Amid a flurry of executive orders affecting transgender Americans, the Trump administration ordered restrictions on gender-affirming care for minors. Calling it “a stain on our Nation’s history,” the Jan. 28, 2025, order seeks to “end” this form of treatment for Americans under 19 years old.
The Conversation U.S. interviewed Elana Redfield, federal policy director at the Williams Institute, an independent research center at the UCLA School of Law dedicated to studying sexual orientation and gender identity law. She describes the aims of the executive order, how much weight it carries, and how it should be understood in the broader context of legal battles over access to gender-affirming care.
What’s the scope of the executive order?
Twenty-six states have already restricted gender-affirming care for minors or banned it outright. So the order seeks to extend restrictions to the rest of the country using the weight of the executive branch.
However, it’s not a national ban on gender-affirming care for minors. Instead, it’s directing federal agencies to regulate and restrict this form of care.
That being said, federal agencies have a tremendous impact on American life. Trans kids rely on publicly funded health insurance programs such as Medicaid and TRICARE, which is administered to the children of active duty service members via the Department of Defense. And a big part of the executive order is directing the federal agencies that administer these programs to review their own policies to ensure that they are not supporting gender-affirming care for minors.
So what we’re really seeing is the federal government trying to erect barriers to kids accessing this care.
Does the executive branch have the authority to unilaterally ban federal funding of certain medical treatments?
The answer is a little mixed. A president might be able to suspend or put a temporary pause on funding a particular type of treatment or service. But the actual parameters of a program – and how agencies should implement them – are determined by Congress and, to some extent, by the courts.
Ultimately, the president can only take actions in ways that are designated by the Constitution, or through some specific power that Congress has granted to the executive branch. I don’t see that authority granted for a lot of what’s contained in this executive order. But many of these directives will probably be litigated in court, where the president will likely argue that he has the power to direct agencies to do all they can to put a halt to gender-affirming care for minors.
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Do private health insurers fall outside the scope of this executive order?
On the surface, yes. But it’s easy to see how directives from the executive branch can touch broader components of the country’s health care system, including private hospitals and private health insurance.
For example, Section 1557 of the Affordable Care Act is a nondiscrimination provision. It says there can be no sex discrimination when it comes to approving health care treatments. This has been interpreted to mean that health insurance plans receiving federal funding cannot deny a policyholder gender-affirming care. However, this interpretation has been blocked by a federal court.
The question of whether this definition of sex discrimination encompasses gender identity is currently playing out in the courts. For example, there’s a pending U.S. Supreme Court decision regarding a Tennessee law banning gender-affirming care for minors. Should the Supreme Court determine that Tennessee is able to ban gender-affirming care for minors, it’s possible to see how this could impact private health insurance coverage for gender-affirming care.Transgender rights supporters and opponents rally outside of the U.S. Supreme Court as the high court hears arguments in a case about Tennessee’s law banning gender-affirming care for minors on Dec. 4, 2024. Kevin Dietsch/Getty Images
What else stood out to you from the executive order?
The executive order directs the Department of Justice to discourage doctors and hospitals from administering gender-affirming care to minors, characterizing it as genital mutilation, which is a heinous-sounding offense. Even though this is an inaccurate comparison, it could have a chilling effect even in states where this form of care is legal.
The order also contains a provision that asks Congress to extend the statute of limitations for gender-affirming care, so that someone who received gender-affirming care as a minor and decides they’re not happy with it decades later can sue their doctor. Some states have already extended the statute of limitations to 30 years for gender-affirming care.
Again, this could have a chilling effect in states where the care is legal. What doctor or hospital would want to expose themselves to this risk?
Of course, these two elements constitute directives from the executive branch, but we don’t know how they’ll be enforced. They do reveal, however, some of the ways in which the administration plans to direct its efforts.
Before Roe v. Wade was overturned, federal funding of elective abortion had been restricted for decades under the Hyde Amendment. You can’t receive coverage for an abortion under a Medicaid plan, for example. Do you see this executive order as Trump trying to simply enact – via fiat, of course – his own version of the Hyde Amendment, but instead applied to gender-affirming care for minors?
I think there’s a key difference between the two. The Hyde Amendment, which has been repeatedly reenacted by Congress, prohibits federal funding of abortion care, but it doesn’t prohibit states from allowing or permitting abortion. It’s always operated as a sort of compromise: It says providers can’t use federal funding for an abortion, but they can use their own funding to administer abortions – and oh, by the way, they can still receive federal funding for other health services.
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This executive order, on the other hand, takes a much more uncompromising position: It tells agency heads to stop directing any and all federal funds to institutions that research or provide gender-affirming care.
Again, it’s important to remember that executive orders aren’t established policy. They’re simply directing agencies to craft certain policies and encouraging lawmakers to enact legislation.
So far, much of the legislation restricting gender-affirming care – whether it’s at the state level or in the executive branch – has centered on minors, or individuals under 19. Are there any threats to gender-affirming care for adults?
