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What is the HHS Transgender Mandate?


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What is the HHS Transgender Mandate?


HHS proposes a new rule to protect families, children and doctors

On May 24, 2019, the U.S. Department of Health and Human Services proposed a new regulation that protects patients, aligns with current medical research, and complies with rulings from two federal courts. The Transgender Mandate, issued in 2016, had required doctors to perform gender transition procedures on any patient referred by a mental health professional, including a child, even if the doctor believed the procedure would be harmful. That rule was struck down in court after it was challenged by nine states, several religious organizations, and an association of over 19,000 healthcare professionals. Today’s rule would bring the regulations in compliance with the court decision, ensuring that the personal decision to undergo transgender medical procedures is kept between a patient and their doctor, free from government interference. 

What is the HHS Transgender Mandate?

In 2016, HHS mandated that doctors[1] must perform gender transition procedures on any child referred by a mental health professional, even if the doctor believes the treatment or hormone therapy could harm the child. Doctors who followed their Hippocratic Oath to act in the best interest of their patient instead of this new mandate would have faced severe consequences, including losing their job[2]

The Transgender Mandate also required virtually all private insurance companies and many employers to cover gender transition procedures or face stiff penalties and legal action[3]. There were two major insurance plans exempted from HHS’s mandate, however—the plans run by HHS: Medicare and Medicaid. 

Why were the government’s plans exempt? Most children referred for gender dysphoria grow up not to be transgender and the government’s own panel of medical experts concluded that these gender transition procedures can be harmful[4]

Medicare and Medicaid didn’t even have to pay for these procedures because HHS’s medical experts believed gender transition procedures can be harmful[5]. But HHS’s political appointees pushed through a rule that would have ruined doctors whose best medical judgment was that they could not perform the very same procedures because it would harm the child under their care

This is not a question of access to care but of forcing a political ideology on doctors against their medical judgment. This mandate was unique in requiring doctors to violate their Hippocratic Oath.

A decision to undergo a gender transition procedure is a difficult and deeply personal one, and it is especially complicated in the case of children. It is a private healthcare decision that should be between a family and their doctor, not decided by politicians and government bureaucrats. 

 
 
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Medical Consensus: HHS's Transgender Mandate Will Harm Children


Medical Consensus: HHS's Transgender Mandate Will Harm Children


Research shows that there are significant risks with gender transition procedures in childhood. Again, that is why HHS’s own medical board advised against requiring coverage of gender transition surgical procedures under Medicare and Medicaid. 

Along with physical impacts like heart conditions, increased cancer risk, and loss of bone density, the peer-reviewed longitudinal studies of children with gender dysphoria (that HHS accepted as valid) found that fewer than 1-in-4 children referred for gender dysphoria continued to experience that condition into adulthood. Some grew out of it, but many of the children ended up realizing that they were not transgender but instead gay or lesbian. 

The Transgender Mandate virtually guaranteed that doctors would be forced—against their medical judgment—to perform procedures aimed at altering the gender of children who are not actually transgender.

Children, especially those wrestling with gender dysphoria, are some of the most vulnerable and at-risk members in our society. It is unconscionable that our government attempted to order doctors to administer hormone therapy and even gender-transition surgery when the best medical science and the doctor’s judgment conclude that such procedures would be irreversibly harmful.

 

 
 
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Transgender Mandate Requires Doctors to Violate Hippocratic Oath


Transgender Mandate Requires Doctors to Violate Hippocratic Oath


Virtually every doctor in America takes some variation of the Hippocratic Oath, promising to put the needs of each individual and unique patient first and do no harm. And yet, for the first time, the Transgender Mandate would have forced doctors to violate their oath. 

Medical science is on the side of any doctor who feels that in a specific case it would be a mistake to begin gender transition procedures on a child. 

The Transgender Mandate did not allow space for the doctor’s medical judgment and did not even allow the doctor to refer the child to another doctor, even one more qualified, or for a hospital to find a doctor willing to perform the procedure. Any refusal by a qualified and practicing doctor to perform such a procedure would have been a violation of the mandate[6]

The mandate was not about access to care. It was not about science or the best medical research. It was clearly not about the welfare and health of children. This mandate would have marked a significant movement away from the accepted medical ethics of our time, ethics that were affirmed and strengthened nearly 70 years ago precisely in response to a time when governments tried to force doctors to administer treatments and perform procedures doctors knew to be harmful.

Too much is at stake to allow this mandate to stand.