Lawsuits targeting the Trump administration’s attempt to block gender-affirming care for young people has bought Oregon hospitals some time. But the push to stop the care has alarmed patients, providers and families while forcing health system officials to negotiate a legal and funding minefield.
President Donald Trump’s Jan. 28 executive order directs federal agencies to cut off grants and other funding to any medical school, hospital or other institution that provides medical treatment for transgender patients under 19. The order conflicts with laws in 17 states, including Oregon, that are intended to ensure transgender people have access to affirming care.
Hospitals' responses to the prospect of losing federal funds has varied.
While hospitals such as Seattle Children’s Hospital have paused some gender-affirming surgeries, all three of Oregon’s health systems with gender-affirming care clinics say they have not made any changes in response to Trump’s order — so far. But they continue to watch it closely.
The American Academy of Pediatrics and other medical associations support the use of affirming treatments for children who experience gender dysphoria, a condition marked by distress by a patient’s identity and their sex at birth. However, heated debates have erupted in recent years over what treatments providers should be allowed to administer to this population. Oregon officials have quietly grappled with the same questions.
Trump’s order targets the use of drugs that block the onset of puberty, hormone treatment and surgeries to treat transgender adolescents. The order refers to gender-affirming treatments for minors as “maiming,” “sterilizing” and “mutilating.”
There were roughly 23,000 transgender people in Oregon, 3,000 of whom were minors, according to a 2022 estimate.
“It is an official statement of bigotry from the President that directs agencies to openly discriminate against vulnerable youth on the basis of their transgender status and sex. It is also a blatant abuse of power.”
The conflict between order and state law has created more uncertainty for transgender people who were demeaned by Trump during the presidential race.
“It is very scary when you have an openly antagonistic and hostile government saying, ‘We are going to insert politics into your health care,’” Julia Przedworski, a researcher who focuses on mental health disparities for transgender people, told The Lund Report.
Przedworski, a member of the state’s Health Equity Committee, said that Oregon already has a shortage of gender-affirming care providers. Regardless of the outcome of the order, there is a concern that doctors will be even more hesitant to provide this care out of fear of becoming a target, Przedworski said.
Transgender people experience higher rates of mental health issues and are at greater risk of suicide. Przedworski said that ensuring access to necessary care is fundamental to the mental health and well-being of transgender people. Oregon has been a leader in establishing gender-affirming care as needed health care, Przedworski said.
But now Przedworski worries that the state will not persist in its commitment as gender-affirming care becomes politicized.
Presidential action poses broad financial threat
Hospitals and medical schools rely on federal grants and research contracts to sustain their budgets. The order also appears to threaten hospitals with a cutoff of all Medicaid and Medicare funding, which in effect could force them to close.
On Friday, Oregon Attorney General Dan Rayfield on Friday joined his counterparts in Washington and Minnesota to file a federal lawsuit arguing that Trump’s order is an attempt to “dictate medical care” that violates the U.S. Constitution.
The suit, filed in federal court in Washington, called the order “a cruel and baseless broadside against transgender youth,” as well as their families and health care providers.
“It is an official statement of bigotry from the President that directs agencies to openly discriminate against vulnerable youth on the basis of their transgender status and sex,” the suit states. “It is also a blatant abuse of power.”
OHSU used more than $413 million in federal research grants and contracts in 2023 to research brain health, vaccines for HIV and malaria, as well as cancer treatments and ADHD, according to the suit.
“It is very scary when you have an openly antagonistic and hostile government saying, ‘We are going to insert politics into your health care."
The loss of grant funding would affect 500 research programs, as well as thousands of staff positions and hundreds of graduate students and postdoctoral fellows, the suit claimed. That includes OHSU’s Graduate Medical Education, which the suit described as one of the largest training programs in the country.
That sum does not include Medicare and Medicaid funding, which together provide a far greater amount of funding to OHSU and other hospitals across the country
At the same time, if health systems stop providing gender-affirming care, they face legal action — both from patients and from state officials.
In New York, which has similar protections, Attorney General Letitia James has warned hospitals that halting care to pediatric transgender patients would violate state law. Her counterparts in 14 states joined her in vowing to enforce state nondiscrimination laws to preserve access.
So far,the Oregon attorney general’s office has told health care providers that state law “remains unchanged,” spokesperson Jenny Hansson told The Lund Report in an email. Rayfield’s office is in the process of preparing more detailed guidance for providers and the LGBTQ community, she added.
Franny White, a spokesperson for the Oregon Health Authority, told The Lund Report in an email that the agency “is actively assessing the potential impact of all executive orders on Oregon.” She added that Oregon law prohibits discrimination based on a person’s gender identity.
Oregon providers say they continue to provide care
An estimate using more conservative methods concluded that as of 2022, Oregon was home to roughly 23,000 transgender people, 3,000 of whom were minors.
All three of Oregon’s health systems with gender-affirming care clinics indicated in statements that they are currently providing care, but did not commit to continuing to do so.
Steve Stadum, OHSU’s interim president, said in a statement emailed to The Lund Report that the university is monitoring federal actions that may affect its programs or services.
“The executive order on gender-affirming care is very scary for patients and their families,” he said. “We are continuing to provide this care.”
A spokesperson for Kaiser Permanente told The Lund Report that it is also monitoring the situation. Its physicians continue to deliver gender-affirming care to its members “subject to all state and federal laws and regulations.”
A spokesperson for Legacy Health told The Lund Report in an email that, “At this time, Legacy Health has not made any changes in the care we provide for our patients.”
Meanwhile, in addition to the suit filed by Oregon in Washington state, other lawsuits tackling the issue are pending in other federal courts. Not only that, but the U.S. Supreme Court continues to consider a lawsuit seeking authorization for state-level bans on youth gender-affirming care.
Given the potential threats, attorney Bruce Howell, a longtime health care law specialist who teaches it at the Willamette University School of Law in Salem, said that health systems and their lawyers need to keep watching “very carefully” how the legal situation develops.
He said the Trump effort, like a series of similar orders on other subjects, tries to override traditional checks and balances on presidential power such as Congress and states’ rights.
He said such efforts, including regarding reproductive rights, amount to a “power play” that has a “phenomenal chilling effect” on important research and needed, science-based health care — even when the orders run counter to the U.S. Constitution.
Nick Budnick contributed reporting.
Definitely concerning what the Federal government is doing but I don't think people are aware of what the Oregon government is doing. OHA and CareOregon's move to force associate mental health providers (Board Registered: Clinical Social Work Associates; Professional Counseling Associates; Marriage and Family Therapist Associates) out of there present jobs and present caseloads is also impacting gender affirming care. CareOregon plans to have a full disruption of care in July 2025 and OHA is planning to do it across all OHP members in June 2026 with their proposed rule change. Oregonians receiving their mental health services for gender affirming care are required to find alternative providers (Qualified Mental Health Provider) under a Certificate of Agreement (COA) organization. This also is impacting care for this demographic and it should not be ignored. It means disruption of rapport with their network of safe individuals to confide in. Years of hard work down the drain. It can also impact the timeline for Gender Affirming letters as OHP members might have to start the whole process over again if they can find a provider who is available, close to them and can keep the same regimen of routine care. Lets be honest, Community Mental Health Programs often spread out services so that they are not weekly for adults. How are you supposed to acquire this imperative letter in a watered down system that will be narrowed, limited and institutionally corrupted?