Editorial: Kaiser’s gender care decision is wrong

Add Kaiser Permanente to the list of health care providers bending to President Donald Trump and his administration. Late last month, Kaiser announced that it would pause gender-affirming surgeries for trans youth under 19. It was a slap in the face to many LGBTQ patients; Kaiser is one of the leading providers of health insurance in the Bay Area. Even if you’re not a trans youth, Kaiser’s decision is deeply troubling. The new policy goes into effect on August 29.

As we reported, Kaiser laid the blame squarely at the federal government, and its decision came shortly after the Department of Justice issued subpoenas to 20 unnamed doctors and clinics across the U.S. It also cited a Federal Trade Commission review of the matter.

“In response to these federal actions, many health systems and clinicians across the country have paused or discontinued providing gender-affirming care for adolescents,” Greg A. Adams, the chair and CEO of the Kaiser Foundation Health Plan and Hospitals, stated in a joint statement with other Kaiser leaders. “As the legal and regulatory environment for gender-affirming care continues to evolve, we must carefully consider the significant risks being created for health systems, clinicians, and patients under the age of 19 seeking this care.”

Kaiser joins Children’s Hospital Los Angeles and Stanford in ending at least some gender-affirming care. CHLA ceased all such care in July; Stanford adopted a policy similar to Kaiser’s, and stopped gender-affirming surgeries to patients under 19 in June. This all comes as nearly 20 health systems across the country had also decided to end or pause various gender-affirming care services for minors. The list included Yale New Haven Health and Connecticut Children’s Medical Center, Phoenix Children’s Hospital, Denver Health, and Northwestern Memorial Hospital. In short, Trump, who has issued executive orders stating there are only two genders and others designed to strip trans people of their rights, is exerting his power to negatively affect the most vulnerable.

California is supposed to be a refuge state for trans youth and their families, but the actions by Kaiser and the other health care providers undermine that effort. Governor Gavin Newsom signed a bill by gay state Senator Scott Wiener (D-San Francisco) to do just that, effective in January 2023. Under the law, officials in the Golden State refuse to participate in any legal action the families' home states take against them. (Newsom’s more recent comments that it’s “deeply unfair” for female trans athletes to compete on girls’ and women’s sports teams has dampened enthusiasm for him in the trans community and called into question his commitment to trans rights.)

In another development, state Attorney General Rob Bonta on August 1, the first day of Transgender History Month, announced that he and other state AGs have filed a lawsuit against the Trump administration regarding the issue. Bonta and the other plaintiffs argue that Trump’s Executive Order 14187, titled “Protecting Children from Chemical and Surgical Mutilation,” interprets federal law to prevent the procedures at health providers that are recipients of Medicare or Medicaid coverage. The lawsuit refers to the executive order as the “denial of care” order.

“The president and his administration’s relentless attacks on gender-affirming care endanger already vulnerable adolescents whose health and well-being are at risk; their demands that our health care providers discriminate against transgender individuals and deny them access to medically-necessary healthcare is cruel and irresponsible,” Bonta stated in a news release. “The Trump administration’s unlawful threats have not only undermined state rights but have directly contributed to diminishing access to gender-affirming care.

“These actions have created a chilling effect in which providers are pressured to scale back on their care for fear of prosecution, leaving countless individuals without the critical care they need and are entitled to under law,” he added.

Bonta’s right about that. The fear of prosecution is real indeed. Kaiser, CHLA, Stanford, and the others have seen the Trump administration sue universities and other entities over perceived wrongdoing. We would argue the administration is demonstrating its authoritarian bent in going after hospitals, colleges, law firms, and other groups. But these medical centers should have stood up for trans youth and their access to care. While there are conflicting studies around the issue, it seems more research is needed, not gutting such care completely.

We’re most disappointed in Kaiser. It has regularly won our readers’ poll for best health care and has long been a supporter of the LGBTQ community, advertising in the Bay Area Reporter and participating in Pride parades and other activities. Many LGBTQ people work for Kaiser, and they, too, are angered by the pause in gender-affirming care for trans patients under 19. LGBTQ parents with trans kids have also been adversely affected, as several told us last month. But more than that, Kaiser’s decision sends a chilling message to all of its other patients: they, too, could one day learn that services they depended on are no longer available.

At the moment, however, this is about the youth themselves. Under the care of physicians, and with input from their parents, they had been able to access gender-affirming care, including surgery, at these medical facilities. Now, they are left with fewer options in California and elsewhere. Studies have shown that gender-affirming care helps young people. Even the U.S. Department of Health and Human Services has a page on its website – restored by court order after it was removed – that states, “Research demonstrates that gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents. Because gender-affirming care encompasses many facets of healthcare needs and support, it has been shown to increase positive outcomes for transgender and nonbinary children and adolescents. Gender-affirming care is patient-centered and treats individuals holistically, aligning their outward, physical traits with their gender identity.”

We’re hopeful that Bonta’s lawsuit will resolve successfully for trans youth, and we call on Kaiser, CHLA, Stanford, and other medical centers to restore their gender-affirming programs quickly. These health care facilities should serve all of their patients, and not cave to the whims of Trump and his administration officials who lack the medical knowledge and are just trying to score cheap political points.