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A federal policy expert weighs in on Trump’s efforts to stifle gender-affirming care for Americans under 19
Elana Redfield, University of California, Los Angeles
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.
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.
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.
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.
So it rejects the idea that gender-affirming care has health benefits, even though there’s robust, extensive evidence supporting access to gender-affirming care. Self-reporting by transgender individuals is overwhelmingly positive: 98% of trans people who had hormone therapy said it made their lives better, according to the 2022 U.S. Transgender Survey.
There are also rigorous standards of practice, including for how you support and treat minors, that are intended to prevent overprescription or overutilization of services.
In other words, there are already barriers in place and checks and balances for minors if they want to access gender-affirming care.
Elana Redfield, Federal Policy Director at the Williams Institute, University of California, Los Angeles
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Long Track Back
Why Downtown Los Angeles Feels Small Compared to Other Cities
Downtown Los Angeles often feels “small” compared to other U.S. cities, but that’s only part of the story. With some of the tallest buildings west of the Mississippi and skyline clusters spread across the region, LA’s downtown reflects the city’s unique polycentric identity—one that, if combined, could form a true mega downtown.
Last Updated on February 18, 2026 by Daily News Staff
Panorama of Los Angeles from Mount Hollywood – California, United States
When people think of major American cities, they often imagine a bustling, concentrated downtown core filled with skyscrapers. New York has Manhattan, Chicago has the Loop, San Francisco has its Financial District. Los Angeles, by contrast, often leaves visitors surprised: “Is this really downtown?”
The answer is yes—and no.
Downtown LA in Context
Compared to other major cities, Downtown Los Angeles (DTLA) is relatively small as a central business district. For much of the 20th century, strict height restrictions capped most buildings under 150 feet, while cities like Chicago and New York were erecting early skyscrapers. LA’s skyline didn’t really begin to climb until the late 1960s.
But history alone doesn’t explain why DTLA feels different. The real story lies in how Los Angeles grew: not as one unified city center, but as a collection of many hubs.
Downtown Los Angeles
A Polycentric City
Los Angeles is famously decentralized. Hollywood developed around the film industry. Century City rose on former studio land as a business hub. Burbank became a studio and aerospace center. Long Beach grew around the port. The Wilshire Corridor filled with office towers and condos.
Unlike other cities where downtown is the place for work, culture, and finance, Los Angeles spread its energy outward. Freeways and car culture made it easy for businesses and residents to operate outside of downtown. The result is a polycentric metropolis, with multiple “downtowns” rather than one dominant core.
A Resident’s Perspective
As someone who lived in Los Angeles for 28 years, I see DTLA differently. While some outsiders describe it as “small,” the reality is that Downtown Los Angeles is still significant. It has some of the tallest buildings west of the Mississippi River, including the Wilshire Grand Center and the U.S. Bank Tower. Over the last two decades, adaptive reuse projects have transformed old office buildings into lofts, while developments like LA Live, Crypto.com Arena, and the Broad Museum have revitalized the area.
In other words, DTLA is large enough—it just plays a different role than downtowns in other American cities.
View of Westwood, Century City, Beverly Hills, and the Wilshire Corridor.
The “Mega Downtown” That Isn’t
A friend once put it to me with a bit of imagination: “If you could magically pick up all of LA’s skyline clusters—Downtown, Century City, Hollywood, the Wilshire Corridor—and drop them together in one spot, you’d have a mega downtown.”
He’s right. Los Angeles doesn’t lack tall buildings or urban energy—it just spreads them out over a vast area, reflecting the city’s unique history, geography, and culture.
A Downtown That Fits Its City
So, is Downtown LA “small”? Compared to Manhattan or Chicago’s Loop, yes. But judged on its own terms, DTLA is a vibrant hub within a much larger, decentralized metropolis. It’s a downtown that reflects Los Angeles itself: sprawling, diverse, and impossible to fit neatly into the mold of other American cities.
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Century City: From Hollywood Backlot to Business Hub
Century City, originally part of 20th Century Fox’s backlot, transformed into a prominent business district in Los Angeles during the 1950s amid the decline of cinema. Developer William Zeckendorf envisioned a mixed-use urban center, leading to iconic skyscrapers and establishing the area as a hub for law, finance, and media, blending Hollywood history with modern business.
Before Century City became one of Los Angeles’ premier business districts, it was part of 20th Century Fox’s sprawling backlot, used for filming movies and housing studio operations. By the 1950s, as television rose and movie attendance declined, 20th Century Fox faced financial challenges and decided to sell a portion of its land.
Developer William Zeckendorf envisioned a “city within a city”—a modern, mixed-use urban center with office towers, hotels, and entertainment facilities. Branded Century City, the name paid homage to its studio roots while symbolizing LA’s vision for the future.
The first skyscrapers, including the Gateway West Building, set the tone for the district’s sleek, futuristic skyline. Architects like Welton Becket and Minoru Yamasaki helped shape Century City’s iconic look. Over time, it evolved from Hollywood’s backlot to a corporate and legal hub, attracting law firms, financial institutions, and media companies.
