Trans rights activists demonstrate outside the House of Representatives in the Oklahoma state capitol ahead of the State of the State address, February 6, 2023, in Oklahoma City. Oklahoma and 25 other states have anti-trans laws on the books.

Sue Ogrocki/AP

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Sue Ogrocki/AP

In the final weeks of the presidential campaign, the slogan rang in voters’ ears: “Kamala is for them. Trump is for you.”

With the success of this part of his closing argument, the incoming Trump administration will likely turn to policy affecting transgender people early in its term. The issue is mentioned twice in President-elect Donald Trump’s 20-point proposal. “Agenda 47” platform: #16 Cut funding for schools that teach “radical gender ideology”; and #17 “Keep men out of women’s sports.” »

But what about health care for transgender people? The Trump campaign and conservative think tanks offer several indications of how the policy might change.

A federal ban on gender-affirming care for minors is likely, says Jon Schweppe, policy director of the American Principles Project, a conservative policy advocacy group that has advocated against transgender policy for years. “With adults, I think Americans are much less enthusiastic about a total ban (on gender-affirming care), but with children, they are very much on board,” Schweppe says . About half of the states have enacted such a ban, although polls vary on the degree of general public support for these efforts.

There are also plans to restrict access to gender transition by limiting insurance coverage. To do this, Republicans could take inspiration from the anti-abortion playbook.

“Certainly one of our goals is to create a Hyde Amendment for so-called gender-affirming care,” Schweppe says. The Hyde Amendment is a 1977 policy which prohibits federal dollars from funding abortion, with few exceptions.

“We don’t believe taxpayer funding should go to minors or adults. We’ve tested this by polling and we’re confident the American people agree,” Schweppe said.

The Hyde Amendment is largely responsible for how abortion became operational outside of the mainstream health insurance system. Patients often pay in cash, either because they do not have abortion coverage or because they do not want the abortion recorded in their medical record. In response, abortion funds were created to provide access to those who do not have insurance coverage or cannot afford to have an abortion themselves.

Investment in “a political winner”

In the presidential race alone, Republicans spent more than $46 million on the “Kamala is for them” message, according to an AdImpact report shared with NPR.

“It turned out to be a political win,” says Schweppe. In total, the party spent $222 million on anti-trans and LGBTQ ads during the 2024 campaign. Democrats, by contrast, spent just under $29 million on LGBTQ ads.

Some Republicans in Congress are signaling their eagerness to turn anti-trans campaign messages into law. A few weeks before the start of the new session, proposed laws and policies concerning access to toilets were designed to target new Rep. Sarah McBride D-Del., who will be the first transgender lawmaker in U.S. history.

Other promises and policies

In 2023, the Trump campaign posted a video and a look at some policy actions Republicans would take “to protect children from left-wing gender madness.”

Specifically, Trump promised to:

• Ban gender-affirming care for young people nationwide.
• Ban Medicare and Medicaid insurance coverage for gender-affirming care for patients of all ages and withhold federal funds from hospitals that provide this care.
• Adopt consequences for schools and teachers who support transgender youth.

Trump also wants the Justice Department to investigate how drug companies and hospitals provide gender-affirming care, and he will seek to pass a federal law saying Title 9 bans transgender women and girls to participate in women’s sports.

Overall, Matt Sharp, of the conservative Christian legal group Alliance Defending Freedom, says he hopes the Trump administration will adopt policies establishing that “the differences between men and women matter, and that states, schools and other places will be allowed to return to common sense.” and recognize these differences.

Even advocates of access to gender-affirming care agree that restrictions will likely be imposed when Trump takes office. “It’s very clear that they have a consistent anti-trans agenda that they’re going to pursue, which is why we’re preparing on multiple fronts,” says Harper Seldinattorney with the ACLU’s LGBTQ and HIV Project.

Trans people have also seen all these ads, Seldin says. “Without any speculation about what this did or did not do to the end result (of the election), I think it creates a climate of fear for trans people,” he says. “I think it also creates a climate of hatred toward people who oppose trans people. It really positions transgender people as the enemy of the mainstream American political system – and trans people are people too.”

Young transgender people in the spotlight

Although Trump’s trans policy goals affect adults in some way, much of conservative activism on this issue has focused on children.

Major U.S. medical groups, including the American Academy of Pediatrics, the American Medical Association and the Endocrine Society, support young people’s access to gender-affirming care, which can range from using preferred pronouns of the child to the use of puberty-blocking drugs and sex hormones. (Surgery is very rare for minors.)

According to a recent report According to the Centers for Disease Control and Prevention, 3% of high school students describe themselves as transgender, although not all necessarily want medical interventions related to that identity.

The CDC found that trans students “experienced a higher prevalence of violence, poor mental health, suicidal thoughts and behaviors, and unstable housing.” The report goes on to note that “having supportive families and peers, feeling connected to family and school, having affirmed a name and pronouns used consistently by others, and having a sense of pride in identity are protective factors for transgender students that mitigate the effects of minority stressors and promote better mental health.

The Trevor Project, which operates a 24/7 crisis line for LGBTQ youth and answers calls to the 988 crisis line for this population, recently published an analysis finding that transgender youth were more likely to attempt suicide after their home state banned gender-affirming care for youth.

The day after the election, there was a 700% increase in calls to the crisis line, which marked the largest increase in daily contacts on record, the Trevor Project wrote to NPR in a statement. Although volume has decreased since November 6, “volume remains higher than normal as LGBTQ+ youth continue to reach out, overwhelmingly, to discuss their concerns about the 2024 election results,” it says. the press release.

Schweppe, of the American Principles Project, rejects this data point, saying research on suicide risk in this population is exaggerated. “We are diametrically opposed to their goals,” he says of the Trevor Project, whose work he describes as indoctrination.

Even if children suffer from gender dysphoria, he says, “we should try to help them identify with their biological sex, try to help them feel comfortable with their body, not tell them that their body is wrong, that the way God created them is wrong,” he says. Importantly, the American Academy of Pediatrics notes in a political declaration that conversion or reparative therapies “have been shown not only to be ineffective but also harmful and are considered outside the mainstream of traditional medical practice.”

The changing legal landscape

On December 4, before Trump’s next presidential term begins in January, the Supreme Court will hear arguments on whether Tennessee’s ban on gender-affirming care for transgender youth is constitutional and, by extension, bans in force in 25 other states.

Sharp, of the Alliance Defending Freedom, hopes the high court will rule on the merits of the case. “Ultimately, we hope he will rule in favor of these state laws and allow them to go into effect,” he says.

Seldin of the ACLU, who represents the transgender children and families in Tennessee who filed the suit, says it is difficult to predict what will happen after the oral arguments, but that they are willing to “be flexible about what we need to do to respond to the present moment.” “. He says LGBTQ rights advocates are also determined to continue fighting for the rights of transgender people.

If judges find the bans unconstitutional, conservative advocacy groups like the American Principles Project plan to “pursue other avenues to effectively shut down these gender clinics,” Schweppe said. This is the overall objective, he adds. “I think we’ve been very transparent about it.”

He isn’t worried about the challenges of passing laws on transgender issues with slim Republican majorities in the House and Senate. He points several Democrats who have argued in recent weeks that support for transgender people is costing the party electoral victories, and who might cross partisan lines to support a women’s sports bill, for example.

“The argument that groups like ours are making to Republican leaders is that not only is this the right thing to do and these are the right laws to pass, but they also have great political benefit,” he said.