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A federal policy expert weighs in on Trump’s efforts to stifle gender-affirming care for Americans under 19

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President Donald Trump signs an executive order in the Oval Office of the White House on Jan. 23, 2025. AP Photo/Ben Curtis

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.

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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.

A crowd of protesters holding signs and flags before the steps of a majestic, columned, white building.
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.

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.

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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.

health and wellness

Zepbound Linked to Lower Healthcare Costs in Adults 55+ With Obesity, Real-World Study Suggests

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A real-world study found sustained Zepbound use in adults 55+ with obesity was linked to lower healthcare costs and fewer hospital and ER visits over time.

A new real-world study of adults over age 55 with overweight or obesity found that sustained use of Zepbound (tirzepatide) for weight management was associated with lower healthcare costs over time compared with similar adults who were not treated. Eli Lilly and Company said the findings were driven in part by lower rates of hospital admissions and emergency department visits, and were published in Diabetes, Obesity and Metabolism.

What the study found

According to Lilly, researchers estimated healthcare cost differences over time (excluding the cost of Zepbound itself) using two established analytic methods. Across both approaches, monthly healthcare costs were lower, on average, among older adults who stayed on Zepbound.

Key estimates reported in the release include:

  • At six months: costs were up to 15% lower (up to $181 per patient, per month).
  • At 12 months: the estimated difference widened to as much as $607 per patient, per month, reflecting up to 38% lower costs than those not treated (estimates varied by model).

In the primary analysis, adults over 55 treated with Zepbound had lower rates of hospital admissions and emergency department visits across every follow-up period, along with numerically higher rates of routine outpatient and office visitsa pattern the company said was consistent with greater engagement in routine care.

Why Medicare is part of the conversation

Lilly said the cost findings may be relevant for older adults, including those in Medicares GLP-1 Bridge program. The company noted that beginning at six months, estimated healthcare savings nearly covered the programs monthly treatment cost of $195 per patient, per month, and by 12 months the estimated savings exceeded the reported monthly treatment cost.

Its important to note the release also emphasizes a limitation: claims data do not capture Zepbounds net price, and the study excluded the cost of Zepbound from total treatment costs. That means the reported differences reflect potential savings elsewhere in care that could offset treatment costs, not the full net cost impact.

Who was included in the analysis

The retrospective observational cohort study used Komodos Healthcare Map, a database of de-identified claims data from more than 330 million individuals enrolled in U.S. healthcare plans. The analysis included 15,843 adults over age 55 (mean age 64.5) with obesity or overweight plus at least one obesity-related complication who initiated Zepbound between November 2023 and September 2025. Each Zepbound user was matched 1:1 with a control participant who met the same eligibility criteria but did not initiate GLP-1 or GIP/GLP-1 receptor agonist medication.

What Zepbound is

Zepbound (tirzepatide) is a dual GIP and GLP-1 receptor agonist indicated for adults with obesity, or some adults with overweight who also have at least one weight-related medical problem, to lose weight and keep it off. Lilly also noted Zepbound is FDA-approved to treat adults with moderate-to-severe obstructive sleep apnea and obesity, and should be used alongside a reduced-calorie diet and increased physical activity.

Safety summary (high level)

The release includes an indications and safety summary with warnings. Among other risks, Lilly notes Zepbound carries a warning about thyroid tumors, including thyroid cancer, and may cause serious side effects such as severe stomach problems, dehydration leading to kidney problems, gallbladder problems, pancreatitis, serious allergic reactions, and low blood sugar (especially when used with certain diabetes medicines). Patients should talk with a healthcare provider about risks and whether the medication is appropriate for them.

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Source

  • PRNewswire / Eli Lilly and Company press release (Aug. 26, 2026): Zepbound linked to lower healthcare costs in adults over age 55 with obesity according to a real-world study

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Economy

U.S. Consumer Confidence Slips as Americans Grow More Cautious About the Future

U.S. consumer confidence edged lower in August as Americans became more pessimistic about jobs, income and business conditions over the next six months, despite improved views of the current economy.

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NEW YORK — U.S. consumer confidence edged lower in August as Americans expressed greater concern about future business conditions, jobs and household income, even as their assessment of the current economy improved.

U.S. consumer confidence slipped in August 2026 as Americans grew more concerned about jobs, income and future business conditions.

The Conference Board reported that its Consumer Confidence Index fell 0.8 points to 89.4 in August, down from 90.2 in July.

The relatively small decline, however, masks a widening gap between how consumers view conditions today and what they expect in the months ahead.

The Present Situation Index, which measures consumers’ assessment of current business and labor market conditions, climbed 6.8 points to 121.2, reversing three consecutive months of declines.

Meanwhile, the Expectations Index, which measures the short-term outlook for income, business and employment conditions, dropped 5.8 points to 68.2.

“Consumer confidence moderated slightly in August for a second consecutive month,” Dana M. Peterson, chief economist at The Conference Board, said in the organization’s Aug. 25 release.

