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Trump’s push to end transgender care for young people opposed by pediatricians

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Trump’s push to end transgender care for young people opposed by pediatricians

A display at the Gender Health Program of Children’s Minnesota hospital. Under a proposed rule announced Thursday, a hospital will lose all its Medicaid and Medicare funding if it continues to provide gender-affirming care for trans people under age 18.

Selena Simmons-Duffin/NPR


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Selena Simmons-Duffin/NPR

Dr. Kade Goepferd watched the Trump administration’s moves on Thursday to ban gender-affirming care for transgender youth with “a mix of sadness and frustration.”

Goepferd, who is the founder of Children’s Minnesota Gender Health Program, says that for the medical community, nothing has changed about the evidence supporting gender-affirming care that could justify the government’s actions.

“There’s a massive propaganda and disinformation campaign that is selectively targeting this small population of already vulnerable kids and their families,” Goepferd says.

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“Men are men”

Federal health officials said many times at Thursday’s announcement that their actions were driven by science and evidence, not politics or ideology. They frequently praised a report published by the Department of Health and Human Services in November. It concluded that clinicians who provide medical care to help youth transition have failed their patients and emphasized the benefits of psychotherapy as an alternative.

At times, health officials cast doubt on the idea that a person could be transgender at all.

“Men are men. Men can never become women. Women are women. Women can never become men,” said Acting CDC Director Jim O’Neill. He added that “the blurring of the lines between sexes” represented a “hatred for nature as God designed it.”

Health Secretary Robert F. Kennedy Jr. said doctors and medical groups had “peddled the lie” that these treatments could be good for children, and that those youth were “conditioned to believe that sex can be changed.”

Doctor groups disagree

The American Academy of Pediatrics, the medical group that represents 67,000 pediatricians across the country, pushed back forcefully on those characterizations.

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“These policies and proposals misconstrue the current medical consensus and fail to reflect the realities of pediatric care and the needs of children and families,” said AAP President Dr. Susan J. Kressly in a statement. “These rules help no one, do nothing to address health care costs, and unfairly stigmatize a population of young people.”

AAP’s official position on this medical care is that it is safe and effective for the young people who need it. That view is shared by the American Medical Association, the Endocrine Society, among other medical organizations.

In a statement Thursday, the American Psychological Association wrote: “APA is deeply concerned about recent federal actions that not only challenge the scientific understanding of gender identity but also potentially jeopardize the human rights, psychological health, and well-being of transgender and nonbinary individuals.”

The most significant proposal released by HHS would withhold all Medicare and Medicaid funding from hospitals — a big portion of their budgets — if they provided gender-affirming care to those under age 18.

The Children’s Hospital Association said that rule — if finalized — would set a dangerous precedent. “Today’s proposed conditions make it possible for all kinds of specialized health care treatments to be withheld based on government-mandated rules,” wrote CEO Matthew Cook. “Millions of families could lose access to the care they need.”

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After a 60-day comment period, the rules could be finalized and then take effect.

Attorneys general in New York and California have said they will fight these rules and protect the rights of trans people to get care in their states. The ACLU has vowed to sue, and more legal challenges are expected.

“I don’t want to be lost”

According to a CDC survey, about 3% of teenagers aged 13-17 identify as transgender, approximately 700,000 people. A poll from health research organization KFF found that less than a third of transgender people took medication related to their identity and 16% had had surgery.

For young people, medical options most commonly include puberty blockers and hormones. Surgery is very rare for minors. “This is health care that evolves over time, is individualized, tailored to a patient’s needs, often after years of relationship with a trusted health care team,” says Goepferd.

NPR spoke to a transgender 15-year old in California this week about the moves Trump administration officials were making to restrict care. “They think what I’m feeling is a phase and that my family should just wait it out and that it’s better I’m unhappy and never receive care,” he says. NPR agreed not to name him because of fears for his safety.

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He says it can be difficult for those who are not transgender to understand that experience, but that, as far as he can tell, these health officials “are not interested in understanding trans people.”

