Republicans in Washington have made a firm pledge to halt medical treatment for the majority of trans Americans. This decision could potentially take effect next year once Donald Trump assumes power. Democrats in Congress hold the key to preventing this from happening if they unite and stand firm. However, it remains uncertain whether they will take action.

Trans Health Care at Stake: The Battle for Medical Access

Background and GOP's Plan

For the past few years, the GOP has centered around an idea to disrupt all trans health care in America. They aim to ban federal funds from going to businesses that provide specific health care for changing one's sex or gender identity, including hormones and surgeries. This would signal to the private sector that it must avoid sex- or gender-affirming care to receive federal dollars and comply with right-wing pundits' demands to "eradicate" and "erase" this form of care.The language in the House Republicans' latest funding bill for the Health and Human Services Department would achieve just that - prohibiting money from any federal program to entities that engage in "social transitioning" or provide drugs and surgery for "gender dysphoria." This diagnosis is used by doctors to justify these medical interventions. Although this legislation has not yet been voted on and would need to be reintroduced in the next Congress, it is a top priority for Republican lawmakers in the House, and Trump himself has promised to ask Congress to "permanently stop federal taxpayer dollars from being used to promote or pay for these [trans] procedures."

Impact on the Private Sector and Medical Care

Bans like these can have a significant impact on the private sector. Once in place, they are difficult to remove, as seen with the Hyde Amendment enacted in the 1970s, which led to most abortions no longer being performed in hospitals and is renewed annually. Medical groups and civil rights advocates in D.C. believe that if a similar Hyde-level ban on federal funding is enacted, many hospitals will prioritize federal dollars over continuing this highly specialized form of medical care. Since much medicine is performed through hospital systems and universities, this could mean an end to access for many.

Consequences for the Trans Community

Surgery for many trans Americans could be canceled, and hormonal treatments could end. A specialized field of medicine that has been practiced for over half a century in the U.S. and is backed by evidence of its need and benefits is now being ostracized. It is difficult to quantify the pain a funding ban legislation could cause to the American trans community, but it would likely lead to lost medical care, forced menopause for some who lose hormones, and in the worst-case scenarios, waves of suicides.Asa Radix, head of the World Professional Association for Transgender Health, says, "I think if they had to make the choice of, 'Do we provide this care and potentially have to close our doors to everybody,' they probably won't do it. It's very disturbing. Legislation like this - even if it hasn't passed - creates an environment where people are incredibly afraid. This is the type of issue where people actually feel suicidal. Are we going to see folks dying by suicide because potentially of laws like this being passed?"

Trump's Actions and the Incoming Administration

Trump, who once said Caitlyn Jenner could use any bathroom at Trump Tower, ran for the Republican nomination this year on a pledge to end any federal government promotion of transition "at any age" and disqualify hospitals treating trans minors from Medicare and Medicaid. His incoming vice president, J.D. Vance, as a senator, introduced legislation banning federal funds to entities performing trans health care and compared trans people to perverts. Trump's choice to run the Health and Human Services Department, Robert F. Kennedy Jr., has said people may be saying they're trans because of pollution. One of Trump's top advisers and financial backers, Elon Musk, days ago endorsed throwing doctors who perform trans health care to people under 18 in prison. A leading candidate to run Trump's Federal Trade Commission, Andrew Ferguson, has promised to use the agency to "investigate the doctors, therapists, hospitals, and others" that perform surgeries and provide hormone medications "to children and adults."

The Democratic Dilemma

Right now, many in the LGBTQ+ advocacy community, as well as some Democratic lawmakers and staff, are terrified that the party might let Republicans enact a funding ban on trans health care. At a minimum, they believe that party leaders will compromise on trans health care coverage in federal funding negotiations, allowing language that bans government-backed insurance plans from covering these services.Stopping any sort of trans health care funding ban would require all Democrats to stand together. If six Senate Democrats sided with Republicans to pass a funding bill with the ban language, it would overcome the legislative filibuster. Democratic staff, political advisers, lobbyists, and civil rights advocates admit they were not prepared to defend trans people at the national level. Since Trump and the GOP's focus on trans issues in the 2024 election, there has been a crisis of faith in the Democratic Party and the LGBTQ+ movement.Despite having almost a decade to prepare a message on trans rights since North Carolina's bathroom ban in 2016, the Democratic Party was caught off guard by the Republican's anti-trans advertising. There is no comprehensive messaging strategy for Democrats on trans rights or health care, and there is little lobbying spend specifically for the trans community. The only group they frequently cite is the Human Rights Campaign.Top personnel at HRC acknowledge that transphobia has become more common since 2016 but were surprised by the GOP's bet on anti-trans advertising. They worry that a conversation about trans rights needs to be done outside of a national campaign to avoid partisanship.The Trump campaign's anti-trans ads were a multi-purpose attack, not only to marginalize trans people but also to paint Harris as disconnected from voters' concerns and commingle conversations about sex changes with tough rhetoric on immigration and crime.