Only one state, Florida, has enacted a law that specifically regulates gender-affirming care for adults. That law basically sets some compliance standards and restricts who can prescribe the care. Florida also banned the use of state funds for gender-affirming care for everyone, adults and children. So that means, for example, those who are incarcerated in state prisons can’t receive gender-affirming care.
Florida isn’t the only state that has enacted a state funding ban. Depending on your insurance, this could mean you’re forced to pay out of pocket for your procedures and treatment, which can be prohibitively expensive.
What are you going to be watching for in the coming weeks?
I’m sure someone’s going to sue to challenge the order. The problem, though, is that an executive order is an expression of policy ideas. You need something to actually happen before lawyers and activists can react to it. So I’ll be tracking federal agencies to see how they specifically try to enact some of these directives.
Is there anything else you’d like to add?
This executive order contains language that characterizes the science around gender-affirming care as junk science. It’s repeatedly described as chemical and surgical mutilation, or as maiming and sterilizing kids. There’s talk of rapid-onset gender dysphoria, which has been discredited.
Harkins Theatres Announces Rob Reiner Tribute Screening on December 17
Rob Reiner Tribute: Harkins Theatres will host a special $5 screening of The American President on December 17 to honor filmmaker Rob Reiner, with all proceeds benefiting the Human Rights Campaign.
Harkins Theatres Announces Rob Reiner Tribute Screening of The American President
Harkins Theatres has announced a special one-day tribute screening honoring acclaimed filmmaker Rob Reiner, celebrating his life’s work and cinematic legacy.
On December 17, select Harkins locations will screen Reiner’s 1995 political romance The American President, with all proceeds benefiting the Human Rights Campaign. Tickets are priced at $5, making the event both an accessible film experience and a charitable fundraiser.
The tribute was announced via Harkins’ official, verified social media accounts and is positioned as a legacy celebration, not a memorial.
🎥 Why The American President?
Released in 1995 and written by Aaron Sorkin, The American President stars Michael Douglas and Annette Bening and remains one of Rob Reiner’s most politically resonant films. The movie blends romance, idealism, and civic responsibility — themes that have consistently appeared throughout Reiner’s career.
The film later served as a creative blueprint for The West Wing, cementing its place in modern political storytelling.
Rob Reiner’s career spans more than five decades, including landmark films such as:
This Is Spinal Tap
Stand By Me
The Princess Bride
When Harry Met Sally…
Misery
A Few Good Men
His work is often praised for balancing entertainment, empathy, and social conscience, making tribute events like this especially meaningful to longtime audiences.
Hollywood Legend Rob Reiner and Wife Found Dead; Son in Custody
Renowned filmmaker Rob Reiner and his wife, Michele Singer Reiner, were found dead in their Los Angeles home in a reported homicide. Police have arrested their son in connection with the case, and tributes are pouring in.
Director Rob Reiner participates in a discussion following a screening of the film LBJ at the LBJ Presidential Library in Austin, Texas on Saturday October 22, 2016 On Saturday evening October 22, 2016, the LBJ Presidential Library held a sneak peek of Rob Reiner’s new filmÊLBJ, starring Woody Harrelson as the 36th president. The film, which premiered at the Toronto International Film Festival in September, chronicles the life and times of Lyndon Johnson who would inherit the presidency at one of the most fraught moments in American history. Following the screening, director Rob Reiner, actor Woody Harrelson, and writer Joey Hartstone joined LBJ Library Director Mark Updegrove on stage for a conversation about the film. LBJ Library photo by Jay Godwin 10/22/2016
Hollywood Legend Rob Reiner and Wife Found Dead; Son in Custody
December 15, 2025
Renowned filmmaker and actor Rob Reiner, 78, and his wife Michele Singer Reiner, 68, were found dead in their Brentwood, Los Angeles home on Sunday, authorities say. Emergency responders were called to the residence Sunday afternoon, where both were discovered with fatal wounds consistent with a stabbing. Police are treating the case as a double homicide.
Los Angeles police arrested the couple’s 32-year-old son, Nick Reiner, in connection with the deaths. He is being held in custody as investigators continue to piece together the circumstances surrounding the incident.
2016 SAMHSA Voice Awards
Reiner was one of Hollywood’s most influential figures, known for his work as a director, producer and actor. His career spanned decades, from early television fame to directing beloved films that shaped American cinema.
Friends, colleagues and public figures have begun sharing tributes and reactions to the news as the investigation is ongoing.
More details will be updated as they become available.
FDA’s COVID-19 Vaccine Safety Claims Lack Solid Evidence—Why Overreaction Could Harm Public Health
COVID-19 vaccine safety: The FDA’s claims about COVID-19 vaccine deaths in children lack strong evidence and could restrict vaccine access. Learn why experts say VAERS reports aren’t proof, and how overreacting may harm public health and trust in vaccines.
The death of children due to an unsafe vaccine is a serious allegation. I am a pediatric cardiologist who has studied the link between COVID-19 vaccines and heart-related side effects such as myocarditis in children. To my knowledge, studies to date have shown such side effects are rare, and severe outcomes even more so. However, I am open to new evidence that could change my mind. But without sufficient justification and solid evidence, restricting access to an approved vaccine and changing well-established procedures for testing vaccines would carry serious consequences. These moves would limit access for patients, create roadblocks for companies and worsen distrust in vaccines and public health. In my view, it’s important for people reading about these FDA actions to understand how the evidence on a vaccine’s safety is generally assessed.
