A federal judge in Maryland on Thursday temporarily blocked enforcement of President Donald Trump’s executive order threatening the federal funding of hospitals that provide gender-affirming care to teenagers.
Judge Brendan Abell Hurson, a President Joe Biden appointee, ruled that the administration can’t withhold federal funding from health care providers who treat transgender minors for at least the next two weeks and must update the court on its compliance by Feb. 20.
The nationwide restraining order seeks to restore access to health services for transgender patients 19 years and younger that had been disrupted by the administration’s “Protecting Children from Chemical and Surgical Mutilation” executive order. The order threatened the federal funding of health care providers that “fund, sponsor, promote, or assist” young people in transitioning from their sex assigned at birth.
But fear and confusion in the health care sector about whether and how to comply with conflicting state and federal laws around the care is likely to continue, particularly as all sides anticipate further appeals, with vulnerable patients caught in the middle.
“What am I going to say? Am I going to say, on the one hand, obey a federal threat? Or state law? Which one is of a higher order? I can’t say that,” said Kenneth Raske, president of the Greater New York Hospital Association. “I’ve only asked them to have moral responsibility — as best they possibly can exercise it — with their patients.”
Even before the order, surgery and medications for transgender teenagers were banned in most GOP-controlled states. Yet the order also prompted many hospitals and clinics in states where that care was legally protected — including California, Colorado, Maryland, Massachusetts, New York and Washington D.C. — to cancel appointments for hormones, surgeries, puberty blockers and other services for teenage transgender patients over the past couple weeks. And some other providers continued to see patients already in their system but declined to take new ones.
Impacted teens and their families, represented by the American Civil Liberties Union and Lambda Legal, sued the administration. They argued that the kids were suffering irreparable mental and physical harm as a result of the ban, that the Trump administration lacks the power to bypass Congress and threaten hospitals’ federal funding, and that the attempt to ban the care violates parents’ right to pursue what they think is best for their children.
No hospital has joined their challenge or brought its own. And while more than a dozen Democratic state attorneys general have called the executive order unlawful and told hospitals that they are obligated to provide the care, they have not sued either.
The hospitals cited in the lawsuit, some of which canceled appointments for adolescents who had waited years to begin treatment, collectively receive hundreds of millions of dollars in federal research and education funds each year. If they lose that money as a result of defying the Trump administration’s executive order, it could jeopardize their clinical trials and other work developing cures for cancer, diabetes, Alzheimer’s and other conditions.
One of the named hospitals — Denver Health — said those grants “represent a significant portion” of its funding and losing them “would critically impair [its] ability to provide care for the Denver community.”
Doctors, legal experts and patient advocates say the current atmosphere of fear and confusion mirrors the health care system’s response to the abortion restrictions states have imposed since Roe v. Wade was overturned in 2022, with risk-averse institutions erring on the side of over-complying with unclear laws to protect themselves legally and financially while patients and parents often shoulder the burden of challenging the policies in court.
“Hospital counsels are going to be making, essentially, what are business decisions,” said Greer Donley, a professor at the Center for Bioethics and Health Law at the University of Pittsburgh. “They’re going to say, ‘Well, this is a huge financial potential risk. This is not worth the fight. Whatever this is bringing in for us financially is not going to cover it.’”