The Beltway Narrative

In light of the election results, a Beltway narrative has emerged that Democrats' support for trans people hurt Harris and others in their elections. Senate Democrats are frustrated with Majority Leader Chuck Schumer, and more moderate members are speaking out. However, there is little evidence that Harris or Democrats' support for trans rights was the deciding factor in the election.Democratic pollster Molly Murphy said the Trump campaign's anti-trans ads were "sticky" but did not shift the Harris campaign's numbers or the state of the race. The most damaging Trump ads for Harris revolved around video clips of her arguing that "Bidenomics is working."Some Democratic staff believe this fight over trans care will test the party's broader commitments to social justice and the enthusiasm of ordinary Democratic voters. The Congressional Progressive Staff Association called for congressional Democrats to "uphold our founding principles and defend those who are marginalized."Dial 988 in the U.S. to reach the National Suicide Prevention Lifeline. The Trevor Project, which provides help and suicide-prevention resources for LGBTQ youth, is 1-866-488-7386. Find other international suicide helplines at Befrienders Worldwide (befrienders.org).

Staff shortages and financial challenges have become critical issues in healthcare delivery. As we move towards 2025, there is increasing pressure from various stakeholders for greater accountability and transparency. In our recently published Numerof & Associates 2025 Healthcare Delivery Outlook, we outline the current situation and potential solutions.

Redefining Healthcare in 2025 - From Crisis to Opportunity

Staff Shortages and Their Impact

In recent years, staffing shortages have become a widespread problem across the healthcare industry. From nurses to physicians and hospital staff, the shortage has led to large-scale labor disputes and providers seeking alternative employment. One report shows that compared to 27 other industries, healthcare ranks last in terms of employee satisfaction with pay. Healthcare employees also score lower than those in other industries in terms of intent-to-stay, engagement, and experience compared to their expectations. This shortage is not only affecting individual providers but also organizations. Small independent physician practices are overwhelmed by regulatory and reporting burdens, lacking the necessary infrastructure and technology. Even large health systems face strong headwinds, with wage and general inflation increasing operating costs and weakening balance sheets. Industry consolidation continues as health systems try to integrate recently acquired providers into their networks and care delivery models.

The Need for a New Approach

2025 represents a pivotal year for healthcare delivery. Dissatisfaction across all levels of the system has created an opportunity to rethink outdated models. By adopting a new, holistic approach that ties payment to outcomes that matter to patients, healthcare organizations can create value for patients while controlling costs. As stated in "Bringing Value to Healthcare", we need to change the underlying business model. This includes prioritizing transparency in cost and quality, connecting payment with relevant outcomes, and requiring accountability across the continuum. Patient-consumers should be able to easily access relevant data to make informed decisions when shopping for providers and health plans.

The Role of Government

In 2025, the federal government will take a closer look at the bureaucracy and reporting requirements that drive up costs without adding value to consumers. The incoming administration understands that the current regulatory environment is distorting the market and increasing the cost of care. A core pillar of the Trump Republican Platform for the U.S. economy is to "slash regulations that stifle jobs, freedom, innovation and make everything more expensive." At the same time, government-mandated transparency will accelerate the development of tools for comparison shopping for non-emergent care. President Trump pushed for price transparency requirements for hospitals during his first term, which were upheld by the Supreme Court in 2020 despite resistance from healthcare providers. In the recent vice-presidential debate, Trump's future Vice President J.D. Vance also emphasized the importance of this issue.

Provider Responses

Providers must respond to the changing landscape by fundamentally rethinking their business models. Traditional cost-cutting measures will not be enough; success will require redesigning care delivery to focus on patient-centricity, efficiency, and measurable outcomes. Forward-thinking organizations will accelerate their participation in capitated models and pursue direct contracting with employers to stabilize revenue. They will continue to emphasize total cost of care to strengthen integration across the care continuum, expand access through urgent care and home health solutions, and address health equity through community partnerships.

The Turning Point in 2025

Healthcare delivery is at a turning point in 2025. Growing dissatisfaction across all levels of the system has created the opportunity for productive change. Innovative, system-level thinking is needed from both the private and public sectors. The path to better outcomes at lower cost of care and a more sustainable, patient-centered model requires a willingness to rethink decades-old care delivery and payment models. Some promising developments suggest that the time has come to embrace this shift, as both government and private sector efforts begin to align towards greater accountability and transparency in care delivery.