Determining cause of death
The FDA memo claims that the deaths of these children were directly related to receiving a COVID-19 immunization. From my perspective as a clinician, it is awful that any child should die from a routine vaccination. However, health professionals like me owe it to the public to uphold the highest possible standards in investigating why these deaths occurred. If the FDA has evidence demonstrating something that national health agencies worldwide have missed – widespread child deaths due to myocarditis caused by the COVID-19 vaccine – I don’t doubt that even the most pro-vaccine physician will listen. So far, however, no such evidence has been presented. While a death logged in VAERS is a starting point, on its own it is insufficient to conclude whether a vaccine caused the death or other medical causes were to blame. To demonstrate a causal link, FDA staff and physicians must align the VAERS report with physicians’ assessments of the patient, as well as data from other sources for monitoring vaccine safety. These include PRISM, which logs insurance claims data, and the Vaccine Safety Datalink, which tracks safety signals in electronic medical records. It’s known that most deaths logged only in VAERS of children who recently received vaccines have been incorrectly attributed to the vaccines – either by accident or in some cases on purpose by anti-vaccine activists.
Heart-related side effects of COVID-19 vaccines
In his Substack and Twitter accounts, Prasad has said that he believes the rate of severe cardiac side effects after COVID-19 vaccination is severely underestimated and that the vaccines should be restricted far more than they currently are. In a July 2025 presentation, Prasad quoted a risk of 27 cases per million of myocarditis in young men who received the COVID-19 vaccine. A 2024 review suggested that number was a bit lower – about 20 cases out of 1 million people. But that same study found that unvaccinated people had greater risk of heart problems after a COVID-19 infection than vaccinated people. In a different study, people who got myocarditis after a COVID-19 vaccination developed fewer complications than people who got myocarditis after a COVID-19 infection. Existing vaccine safety infrastructure in the U.S. successfully identifies dangers posed by vaccines – and did so during the COVID-19 pandemic. Today, most COVID-19 vaccines in the U.S. rely on mRNA technology. But as vaccines were first emerging during the COVID-19 pandemic, two pharmaceutical companies, Janssen and AstraZeneca, rolled out a vaccine that used a different technology, called a viral vector. This type of vaccine had a very rare but genuine safety problem that was detected.A report in VAERS is at most a first step to determining whether a vaccine caused harm. VAERS, the Vaccine Safety Datalink, clinical investigators in the U.S. and their European counterparts detected that these vaccines did turn out to cause blood clotting. In April 2021, the FDA formally recommended pausing their use, and they were later pulled from the market. Death due to myocarditis from COVID-19 vaccination is exceedingly rare. Demonstrating that it occurred requires proof that the person had myocarditis, evidence that no other reasonable cause of death was present, and the absence of any additional cause of myocarditis. These factors cannot be determined from VAERS data, however – and to date, the FDA has presented no other relevant data.
A problematic vision for future vaccine approvals
Currently, vaccines are tested both by seeing how well they prevent disease and by how well they generate antibodies, which are the molecules that help your body fight viruses and bacteria. Some vaccines, such as the COVID-19 vaccine and the influenza vaccine, need to be updated based on new strains. The FDA generally approves these updates based on how well the new versions generate antibodies. Since the previous generation of vaccines was already shown to prevent infection, if the new version can generate antibodies like the previous one, researchers assume its ability to prevent infection is comparable too. Later studies can then test how well the vaccines prevent severe disease and hospitalization. The FDA memo says this approach is insufficient and instead argues for replacing such studies with many more placebo-controlled trials – not just for COVID-19 vaccines but also for widely used influenza and pneumonia vaccines. That may seem reasonable theoretically. In practice, however, it is not realistic. Today’s influenza vaccines must be changed every season to reflect mutations to the virus. If the FDA were to require new placebo-controlled trials every year, the vaccine being tested would become obsolete by the time it is approved. This would be a massive waste of time and resources.Influenza vaccines must be updated for every flu season.Jacob Wackerhausen/iStock via Getty Images Plus Also, detecting vaccine-related myocarditis at the low rate at which it occurs would have required clinical trials many times larger than the ones that were done to approve COVID-19 mRNA vaccines. This would have cost at least millions of dollars more, and the delay in rolling out vaccines would have also cost lives. Placebo-controlled trials would require comparing people who receive the updated vaccine with people who remain unvaccinated. When an older version of the vaccine is already available, this means purposefully asking people to forgo that vaccine and risk infection for the sake of the trial, a practice that is widely considered unethical. Current scientific practice is that only a brand-new vaccine may be compared against placebo. While suspected vaccine deaths should absolutely be investigated, stopping a vaccine for insufficient reasons can lead to a significant drop in public confidence. That’s why it’s essential to thoroughly and transparently investigate any claims that a vaccine causes harm.