Jobs Look Better Today — But Consumers Worry About Tomorrow

Americans’ perceptions of the current labor market improved considerably during August. About 27% said jobs were plentiful, up from 24.4% in July, while 19.5% said jobs were hard to get, down from 21.7%.

The outlook for the next six months was considerably weaker.

Only 14.6% expected more jobs to become available, compared with 16.4% in July. At the same time, 26.1% expected fewer jobs.

Consumers were also less optimistic about their incomes. About 17.6% expected their income to increase, down from 19.5% in July, while 13.8% expected their income to decline.

Prices Remain on Consumers’ Minds

Inflation continues to influence how Americans feel about the economy. According to The Conference Board, consumers’ written responses frequently mentioned prices, oil and gasoline, food and groceries, trade, jobs, and war or conflict.

Average and median expectations for inflation over the next 12 months also increased slightly.

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Interest rates remain another concern. More than six in 10 consumers — 61.3% — expected interest rates to rise over the next year, although that was slightly lower than the 62% recorded in July.

Consumers Are Still Planning to Spend

The softer outlook hasn’t eliminated Americans’ willingness to make purchases.

Auto-buying expectations remained strong on a six-month moving-average basis, while homebuying expectations declined slightly in August but remained on a longer-term upward trend after hitting decade lows in early 2024.

Restaurants, bars and takeout; utilities; and streaming, internet and mobile services ranked among consumers’ leading planned service expenses.

Consumers were less enthusiastic about discretionary activities including movies, personal-travel hotels, airfare, amusement parks, museums and historical sites.

Why It Matters

The August numbers paint a mixed picture of the American consumer.

People are seeing some improvement in the economy they are experiencing today, particularly in the labor market. But their expectations for the next six months are becoming noticeably more cautious.

That divide matters because consumer spending represents a major part of U.S. economic activity. If concerns about employment, inflation and household income begin translating into reduced spending, weakening confidence could eventually become more significant for the broader economy.

For now, the August survey suggests Americans haven’t stopped spending — but they’re increasingly keeping an eye on what may be coming next.

The preliminary August Consumer Confidence Survey was conducted online for The Conference Board by Toluna. The survey period was Aug. 3–16, 2026.

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Source: The Conference Board, August 2026 Consumer Confidence Survey®, released Aug. 25, 2026.

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Lifestyle

California and Minnesota Face $1B Medicaid Funding Hold

The Trump administration is withholding more than $1 billion in Medicaid funding from California and Minnesota over disputed medical claims. A social-policy historian examines how concerns about fraud have historically been used to justify funding cuts and undermine public confidence in Medicaid.

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Agents, many wearing jackets or vests emblazoned with 'FBI,' exit a building with what appears to be a trove of documents.Medicaid Funding.
Federal agents execute a search in December 2025 tied to potential Medicaid fraud in Bloomington, Minn. Christopher Juhn/Anadolu via Getty Images

Ben Zdencanovic, University of Cambridge

California and Minnesota Face $1B Medicaid Funding Hold

The Trump administration announced on July 21, 2026, that it’s withholding US$867 million in federal healthcare funding for California and $200 million for Minnesota – a total of more than $1 billion.

Federal officials said the two states had failed to provide sufficient evidence that a number of disputed medical claims were legitimate. These include bills for in-home care and other services covered by the two states’ Medicaid programs for low-income residents.

Medicaid administrators say the funds can be recovered if the states supply the requested documentation. But the action is highly unusual: Typically, Medicaid officials partner with states to conduct an audit when they suspect fraud, a careful process that often takes years.

It’s the second time in 2026 that the Trump administration has withheld or deferred federal Medicaid funds for several states, including California and Minnesota, because of alleged fraud and abuse. The Democratic governors of those states have called the decision a politically motivated attack on their constituents.

I’m a historian of social policy who led the first comprehensive historical overview of Medi-Cal, California’s statewide Medicaid system. I’ve found that U.S. leaders have long used the language of fraud and abuse to blur the line between correcting very real failures within Medicaid and – as I believe the Trump administration is currently doing – discrediting and defunding the program itself.

Who pays when Medicaid is cut? It affects children’s health care, nursing home care, disability services and health insurance.

Slashing the safety net

The Medicaid restrictions are part of the Trump administration’s overall efforts to slash federal funding for the safety net.

The large tax-and-spending bill that Trump signed into law in July 2025 as the cornerstone of his second-term agenda pared eligibility for Medicaid by introducing work requirements for some adults. It is cutting close to $1 trillion in federal spending on the program over the next decade.

Researchers estimate that almost 12 million people, on top of the estimated 28 million without health insurance in 2025, could become uninsured by 2034 due to these changes. By mid-2026, more than 3 million people had already lost their insurance coverage due to Republican changes to the Affordable Care Act.

‘Padlocking’ the ‘cookie jar’

In February 2026, Vice President JD Vance, Health Secretary Robert F. Kennedy Jr. and Dr. Mehmet Oz, the administrator of the Centers for Medicare & Medicaid Services, or CMS, announced a new anti-fraud initiative called Comprehensive Regulations to Uncover Suspicious Healthcare.