He describes the long and deliberate process he made with his parents and doctors before he began taking testosterone. “The decision to not start gender-affirming care is often just as permanent as a decision to start it,” he says. “Not starting [hormone therapy], for some people, it feels like ruining our body, because there are certain changes we can never have.”

Now, after six months on testosterone, he feels like he’s on the right path, and is worried about the prospect of losing access to his medication if HHS’s efforts to shut down care nationally succeed. “It feels like someone’s throwing me into the bush just off the path I’m on, and that’s kind of terrifying,” he says. “I don’t want to be lost. I want to keep going where I’m going.”

“Deep moral distress”

More than half of states already ban gender-affirming care for young people after a frenzy of laws passed since 2021 in Republican-led states. This week, Republicans in the House led efforts to pass two federal bills that would restrict access to care, including one that could put doctors who provide the care in prison for up to ten years. It’s unclear if the bills will be voted on in the Senate.

Although nothing has officially changed in states where the care is still legal, these efforts to enact national restrictions have doctors and health systems in those states bracing for the possibility that their clinics will have to close down.

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Dr. Kade Goepferd is standing in an exam room at Children's Minnesota hospital.

Dr. Kade Goepferd takes care of transgender and gender diverse young people at Children’s Minnesota hospital.
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“There’s a deep moral distress when you know that there is care that you can provide to young people that will measurably improve their health and the quality of their life, and you’re being restricted from doing that,” Goepferd of Children’s Minnesota says. “And there’s a moral distress in feeling like — as a hospital or a health care system — you have to restrict care that you’re providing to one population to remain financially viable to provide health care for other kids.”

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Map: 4.6-Magnitude Earthquake Shakes Northern California

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Map: 4.6-Magnitude Earthquake Shakes Northern California

Note: Map shows the area with a shake intensity of 4 or greater, which U.S.G.S. defines as “light,” though the earthquake may be felt outside the areas shown.  All times on the map are Pacific time. The New York Times

A light, 4.6-magnitude earthquake struck in Northern California on Thursday, according to the United States Geological Survey.

The temblor happened at 1:41 a.m. Pacific time about 1 mile southeast of Boulder Creek, Calif., data from the agency shows.

U.S.G.S. data earlier reported that the magnitude was 5.1.

As seismologists review available data, they may revise the earthquake’s reported magnitude. Additional information collected about the earthquake may also prompt U.S.G.S. scientists to update the shake-severity map.

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Source: United States Geological Survey | Notes: Shaking categories are based on the Modified Mercalli Intensity scale. When aftershock data is available, the corresponding maps and charts include earthquakes within 100 miles and seven days of the initial quake. All times above are Pacific time. Shake data is as of Thursday, April 2 at 5:41 a.m. Eastern. Aftershocks data is as of Thursday, April 2 at 6:11 a.m. Eastern.

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Appeals court rejects HUD homelessness overhaul saying it would be “disastrous”

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Appeals court rejects HUD homelessness overhaul saying it would be “disastrous”

Tents are lined up on Skid Row Thursday, July 25, 2024, in Los Angeles.

Jae C. Hong/AP


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Jae C. Hong/AP

A federal appeals court late Wednesday rejected the Trump administration’s push to impose new conditions on homelessness funding, saying implementing them “would be immediately destabilizing and disastrous.” The ruling upheld a lower court’s preliminary injunction, the latest rebuke to a major shift that advocates warn would push 170,000 people in federally subsidized housing back into homelessness. That would include many who are disabled, elderly and veterans.

The Department of Housing and Urban Development wants to slash money for permanent housing and shift it to transitional programs that require sobriety, mental health treatment and other conditions. HUD Secretary Scott Turner has said this would nudge people toward self-sufficiency. The agency did not say whether it would appeal the ruling, but said in a statement that it “remains committed to reforming the misguided ‘Housing First’ approach that for years funded the self-serving homeless industrial complex, rewarded activists, and ignored solutions.”

The change in how to spend nearly $4 billion dollars a year would upend two decades of bipartisan federal policy, an approach the appeals court ruling said “has proven effective.”

