BIRNBAUM: Complete devastation for these families. I mean, they won’t know where to go. They won’t have recourse. People are already asking me questions about stockpiling hormones, getting them overseas through the internet. Sometimes people are talking about buying things that they don’t even know what it is that they’re buying, because there’s no quality control. This is just devastating. And young people and their parents are terrified.
I can’t tell you, when the executive order first came out back at the end of January, the number of families that came to me seeking care because I refused to stop providing care when other facilities immediately bent at the knee to the executive order and shut down their youth clinics. It’s just giving people a place where they can go and safe refuge, that alone helps improve the outcomes. But I don’t know what’s going to happen to them in the long run if someone like me is completely stopped from providing this type of care.
AMY GOODMAN: Dr Mehmet Oz said, “We want our hospitals returning to healing, not harming, the patients entrusted in their care, or they’re going to pay a very high price.” Explain what gender-affirming care is, the range of that care.
DR. JEFFREY BIRNBAUM: In this age group, we start with counseling. Young people need to have an understanding of who they are, and try and solidify their identity to determine what medical interventions may be appropriate. Right at the onset of puberty, ideally, would be the time to introduce puberty blockade through drugs like leuprolide and triptorelin. Those are commonly prescribed drugs. Histrelin is an implant. And that is 100% reversible. When they start talking about irreversible damage, puberty blockade is 100% reversible and safe. We’ve been using it for decades. We’ve been treating precocious puberty with it for decades. We have lots of experience. And so, you know, I don’t put much stock in what they’re saying about that.
When young people want to start gender transitioning, sometimes I may start at age 16, which is a common age to start, but I would be willing to start younger with the consent of the parents and having lots of discussion, starting on either testosterone or estradiol treatment. That allows their body to change with their gender that they identify with. And mind you, it’s not only in gender-affirming care that we use those drugs. We use those drugs in delayed puberty, as well, other diseases like congenital adrenal hyperplasia. There are numerous, numerous other entities that we have lots of evidence of safety and efficacy that we apply to using in gender-affirming care.
Surgeries are something that often does not happen until someone is much older. Quite often they’ll have what’s typically called top surgery as a first — as a first procedure done. These are irreversible treatments, as are the hormonal treatments. And, you know, there are other examples of body modification in teenagers, such as rhinoplasty, nose jobs. You know, sometimes you’ll see a beautiful teenage girl wanting a nose job because she thinks her nose is too big. That’s irreversible. Why would it be allowed for her and not for somebody who is transgender, transgender youth? We would also have breast augmentation or breast reduction in teenagers, which is allowed surgery. Why would that be allowed, but this wouldn’t? It just makes no sense whatsoever.
AMY GOODMAN: As we begin to wrap up, Chase Strangio, with more than half of states already having bans, a recent Washington Post report found school hate crimes rose sharply in states with anti-LGBTQ laws. Can you talk about, at every level, what happens from now on? You’ve got this House vote; it goes to the Senate. What do you expect? And what do you expect in states across the country?
CHASE STRANGIO: Yeah, unfortunately, what we’re seeing, on every branch of government across the country, is these escalating attacks in schools, in healthcare, in access to identification documents. Hopefully people will continue to mobilize. This will not pass the Senate. Dr. Birnbaum won’t have to worry about cutting off care to his patients because of a threat of criminal liability. But nothing is for sure. We have to take action. And yesterday in that HHS press conference, you had the deputy secretary of health talking not about health, not about science, but about a principle evil in relation to the rejection of what God intended of us. That is not about science. That is about a wholesale rejection of trans identity. We have to be attuned to that, and we have to be mobilizing to stop it.
AMY GOODMAN: And the Senate, what do you expect? And how are you organizing?
CHASE STRANGIO: Right now this is a bill that has passed the House. It goes to the Senate. And we all have a role to play. We need to contact our senators and make sure they do not vote for this —
AMY GOODMAN: They need 60 votes?
CHASE STRANGIO: They need 60 votes in the Senate, so, hopefully, the caucus sticks together and stops this from passing. But nothing is a sure thing, so we need people to mobilize. I’m optimistic that this will not become law, but, again, we can’t take anything for granted. We have a president that is threatening, on every metric, to coerce the shutdown of this care nationally. And that’s on us to organize and mobilize, and we’re doing that, but we need everyone to join us.
AMY GOODMAN: Chase Strangio, co-director of the American Civil Liberties Union’s LGBTQ & HIV Project, Dr. Jeffrey Birnbaum, pediatrician and adolescent medicine specialist who works with transgender youth here in New York City, we thank you both for being with us. And we’ll continue to cover, of course, this story.
Coming up, we look at the case of Kilmar Ábrego García, the Maryland father who was wrongfully deported to El Salvador earlier this year. Last week, he reunited with his family after months in ICE detention back in the United States, but his ordeal is not over. Stay with us.
