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A pair of extreme new Trump administration rules aimed at functionally banning gender-affirming healthcare for transgender youth could force even more hospitals to close down.

NPR reported Thursday that the Department of Health and Human Services (HHS) drafted a proposed rule that would prohibit federal Medicaid reimbursement for medical care provided to transgender patients younger than 18 and prohibit the same from the Children’s Health Insurance Program (CHIP) for patients under 19.

Another proposed rule goes even further, blocking all Medicaid and Medicare funding to hospitals that provide gender-affirming care to youth.

As Erin Reed, an independent journalist who reports on LGBTQ+ rights, explained, this “would effectively eliminate access to such care nationwide, except at the few private clinics able to forgo Medicaid entirely, a rarity in transgender youth medicine.”

The policies are of a piece with the Trump administration and the broader Republican Party’s efforts to eliminate transgender healthcare for youth across the country.

Bans on gender-affirming care for those under 18 have already been passed in 27 states, despite evidence that early access to treatments like puberty blockers and hormones can save lives.

As Reed pointed out, a Cornell University review of more than 51 studies shows that access to such care dramatically reduces the risk of suicide and the rates of anxiety and depression among transgender adolescents.

The new HHS rules are being prepared for public release in November and would not be finalized for several more months.

But if passed, the ramifications could extend far beyond transgender people, impacting the entire healthcare system, for which federal funding from Medicare and Medicaid is a load-bearing piece. According to a report last year from the American Hospital Association, 96% of hospitals in the US have more than half their inpatient days paid for by Medicare and Medicaid.

It is already becoming apparent what happens when even some of that funding is taken away. As a result of the massive GOP budget law passed in July, an estimated $1 trillion is expected to be cut from Medicaid over the next decade. According to an analysis released Thursday by Protect Our Care, which maintains a Hospital Crisis Watch database, more than 500 healthcare providers across the country are already at risk of shutting down due to the budget cuts.

Tyler Hack, the executive director of the Christopher Street Project, a transgender rights organization, said that the newly proposed HHS rule would be “forcing hospitals to choose between providing lifesaving care for trans people or maintaining the ability to serve patients through Medicare and Medicaid.”

“Today’s news marks a dangerous overreach by the executive branch, pitting trans people, low-income families, disabled people, and seniors against each other and making hospitals choose which vulnerable populations to serve,” Hack said. “If these rules become law, it will kill people.”