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The mere threat of losing funding as this case plays out has already had “serious real-world harm,” the ruling noted. Citing evidence from plaintiffs, it said multiple local homeless services providers had stopped accepting new clients, and “stopped referring new clients to certain permanent housing programs … because of the planned [funding] cuts.”

A coalition of non-profit homelessness advocacy groups, local governments and mostly Democratic-led states brought the legal challenge, arguing the last-minute overhaul announced last fall was unlawful.

“We are relieved,” the coalition said in a statement, and “remain dedicated to protecting proven solutions to homelessness.”

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Judge delays Luigi Mangione’s federal trial by about a month but won’t push it to next year | CNN

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Judge delays Luigi Mangione’s federal trial by about a month but won’t push it to next year | CNN

A federal judge on Wednesday declined to delay the federal trial of Luigi Mangione until next year, denying a request by his attorneys who had expressed concern they couldn’t prepare for trial while simultaneously defending the 27-year-old in state court.

US District Judge Margaret Garnett instead slightly modified the dates of the federal trial in the killing of United Healthcare CEO Brian Thompson, pushing the start of jury selection to October 5 – four weeks after it had been previously scheduled. Opening statements in the case are now scheduled for October 26 or November 2, Garnett said.

“I am skeptical of moving the trial wholesale into 2027 when the state trial has not been adjourned, and I think it’s a little bit of the tail wagging the dog,” she said. “I don’t have any control over the state’s schedule.”

The judge’s decision means Mangione is expected to stand trial in federal court about four months after the scheduled start of his trial on separate charges in New York state court – although she indicated the new dates of the federal trial could be revised.

The December 2024 fatal shooting happened on a Midtown Manhattan sidewalk outside a hotel where Thompson, 50, was set to attend an annual investors conference. Mangione’s arrest five days later at a McDonald’s restaurant in Altoona, Pennsylvania, ended a multi-state manhunt.

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Mangione pleaded not guilty to two counts of stalking in the federal case, and second-degree murder and eight other counts in the state case. If convicted of the most serious charges, he could face up to life in prison.

Mangione’s attorneys had asked Garnett to delay the federal case to January 2027, expressing concern it would overlap with the prosecution in state court, complicating their ability to adequately defend their client.

“Realistically, defense counsel cannot be defending Mr. Mangione in state court on second-degree murder charges that carry a maximum sentence of twenty-five years to life while, at the same time, also reviewing 800 questionnaires for a federal case that carries a maximum life sentence,” defense attorney Karen Friedman Agnifilo wrote in a March letter to Garnett.

Prosecutor Dominic Gentile, who argued against a delay, said Wednesday the public has a right to a speedy trial.

“Your Honor need only look out the window to see the people that follow this defendant and believe that what he did was right,” he said at the hearing, referencing those who support Mangione based on their own anger and resentment toward the American health care system.

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“This case is ready to move forward,” he added.

Gentile suggested the defense was seeking a delay in part because the law firm represents another high-profile client – Harvey Weinstein, who faces a retrial for an alleged sex crime in New York state court later this month.

The defense, however, said that played no role in their decision to ask for the delay.

“That is not a factor whatsoever,” Friedman Agnifilo told the judge.

Garnett brushed the matter aside, saying other cases are not her concern. Rather, the judge is most worried about Mangione’s state case impacting the federal jury selection process, she said. Potential jurors would be filling out questionnaires while “there’s a massive press pool and a lot of attention on the state trial which is ongoing just two blocks from here,” Garnett said.

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It is unclear if the scheduling change in the federal case will impact Mangione’s state trial, which is set to begin with jury selection on June 8. New York Judge Gregory Carro previously indicated he would move the state trial to September if federal prosecutors appealed Garnett’s ruling removing the death penalty from Mangione’s federal case. In February, prosecutors indicated they do not plan to appeal the ruling.

Mangione’s defense attorneys – who have repeatedly said they will not be ready for the state trial to begin in June – referenced Carro’s possible delay in court Wednesday in an attempt to sway the federal judge.

Friedman Agnifilo said they are asking the state judge for additional time to conduct investigations in support of their defense.

This story has been updated with additional information.

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