The Gender Affirming Care Ban Headlines Are Scary — Here’s What’s Actually Happening

The last 24 hours have brought a wave of alarming headlines about gender-affirming care. For trans and gender-diverse youth, and the families already doing enormous emotional and logistical work just to access care, this has understandably caused another spike in fear and confusion.

I will do my best to break down what's actually happening, but before I do, I want you to know that everyone at Seven Hills Family Medicine is deeply sorry that this is happening. You deserve stability, clarity, and evidence based care- not to be treated as political pawns.

First, the Scariest Headline: A Proposed Federal Ban

On Thursday, a bill sponsored by Rep Marjorie Taylor Greene passed the U.S. House of Representatives. It attempts to create a nationwide ban on gender-affirming care for minors and criminalize clinicians who provide it. That sounds terrifying (and it is meant to), but here’s the key thing to understand: this bill is not expected to become law, and MTG knows it.

To become law, the bill would need to clear the U.S. Senate. Nobody expects that to happen. Under current Senate rules it requires 60 votes (cheers to the filibuster) to pass this kind of legislation, and to quote Lin Manuel Miranda, "[they] don't have the votes, ah-ah-AH." As long as the filibuster remains in place, there is no realistic path for this bill to become law.

So why introduce it?

Because it sets the stage for the second, more serious development.

The Real Threat: Federal Payment Rules as a Backdoor Ban

On Thursday, December 18th, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule change that would formalize the Trump administration’s legally dubious executive order announced earlier this year. This proposed rule would restrict or prohibit Medicaid and Medicare reimbursement for institutions that provide gender-affirming care to patients under the age of 19.

Now, before you start writing letters to your hospital telling them how vital and important gender care is, there is a hard truth that needs acknowledging: Medicaid and Medicare together make up the largest single source of healthcare reimbursement in the United States. For many academic medical centers (where most pediatric and adolescent gender-affirming care programs are located), Medicaid and Medicare can account for 40–60% or more of total revenue.

Think of it like this: the government isn’t saying “this care is illegal.”

They’re saying, “If you provide it, we can stop paying your hospital.”

That doesn’t just affect gender-affirming care. It puts all of a hospital’s Medicaid and Medicare funding at risk; the money that pays for births, cancer care, ICU beds, and pediatric visits.

No hospital system can survive without that funding.

This means that even institutions that want to continue providing evidence-based, ethical care may be forced to stop — not because the care is unsafe, but because the financial pressure is impossible to absorb.

Important: This Is a Proposed Rule, Not a Final One

Right now, these CMS changes are proposed rules, not finalized policy. The government isn't withholding Medicare reimbursement yet.

What happens next:

• A public comment period (typically 60 days)

• Internal review

• And almost certainly legal challenges

  
  

New York Attorney General Letitia James has already publicly stated that she intends to defend patient rights and challenge discriminatory actions that conflict with existing federal and state law. Other states and organizations are expected to follow.

So while this is serious, it is not settled. There is still time and space to push back, and we must.

Who Is Affected, And Who Is Not

If you receive care through a non-insurance-based practice, such as a Direct Primary Care (DPC) model, these proposed CMS rules do not directly apply to your care. This is one of the reasons Seven Hills Family Medicine is structured the way it is. We are very familiar with these undemocratic political tactics, and we built our practice to withstand a worst-case scenario. Being a small practice can feel exposed at times, but our independence from insurance reimbursement protects our patients (and our doctors) from political interference like this.

Unfortunately, many families in the U.S. have little to no access to non-insurance-based care. For many trans youth, academic medical centers are the only option, which is why this proposed rule cannot stand.

What You Can Do Right Now

• Submit a public comment opposing discriminatory CMS rules when the comment period opens (we will update you when it does)

• Support legal advocacy organizations challenging these policies, such as the ACLU

• Stay grounded in credible medical sources, not political advertising

• Reach out to community organizations that can help connect you to alternative care. Locally, this includes HeSheZe and We; regionally, the Campaign for Southern Equality

• Protect your energy — panic is the goal of these headlines. Don’t let them win

And if you are a patient or family navigating care right now: you are not alone. We are one of many community organizers and advocates watching this closely, preparing proactively, and committed to continuing evidence-based, ethical care.

The Bottom Line

• The House bill is political theater and is not expected to become law

• The CMS reimbursement strategy is the real mechanism being used

• This is a financial pressure campaign, not a scientific one

• Proposed rules can still be challenged — and likely will be

• Independent, non-insurance-based practices are insulated from this tactic

  
  

You should not have to become an expert in federal bureaucracy just to access healthcare. We’re sorry that you do, and we will continue to translate, advocate, and stand with you.