What Trump’s win could mean for transgender health care access, athletes

This story originally appeared on NPR.

Morning Edition is diving into promises President-elect Donald Trump said he would fulfill on Day 1 his second term. In this final part, NPR’s Michel Martin talks to two experts about Trump’s promise to limit access to health care for transgender individuals and banning trans athletes from women’s sports.

What Trump has said about transgender people throughout his campaign

The president-elect spent a lot of time and money on transgender issues during his 2024 presidential campaign. The Trump campaign spent $11 million dollars on an ad targeting both Vice President Harris’ policies on transgender people.

“Kamala is for they/them. President Trump is for you” was the closing statement of multiple ads.

“On Day 1, I will sign an executive order instructing every federal agency to cease the promotion of sex or gender transition at any age. They’re not going to do it anymore,” Trump said at a ‘Mom’s for Liberty’ event in August of this year. 

It’s unclear what Trump meant by “federal agency,” but he has repeatedly said that public schools will no longer receive federal funding if they promote ideas related to gender transitioning or transgender people.

Trump has also said that any hospital or health-care provider that performs gender-affirming surgeries or care to minors would no longer meet federal health and safety standards and will no longer receive funding from the federal government.

The 2024 GOP platform, which leans heavily on Trump’s “America First” messaging, lists “Keep Men Out of Women Sports” in its 20 promises for the next administration.

“We will keep men out of women’s sports, ban Taxpayer funding for sex change surgeries, and stop Taxpayer-funded Schools from promoting gender transition, reverse Biden’s radical rewrite of Title IX Education Regulations, and restore protections for women and girls,” the party platform language reads.

Can Trump pass an executive order banning gender-affirming care?

Several federal programs and laws address gender-affirming care for transgender people, including Medicare, Medicaid and Veterans Affairs. Veterans Affairs currently does not provide gender affirming surgeries, but does provide hormone replacement therapy. Medicare, which provides federal health insurance for individuals 65 years or older, only started providing gender affirming services in 2014. 

Gender affirming care through Medicaid, which covers healthcare for low-income people, varies greatly depending on what state an individual lives in, and a federal ban on it providing gender affirming care might not be possible.

“Medicaid is something that is largely administered by the states,” Jami Taylor, a professor at the University of Toledo in Ohio who has written extensively about the transgender rights movement and public attitudes about transgender people, told Morning Edition. “There is currently state variation on whether or not they’re going to exclude these types of procedures or not.”

The Affordable Care Act also contains non-discrimination protections, meaning that medical treatment must be given regardless of gender or sexual orientation, making it harder for a federal ban against any minority group to be enacted.

Taylor told NPR’s Michel Martin that any executive order Trump enacts is almost certain to be litigated.

“As long as the ACA is in place, there may be litigation,” Taylor said.

Sasha Buchert, who was lead counsel for Karnoski v. Trump, a federal lawsuit that challenged Trump’s ban on transgender people serving in the military, said that she expects there to be a lot of legal cases against Trump’s planned policies targeting transgender people. Her main argument is that transgender people are entitled to protections under the Civil Rights Act, which was amended to include transgender people in 2020. 

“It would be contrary to law and also it would violate the constitutional and statutory protections that transgender people enjoy,” Buchert said.

How would care bans affect trans minors versus adults?

Banning gender affirming care for minors may not end up fully in Trump’s hands. In December, the Supreme Court will hear oral arguments in L.W. v. Skrmetti/U.S. v. Skrmetti, a lawsuit challenging Tenesse’s statewide ban on gender affirming care for minors. If the court upholds this ban, other states with bans on trans health care could stay in place.

“It’s similar to the concerns people have about [the Supreme Court] advancing a national abortion ban,” Buchert told NPR’s Michel Martin. “It’s always something that we’re concerned about. But we stand ready to step into the breach.”

Taylor believes that when it comes to gender affirming care for minors, it’s a different legal ballgame than for adults.

“The politics of that is different for adults,” Taylor said. “Think about all the things we allow adults to do that are sometimes bad for them. We don’t regulate because it’s an adult decision. And so that would play differently than it does for children politically.”

How Trump could ‘keep women out of men’s sports’

Trump has promised to roll back the Biden administration’s Title IX protections in his second term. This includes prohibiting discrimination and harassment based on sexual orientation and gender identity,

“The bill would also make it clear that Title IX prohibits men from participating in women’s sports,” Trump said in a campaign video on social media.

While Trump may be able to roll back these protections, Taylor says that this is a space that has changed a lot depending on who is in the executive branch of government. She pointed out that this has happened before: Obama-era Title IX policies were rolled back by the Trump administration, and then partly reinstated by the Biden administration. So while Trump may change Title IX, there’s always a chance that it can be undone again.

“One of the things that we know with executive action on trans rights is it’s not sticky,” Taylor said. “Executive actions can be very impermanent.”

What Trump’s team says

NPR asked the Trump transition team if the president-elect had any concerns that some of his promises may violate civil rights protections. In response, spokesperson Karoline Leavitt offered the following statement:

“The American people re-elected President Trump by a resounding margin giving him a mandate to implement the promises he made on the campaign trail. He will deliver.”

Concerns about the effects of restrictions on gender affirming care

Since Trump’s win, transgender people have been flooding crisis hotlines meant to serve them. Rainbow Youth Project, a group that serves LGBTQ+ youth has received more calls in the past week and a half than it typically gets in a month, the Associated Press reports.

A study published in the journal Nature Human Behavior in September links an increase in attempted suicide attempts by young people in 19 states that passed anti-trans laws.

Transgender children and their families have moved states to continue to access gender affirming care. Nearly half the states in the country have some restrictions on this kind of care in place.