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Trans health care under Trump may follow the abortion playbook and its Hyde amendment
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Ringing in voters' ears in the final weeks of the presidential campaign was the tagline: "Kamala is for they/them. Trump is for you."
With the success of that part of its closing argument, the new Trump administration is likely to turn to policy affecting transgender people early in its tenure. The issue is mentioned twice in President-elect Donald Trump's 20-point "Agenda 47" platform: #16 Cut funding to schools that teach "radical gender ideology"; and #17 "Keep men out of women's sports."
But what about health care for transgender people? The Trump campaign and conservative think tanks offer several indications of how policy could change.
A federal ban on gender-affirming care for minors is likely, says Jon Schweppe, policy director at the American Principles Project, a conservative political advocacy group that has advocated against transgender policy for years. "With adults, I think the American people are much less enthusiastic about a full ban [on gender affirming care], but with kids, they're all about it," Schweppe asserts. About half of states have enacted such a ban, although polls vary on how much or little the broader public supports these efforts.
There are also plans to curb access to gender transition by limiting insurance coverage. To do this, Republicans could take a page from the anti-abortion rights playbook.
"Definitely one of our goals is to create a Hyde Amendment for so-called gender-affirming care," says Schweppe. The Hyde Amendment is a 1977 policy that prohibits federal dollars from paying for abortion with limited exceptions.
"We don't believe taxpayer funding should go towards that for minors or for adults. We've poll tested that, and we're pretty confident that the American people agree," Schweppe says.
The Hyde Amendment largely is responsible for how abortion came to operate outside of the usual health insurance system. Patients often pay in cash, either because they don't have coverage for abortion, or because they don't want an abortion on their medical record. In response, abortion funds were created to allow people who don't have insurance coverage or the means to afford an abortion on their own to have access.
Investment in "a political winner"
In the presidential race alone, Republicans spent more than $46 million on the "Kamala is for they/them" message, according to a report by AdImpact shared with NPR.
"This has shown itself to be a political winner," says Schweppe. Overall, the party spent $222 million on anti-trans and LGBTQ ads during the 2024 campaign. Democrats, in contrast, spent just under $29 million on LGBTQ ads.
Some congressional Republicans are signaling their eagerness to turn anti-trans campaign messaging into lawmaking. Weeks before the new session begins, proposed laws and policies about bathroom access have been crafted to take aim at incoming Rep.Sarah McBride D-Del., who will be the first transgender lawmaker to serve in the U.S. Congress.
Other promises and policies
In 2023, the Trump campaign released a video and outline of some policy steps Republicans would take "to protect children from left-wing gender insanity."
Specifically, Trump promised to:
- Ban gender-affirming care for youth nationally.
- Ban Medicare and Medicaid insurance coverage for gender-affirming care for patients of all ages and withhold federal funds from hospitals that provide the care.
- Enact consequences for schools and teachers that affirm transgender youth.
Trump also wants a Justice Department investigation into how drug companies and hospitals are providing gender-affirming care, and he will seek to pass a federal law saying Title 9 prohibits transgender women and girls from participating in women's sports.
Overall, Matt Sharp of the Christian conservative legal group Alliance Defending Freedom says he's hopeful that the Trump administration will enact policies establishing that "differences between men and women matter, and that states and schools and other places will be allowed to go back to common sense and to recognize those differences."
Even supporters of access to gender-affirming care agree that restrictions are likely coming when Trump takes office. "It's very clear that they have a coherent, anti-trans agenda that they're going to pursue, so we're preparing along multiple fronts," says Harper Seldin, a staff attorney at the ACLU's LGBTQ & HIV Project.
Trans people saw all those ads, too, Seldin says. "Without in any way speculating on what that did or did not do to the ultimate result [of the election], I do think it creates a climate of fear for trans people," he says. "I think it also creates a lot of permission for a climate of hate for people who are opposed to trans people. It really positions transgender people as the enemy of the regular American polity — and trans people are people, too."
Transgender young people in the spotlight
Although Trump's policy goals when it comes to trans people would affect adults in some ways, the focus of a lot of conservative activism on this issue has centered on kids.
Major American medical groups, including the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society support access to gender-affirming care for youth, which can range from using a child's preferred pronouns to using puberty blocking medications and sex hormones. (Surgery is very rare for minors.)
According to a recent report from the Centers for Disease Control and Prevention, 3% of high school students describe themselves as transgender, although not all of them necessarily want medical interventions related to that identity.
CDC found trans students "experienced a higher prevalence of violence, poor mental health, suicidal thoughts and behaviors, and unstable housing." The report goes on to note that "having supportive families and peers, feeling connected to family and school, having affirmed name and pronouns used consistently by others, and having a sense of pride of identity are protective factors for transgender students that buffer the effects of minority stressors and promote better mental health."
The Trevor Project, which runs a 24/7 crisis line for LGBTQ youth and answers calls from the 988 crisis line for this population, recently published an analysis finding that transgender youth were more likely to attempt suicide after their home state passed a ban on gender affirming care for youth.
The day after the election, there was a 700% increase in calls to the crisis line, which marked the largest surge in daily contact ever, the Trevor Project wrote to NPR in a statement. Even though the volume has done down since Nov 6, "volume remains higher than normal as LGBTQ+ young people continue to reach out, overwhelmingly, to discuss concerns about the 2024 election results," the statement reads.
Schweppe, of the American Principles Project, dismisses that data point, claiming research on suicide risk in this population is exaggerated. "We are diametrically opposed to what their goals are," he says of the Trevor Project, whose work he described as indoctrination.
Even if children may be suffering from gender dysphoria, he says, "we should be trying to help them identify with their with their biological sex, try to feel help them feel comfortable with their bodies, not tell them that their bodies are wrong, that the way God made them is wrong," he says. Importantly, the American Academy of Pediatrics notes in a policy statement that conversion or reparative therapies "have been proven to be not only unsuccessful but also deleterious and are considered outside the mainstream of traditional medical practice."
The shifting legal landscape
On Dec. 4, before the next Trump presidential term begins in January, the Supreme Court will hear arguments on whether Tennessee's ban on gender-affirming care for transgender youth is constitutional, and by extension, the bans in 25 other states.
Sharp of the Alliance Defending Freedom says he hopes that the high court will decide on the substance of the case. "Ultimately, we hope that it will rule in favor of these state laws and allow them to go into effect," he says.
Seldin of the ACLU, which represents the Tennessee transgender kids and families who brought the case, says it's hard to predict what will happen after oral arguments, but that they're prepared to "be flexible with what we need to do to meet the moment." He says LGBTQ advocates are equally determined to keep fighting for the rights of transgender people.
If the justices do hold that the bans are unconstitutional, conservative advocacy groups like the American Principles Project plan to "pursue other avenues to effectively shut down these gender clinics," Schweppe says. That's the overall goal, he adds. "I think we've been very transparent about that."
He's not worried about the difficulties of passing laws on transgender issues with narrow Republican majorities in the House and Senate. He points to several Democrats who argued in recent weeks that support for transgender people cost the party electoral wins, and who might cross party lines to support a bill on women's sports, for instance.
"The case that groups like ours are making to Republican leadership is that, not only is this the right thing to do and these are the right laws to pass, but they're also of great political benefit," he says.
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