A federal judge in Oregon has overturned the Trump administration's effort to strip federal funding from hospitals and health systems that provide gender-affirming care to children, dealing another blow to Robert F. Kennedy Jr's agenda as secretary of the Department of Health and Human Services.
Judge Mustafa T Kasubhai issued a 49-page decision Saturday that lambasted the administration's legal reasoning, calling the policy "clearly unlawful" and accusing officials of attempting to "bully or gaslight" the court. The judge noted that the administration's argument that the ban amounted to a personal opinion was "a bald-faced lie."
Kennedy had announced in December that any health system providing pediatric gender-affirming care would be suspended from receiving Medicaid and Medicare funding. Since nearly all major hospitals rely on these federal programs, the policy effectively functioned as a nationwide ban on the care. Kennedy claimed the care was "neither safe nor effective," but major medical organizations support its use for transgender and gender-expansive youth.
The declaration invoked an emergency regulation meant for public health crises, but officials bypassed the standard rule-making process that includes public comment. Within days, the HHS general counsel began referring health systems to investigators for violating the policy. At least 40 health systems stopped providing the care in response to the funding threat.
The judge's ruling found that the policy violated federal administrative law and the Medicare statute, which forbids federal officials from exercising "any supervision or control over the practice of medicine." The order also prevents the administration from implementing similar policies under different names to restrict care by withholding funding.
Shannon Minter, legal director of the National Center for LGBTQ Rights, called the decision "incredibly powerful" and "far-reaching." The ruling blocks both the immediate declaration and a proposed rule that would have prevented Medicaid and Medicare from paying for gender-affirming care.
Jan Oosting, an associate professor of nursing at City University of New York, said the decision removes "the biggest source of fear, which was the threat of losing Medicare and Medicaid funding." She expects hospitals will reassess their programs and resume care that was halted or suspended.
The case originated when Oregon and 21 other states sued the administration over the funding threat. One health system, Childrenâs Minnesota, resumed offering gender-affirming care after a preliminary injunction blocked the rule in March. Another system, Childrenâs Hospital Colorado, ceased providing the care, and patients have sued the hospital. The decision may affect that pending case before Colorado's supreme court.
Kennedy's tenure at HHS has faced multiple legal setbacks beyond gender-affirming care. Another federal court halted the agency's attempt to revise vaccine recommendations, and recent research and regulatory actions have undermined controversial announcements by Trump and Kennedy regarding autism.
Healthcare experts emphasized the significance of the ruling for broader healthcare policy. Oosting noted that the decision reinforces that "major changes in healthcare policy have to follow the law," with potential implications for other politicized changes like abortion restrictions. Minter described the decision as "a powerful tool to stop the federal government from attempted overreach" in healthcare.
The ruling does not eliminate state-level barriers to gender-affirming care. Several states have passed their own bans, and Ohio's supreme court is expected to rule on the constitutionality of a state ban in coming months. Some families in restrictive states remain able to access care by traveling or moving out of state, though experts note this is burdensome and expensive.
Author James Rodriguez: "This is the second major legal defeat for Kennedy's healthcare agenda in as many months, and it underscores a basic truth: even this administration can't simply rewrite federal law by declaration."
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