Transgender care in California could be affected under Trump

When Mars Wright saw Donald Trump re-elected president, the 29-year-old Los Angeles artist and streetwear designer was relieved, as he had already undergone surgeries for gender transition.

Wright, a transgender man, chronicled his medical journey online, stretching and dancing to show how his body was transformed after the masculinization procedure, which he called the “Dorito chip” because it changed his shape. His surgery was covered by the LA Care plan he obtained through Covered California, the marketplace established under the Affordable Care Act for Californians to purchase insurance.

“I’m privileged to be here,” Wright said of living in California. “And I think about how people need to come here to be able to medically transition.”

California leaders have sought to protect access to such procedures for transgender people. State-licensed health plans must provide medically necessary gender-affirming care to transgender individuals. Doctors who provide this type of care in California are legally protected from laws that criminalize it in other states.

But even in California, experts and advocates said, access to gender-affirming care could be harmed by federal action as Trump takes office for a second term, vowing to stop “leftist gender mania” and calling gender transition for minors a form of gender reassignment. child abuse. State lawmakers have vowed to push back against efforts to block gender-affirming care, which could fuel future fights in court.

“I’m not going to sit here and say California can roll back every vile federal attack on transgender people,” said State Sen. Scott Wiener (D-San Francisco), who supports protections for transgender patients and their doctors. But we will do everything we can to support the community,” he said.

President-elect Trump has vowed to pressure Congress to block the use of federal funds for gender-affirming care, including surgery. Republican party platform. Exactly how a ban would be implemented is not yet known, but experts say the Trump administration could model it after the Hyde Amendment, which has been in place for decades. widely banned use of federal funds for abortion.

Eliminating federal funding would have far-reaching effects because “there is some element of federal funding in almost every corner of the healthcare system,” said Kellan E. Baker, executive director of the Whitman-Walker Institute, which conducts health research and advocacy. Issues for LGBTQ people. Its effects “will be hardest on those who cannot afford the health care they need.”

Among those affected, he said, will be transgender people who rely on public programs like Medicaid. But because Medicaid is jointly funded by states and the federal government, California leaders may choose to use state funds to pay for gender-affirming care, experts said.

“California has shown a preference for funding much more than Medicaid would nationally,” said John Baackes, chief executive of LA Care, a health plan that serves more than 2 people; such as covering low-income Californians regardless of immigration status. Million people in LA County. “The state can say, ‘Okay, we’ll fund it.’”

Mars Wright sits in a small studio space in his apartment with his elderly dog, Lucy.

(Gina Ferazzi/Los Angeles Times)

Trump is also expected to do this Ask for changes to Medicaid This would reduce federal spending and could strain California financially if it wants to continue other programs available under Medi-Cal, the state’s Medicaid program. But advocates warn that because transgender people make up a small portion of the population — presumably 0.6% of U.S. teens and adults in one analysis — bearing the cost of gender-affirming care would not be a large expense.

States have wide latitude on their spending, but Trump has previously tried to use Medicaid to pressure California on its policies, experts said. Trump administration nearing the end of its first term threatened to keep Some Medicaid funding was available from California because the state required insurance companies to cover abortion care.

That threat ultimately fizzled, but it could hint at how his administration might try to pressure California. A Trump representative did not respond to an email seeking comment on this possibility.

At clinics run by the Los Angeles LGBT Center, anxious patients ask: “Should I take a year’s worth of hormones now? Should I do all the surgeries I want to do?” said chief medical officer Dr. Kaiyti Duffy. “We will provide these services as long as we can,” he tried to reassure them.

Trump could also impose broader restrictions that would not only block the use of federal dollars for gender-affirming care, but would also ban providers who provide such care from receiving federal funding.

Some of their recommendations specifically target gender-affirming care for youth; this became the focus of young people. quarrel It harms children who do not understand the consequences of such treatment. Greg Burt, vice president of the California Family Council, called it “telling children that it is possible to be born in the wrong body is the biggest lie this state has inflicted on our young people.”

American Academy of Pediatrics recommends Transgender youth have access to comprehensive gender-affirming care.

A Central Valley mother said puberty blockers were a “pause button” for her transgender child, now 14, that relieved despair and gave the family time to figure out what he needed. Relying on federally funded Tricare insurance for service members, the military family consulted doctors and eventually turned to hormone therapy with testosterone.

“With each phase of medical care, he became more and more conscious,” said the mother, who asked not to be identified to protect her child’s privacy. “He went from being quiet and calm to being active, vibrant and thriving.”

She said they made plans to leave the country if her child was prevented from receiving such care in California.

Trump called for a ban on gender-biased grooming for teenagers in every state, calling it mutilation. During the campaign, Trump said he would seek to terminate from Medicaid and Medicare any health care provider “involved in the chemical or physical mutilation of minors.”

Julianna S. Gonen, director of federal policy at the National Center for Lesbian Rights, said the Medicare and Medicaid programs “are the biggest leverage the federal government has because hospitals get a lot of money from them.” The threat of losing the program is “so serious that hospitals will likely comply with these rules before they risk being removed from the programs.”

The White House could seek a federal ruling that such care is dangerous or experimental, and that would be reflected in federally funded programs, experts said.

Alejandra Caraballo, a clinical instructor at Harvard Law School’s Cyber ​​Law Clinic, said that for many healthcare providers, “it is easier to abandon a transgender patient when there is a risk of losing your federal funding (i.e., your ability to operate).”

Trump administration may also step back federal regulations This prohibits healthcare providers from denying care to transgender patients if the same type of care is provided to others. But California’s own own rules Prohibiting health plans from denying care based on gender identity.

Some believe the Trump administration may also seek to restrict hormonal therapy through Food and Drug Administration regulations. But Amanda McAllister-Wallner, interim executive director of the consumer advocacy group Health Access California, said trying to determine who is providing “gender-affirming care” can be tricky for federal officials because such interventions have also been used for other conditions.

“It’s not very clear whether this service is being provided because of someone’s diagnosis of gender dysphoria or for some other reason?” McAllister-Wallner said.

a study A study of insured patients published in JAMA Network Open found that the number of breast reduction procedures for transgender youth last year far exceeded the number of breast reduction procedures for nontransgender boys. Surgeries for transgender youth are “rare and almost exclusively breast-related procedures,” and no surgeries were identified in transgender youth age 12 or younger, the researchers said.

Before election day, Bamby Salcedo planned to push for improved gender-affirming care through a campaign. Medi-Cal initiative It is called CalAIM. Salcedo, president and executive director of the TransLatin@ Coalition, an advocacy group founded by transgender women in Los Angeles, said the election has put that effort on the back burner.

Afterwards, Salcedo continued to push for LA County budget allocations to support the needs of transgender people, saying local government needed to step up. He was also busy planning a fashion show to celebrate the 15th anniversary of his founding, calling it “a chance for that night to bring joy to our people.”

“We will get through this in any way possible,” he said.

Mars Wright poses for a photo. Wright was able to get body masculinization surgery through Covered California insurance

(Gina Ferazzi/Los Angeles Times)

Wright was among the designers exhibiting at the event. Before having the surgical procedures, he said: “I was afraid to meet. I was afraid to wear clothes I loved. I was afraid to go to the sea.” Now he joked, “I can’t keep my shirt on.”

“I’m in a place where I love being trans.”