Today, Century City stands as a testament to Los Angeles’ postwar optimism, westward expansion, and multi-centered urban growth—a unique blend of Hollywood history and modern business.
Related STM Daily News Links:
- The Evolution of Los Angeles Public Transportation
- Why Los Angeles Grew Into a Sprawling City
- Downtown Los Angeles: Past, Present, and Future
Dive into “The Knowledge,” where curiosity meets clarity. This playlist, in collaboration with STMDailyNews.com, is designed for viewers who value historical accuracy and insightful learning. Our short videos, ranging from 30 seconds to a minute and a half, make complex subjects easy to grasp in no time. Covering everything from historical events to contemporary processes and entertainment, “The Knowledge” bridges the past with the present. In a world where information is abundant yet often misused, our series aims to guide you through the noise, preserving vital knowledge and truths that shape our lives today. Perfect for curious minds eager to discover the ‘why’ and ‘how’ of everything around us. Subscribe and join in as we explore the facts that matter. https://stmdailynews.com/the-knowledge/
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Community
Local governments provide proof that polarization is not inevitable
Local politics help mitigate national polarization by focusing on concrete issues like infrastructure and community needs rather than divisive symbolic debates. A survey indicates that local officials experience less partisanship, as interpersonal connections foster recognition of shared interests. This suggests that reducing polarization is possible through collaboration and changes in election laws.
Lauren Hall, Rochester Institute of Technology
When it comes to national politics, Americans are fiercely divided across a range of issues, including gun control, election security and vaccines. It’s not new for Republicans and Democrats to be at odds over issues, but things have reached a point where even the idea of compromising appears to be anathema, making it more difficult to solve thorny problems.
But things are much less heated at the local level. A survey of more than 1,400 local officials by the Carnegie Corporation and CivicPulse found that local governments are “largely insulated from the harshest effects of polarization.” Communities with fewer than 50,000 residents proved especially resilient to partisan dysfunction.
Why this difference? As a political scientist, I believe that lessons from the local level not only open a window onto how polarization works but also the dynamics and tools that can help reduce it.
Problems are more concrete
Local governments deal with concrete issues – sometimes literally, when it comes to paving roads and fixing potholes. In general, cities and counties handle day-to-day functions, such as garbage pickup, running schools and enforcing zoning rules. Addressing tangible needs keeps local leaders’ attention fixed on specific problems that call out for specific solutions, not lengthy ideological debates.
By contrast, a lot of national political conflict in the U.S. involves symbolic issues, such as debates about identity and values on topics such as race, abortion and transgender rights. These battles are often divisive, even more so than purely ideological disagreements, because they can activate tribal differences and prove more resistant to compromise.
Such arguments at the national level, or on social media, can lead to wildly inaccurate stereotypes about people with opposing views. Today’s partisans often perceive their opponents as far more extreme than they actually are, or they may stereotype them – imagining that all Republicans are wealthy, evangelical culture warriors, for instance, or conversely being convinced that all Democrats are radical urban activists. In terms of ideology, the median members of both parties, in fact, look similar.
These kinds of misperceptions can fuel hostility.
Local officials, however, live among the human beings they represent, whose complexity defies caricature. Living and interacting in the same communities leads to greater recognition of shared interests and values, according to the Carnegie/CivicPulse survey.
Meaningful interaction with others, including partisans of the opposing party, reduces prejudice about them. Local government provides a natural space where identities overlap.
People are complicated
In national U.S. politics today, large groups of individuals are divided not only by party but a variety of other factors, including race, religion, geography and social networks. When these differences align with ideology, political disagreement can feel like an existential threat.
Such differences are not always as pronounced at the local level. A neighbor who disagrees about property taxes could be the coach of your child’s soccer team. Your fellow school board member might share your concerns about curriculum but vote differently in presidential elections.
These cross-cutting connections remind us that political opponents are not a monolithic enemy but complex individuals. When people discover they have commonalities outside of politics with others holding opposing views, polarization can decrease significantly.
Finally, most local elections are technically nonpartisan. Keeping party labels off ballots allows voters to judge candidates as individuals and not merely as Republicans or Democrats.
National implications
None of this means local politics are utopian.
Like water, polarization tends to run downhill, from the national level to local contests, particularly in major cities where candidates for mayor and other office are more likely to run as partisans. Local governments also see culture war debates, notably in the area of public school instruction.
Nevertheless, the relative partisan calm of local governance suggests that polarization is not inevitable. It emerges from specific conditions that can be altered.
Polarization might be reduced by creating more opportunities for cross-partisan collaboration around concrete problems. Philanthropists and even states might invest in local journalism that covers pragmatic governance rather than partisan conflict. More cities and counties could adopt changes in election law that would de-emphasize party labels where they add little information for voters.
Aside from structural changes, individual Americans can strive to recognize that their neighbors are not the cardboard cutouts they might imagine when thinking about “the other side.” Instead, Americans can recognize that even political opponents are navigating similar landscapes of community, personal challenges and time constraints, with often similar desires to see their roads paved and their children well educated.
The conditions shaping our interactions matter enormously. If conditions change, perhaps less partisan rancor will be the result.
Lauren Hall, Associate professor of Political Science, Rochester Institute of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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