Left: New York Attorney General Letitia James speaks during a press conference regarding former U.S. President Donald Trump and his family’s financial fraud case on September 21, 2022 in New York (photo by YUKI IWAMURA/AFP via Getty Images). Right: Donald Trump speaks at a ‘Save America’ rally on October 22, 2022 in Robstown, Texas (photo by Brandon Bell/Getty Images).
A coalition of states is suing the Trump administration over policies aimed at banning federal support for gender-affirming medical care.
On Jan. 20, President Donald Trump signed Executive Order 14187, entitled, “Protecting Children from Chemical and Surgical Mutilation.”
Under the terms of that order and two implementing directives, the 45th and 47th president intends to cut off all federal funding for institutions that offer pediatric gender transition services or provide any kind of gender-affirming care for people under the age of 19.
On Friday, in a 79-page lawsuit, 15 states and the District of Columbia, are asking a federal judge in Massachusetts to declare the order “unconstitutional and unlawful” and enjoin its application.
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The plaintiffs, led by Massachusetts and New York Attorney General Letitia James, say the litigation is aimed at countering federal threats against state laws protecting the provision of gender-affirming care.
“Many Plaintiff States have enacted laws, policies, and protections for transgender residents, including transgender and intersex people under 19 years of age, in an appropriate and lawful exercise of their traditional police power to regulate the practice of medicine within their borders,” the lawsuit reads. “These protections include the right to access medically necessary healthcare, regardless of gender identity.”
The plaintiffs allege the federal government is intent on effectuating the equivalent of a nationwide ban on such care through a campaign of “baseless civil and criminal prosecution, as well as onerous investigations and data demands,” according to the lawsuit.
From the filing, at length:
Plaintiff States have the authority and exercise the authority to regulate the practice of medicine within their States. Moreover, the regulation of healthcare and of the practice of medicine is a core function of state authority under our system of federalism.
The States— not the federal government—are empowered to regulate the practice of medicine and the medical profession, including by licensing medical professionals ensuring that evidence-based medical care is available to their residents. Defendants’ efforts to leverage unrelated and inapplicable statutes to institute a de facto national regime barring the provision of this care to adolescents flatly disregards this long-established state authority and seeks to impose a federal standard of medical care on every medical provider in the country, effectively usurping a core state police power…
“The federal government is running a cruel and targeted harassment campaign against providers who offer lawful, lifesaving care to children,” James said in a press release announcing the litigation. “This administration is ruthlessly targeting young people who already face immense barriers just to be seen and heard, and are putting countless lives at risk in the process. In New York and nationwide, we will never stop fighting for the dignity, safety, and basic rights of the transgender community.”
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The heart of the Trump administration’s campaign against transgenderism is the weaponization of several federal statutes that have nothing do with gender-affirming care, the plaintiffs argue.
In one section of the president’s order – and a concomitant enforcement directive issued by U.S. Attorney General Pam Bondi – the federal government purports to use a federal law against female genital mutilation (FGM) — a practice almost exclusively occurring outside of the Americas — to secure compliance. On its own terms, this section anticipates using “law enforcement officers to coordinate” the enforcement of the 1996 federal ban on FGM.
To hear the plaintiffs tell it, however, the U.S. Department of Justice is abusing this law – as well as two other statutes that are not intended for such uses – to go after legitimate medical providers.
“DOJ has issued these directives notwithstanding the fact that there is no lawful basis for it to do so,” the lawsuit continues. “On the contrary, these directives reverse and conflict with the law, as well as years of practice. In other words, DOJ has improperly weaponized its authority by issuing a novel and atextual legal interpretation that has intimidated providers, pressuring them to stop offering lawful, necessary, and often lifesaving medical care to transgender adolescents.”
The litigation alleges numerous violations of the Administrative Procedure Act, the federal statute governing the behavior of federal departments and agencies, as well as a 10th Amendment challenge – a formerly-rare avenue of relief that has become increasingly common in lawsuits against the second Trump administration.
“In the complaint, the attorneys general emphasize that medical experts overwhelmingly agree that gender-affirming care is safe, necessary, and in many cases, lifesaving care,” the press release continues. “Every major medical association in the United States, including the American Academy of Pediatrics, the American Medical Association, and the American Psychiatric Association, recognizes gender-affirming care as the appropriate treatment for gender dysphoria. Denying access to such care has been shown to significantly increase rates of depression, anxiety, and suicidality in transgender youth.”
