More than a dozen states filed a lawsuit Friday against the Trump administration over what they describe as an unlawful intimidation campaign against hospitals and other providers of gender-affirming care.
Citing executive agency guidances, demands for data and threats of civil and criminal prosecution, the complaint calls out several examples over the past few months in which pediatric hospitals and health systems said they would no longer provide some or all gender-affirming care services to young patients due to federal scrutiny.
“The federal government is running a cruel and targeted harassment campaign against providers who offer lawful, lifesaving care to children,” New York Attorney General Letitia James, one of the plaintiff attorneys general, said in a release. “This administration is ruthlessly targeting young people who already face immense barriers just to be seen and heard, and are putting countless lives at risk in the process.”
President Donald Trump signed executive orders shortly after reentering the White House that denounced transgender identity and made the federal government recognize only male and female sexes. Parts of that order and another forbidding federal funds from organizations providing gender-affirming care to those under the age of 19 were partially blocked in March.
Still, federal agencies have followed the directive to investigate and potentially conduct enforcement against gender-affirming care delivery. These include two Department of Justice directives issued April 22 and June 11—which the plaintiffs are asking the court to toss—and Department of Health and Human Services policy changes, hospital probes and investigations.
The White House, in multiple press releases, has celebrated reports of health systems like Yale New Haven Health, Kaiser Permanente and Children’s Hospital Los Angeles ending or suspending such services.
“The result is an atmosphere of fear and intimidation experienced by transgender individuals, their families and caregivers, and the medical professionals who seek only to provide necessary, lawful care to their patients,” reads the legal complaint from 15 blue state attorneys general, the District of Columbia and Pennsylvania Gov. Josh Shapiro.
The plaintiffs disputed the administration’s prior references to federal laws (e.g., the Female Genital Mutilation statute; the Food, Drug and Cosmetic Act; and the False Claims Act) it said justify its position against the services. They wrote that “no federal law prohibits, much less criminalizes, the provision or receipt of gender-affirming care for transgender adolescents.”
On the other hand, federal agencies’ threatening actions and the resulting service shutdowns occurred in states with laws protecting transgender individuals from discrimination in the provision of healthcare, raising the issue of states' rights, the plaintiffs wrote.
“The regulation of medicine is a core traditional police power belonging to the States and protected by the Tenth Amendment,” they wrote. “Yet through the challenged actions, the Defendants seek to trammel on State power and eliminate this care, even in those States where such care is supported, and indeed protected, by law.”
Earlier this year, a Supreme Court ruling upheld a Tennessee law banning the provision of gender-affirming care for minors. More than two dozen states have similar laws in place.
Gender-affirming care comprises a range of social, behavioral and medical services that may include hormone therapy and, rarely, surgical procedures, the latter of which is most vigorously targeted by those opposing the treatments.
The services are endorsed by leading medical associations including the American Academy of Pediatrics, the American Medical Association and the American Psychological Association, which have said that restrictions can result in severe behavioral issues and potentially self-harm. Federal agencies have criticized these organizations for what they describe as suppressing contrary viewpoints and asserted the services harm children.