Also known by its rather unsubtle acronym, CRUSH, this initiative is taking unprecedented steps to withhold and defer funds in response to suspected fraud. “CMS is done trying to catch fraudsters with their hands in the cookie jar,” Oz said in announcing CRUSH’s formation. “Instead, we’re padlocking the jar and letting them starve.”

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To be sure, Medicaid fraud, waste and abuse – such as providers billing Medicaid for services that are unnecessary or never rendered – are very real problems that cost taxpayers billions of dollars annually. They do divert funds from the low-income and disabled Americans enrolled in the program.

But the Trump administration’s latest moves are part of a much broader history of weaponizing Medicaid fraud and abuse – both real and imagined. I see them as a politicized attempt to prove that Medicaid itself is wasteful, that state governments cannot be trusted to administer federal money, and that public benefits inevitably invite dishonesty.

Robert F. Kennedy Jr. points to a chart pertaining to Medicaid fraud.
Secretary of Health and Human Services Robert F. Kennedy Jr. speaks about alleged Medicaid fraud and charges in Minneapolis in May 2026. Christopher Juhn/Anadolu via Getty Images

Providing little oversight at the start

Medicaid was established, along with Medicare for older adults, in 1965 as part of President Lyndon B. Johnson’s “Great Society” reforms. Despite providing millions of Americans with health insurance coverage for the first time, these programs had few centralized mechanisms for the kind of federal oversight that could prevent and catch fraud and abuse.

And the sheer scale and complexity of the Medicaid system – joint federal-state funding, varying eligibility requirements, millions of enrollees and thousands of providers – created opportunities for questionable billing practices among providers.

The 1970s saw a number of highly publicized Medicaid scandals involving nursing homes, laboratories, pharmacies and so-called “Medicaid mills” – healthcare providers that sought to bill the government for large numbers of Medicaid patients for shoddy and often fraudulent care.

A series of high-profile congressional investigations spurred demand for stronger Medicaid oversight and enforcement. That led to the Medicare-Medicaid Anti-Fraud and Abuse Amendments of 1977, which established the national Medicaid Fraud Control Units program.

The state-run Medicaid Fraud Control Units received generous federal matching funds to investigate and prosecute fraud.

The most serious Medicaid fraud was generally committed by healthcare providers and contractors, not patients. Medicaid Fraud Control Units were principally responsible for investigating providers, while also prosecuting the abuse and neglect of patients whose care was billed to Medicaid.

At the same time, however, Medicaid was becoming entangled in a broader political debate over social spending, whether many Americans were becoming too dependent on government benefits, and the alleged use of benefits by people who should not have received them. In the 1980s and 1990s, widely circulated stories about Medicaid exposed fraud and malfeasance by providers.

But disproportionately, they also highlighted the comparatively few instances of fraud by people enrolled in the program, such as cases where they submitted false receipts for covered medically related travel or sold drugs they obtained through Medicaid for free or at low cost.

Using Medicare fraud to justify spending cuts

The distinction between Medicaid and cash assistance programs, such as the Aid to Families with Dependent Children “welfare” program, frequently disappeared in political rhetoric. False or exaggerated stories that portrayed African American single mothers living extravagantly while fraudulently claiming welfare benefits became potent symbols of supposed government failure.

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While campaigning as a presidential candidate, Ronald Reagan seized on this trope of the “welfare queen” in his attacks on social spending.

A large crowd of people wait on lines in a black and white photo from the 1970s.
People line up at the Baltimore City Welfare Office in 1975, years before concerns about social spending led to big cuts to safety net programs. O’Halloran/Library of Congress via Getty Images

By the mid-1990s, opposition to welfare programs had become increasingly bipartisan. Politicians in both parties often used tales of Medicaid fraud on the part of providers and recipients to justify tighter eligibility rules and spending cuts.

Federal oversight expanded further with the Deficit Reduction Act of 2005, which created the Medicaid Integrity Program and strengthened federal oversight of state programs. The Affordable Care Act, the landmark healthcare legislation Congress passed in 2010, added new measures to screen providers and verify billing.

Concerns about Medicaid’s “integrity” became highly politicized in the debates surrounding the ACA. Critics of Medicaid expansion argued that increasing the number of people who could get health insurance through the program would increase fraud and improper enrollment. Supporters of expanding Medicaid to help more Americans gain health insurance maintained that anti-fraud rhetoric often disguised ideological opposition to the program’s expansion.

Blurring distinctions then and now

For the six decades that this program has helped millions of low-income Americans get healthcare, politicians have blurred the distinction between protecting Medicaid from abuse and using abuse to discredit Medicaid itself.

In my view, the Trump administration’s campaigns against California and Minnesota continue that pattern. It is using real weaknesses within Medicaid to advance much broader political arguments: that Democratic states cannot be trusted, that public benefits naturally invite abuse, and that withholding funds is itself a form of reform.

The result will no doubt be that fewer low-income Americans will be able to get the healthcare they need.

Ben Zdencanovic, Assistant Professor of U.S. History, University of Cambridge

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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