Activism

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.”

Rather than belabor you today with the latest Trump outrages, I want to share with you conclusions I’ve drawn from my conversation yesterday with Zohran Mamdani (you can find it here and at the bottom of this piece) about why he has a very good chance of being elected mayor of New York City on Tuesday.

He has five qualities that I believe are likely to succeed in almost any political race across America today. If a 34-year-old state assemblyman representing Astoria, Queens, who was born in Uganda and calls himself a democratic socialist, can get this far and likely win, others can as well — but they have to understand and be capable of utilizing his secret sauce.

Here are the five ingredients:

1. Authenticity. Mamdani is the real thing. He’s not trying to be someone other than who he is, and the person he is comes through clear as a bell. I’ve been around politicians for most of my life (even ran once for governor of Massachusetts) and have seen some who are slick, some who are clever, some who are witty, some who are stiff, but rarely have I come across someone with as much authenticity as Mamdani. Authenticity is the single most important quality voters are looking for now: someone who is genuine. Who’s trustworthy because they project credibility and solidity. Whose passion feels grounded in reality.
2. Concern for average working people. Mamdani isn’t a policy wonk who spouts 10-point plans that cause people’s eyes to glaze over. Nor is he indifferent to policy. Listen to his answers to my questions and you’ll hear a lot about the needs of average working people. That’s his entire focus. Many politicians say they’re on the side of average working people, but Mamdani has specific ideas for making New York City more affordable. I’m not sure they’ll all work, but I’m sure voters are responding to him in part because his focus is indisputable and his ideas are clear and understandable.
3. Willingness to take on the powerful and the wealthy. He doesn’t hesitate to say he’ll raise taxes on the wealthy to pay for what average working people need. You might think this would be standard fare for Democrats, but it’s not. These days, many are scared to propose anything like this for fear they’ll lose campaign funding from big corporations and the rich. But Mamdani’s campaign isn’t being financed by big corporations or the rich. Because of New York City’s nearly four-decade-old clean elections system that matches small-dollar donations with public money, Mamdani has had nearly $13 million of government funds to run a campaign against tens of millions of dollars that corporate and Wall Street Democrats — and plenty of Republicans — have spent to boost Democratic former governor Andrew Cuomo. We need such public financing across the nation.
4. Inspiration. Many people are inspired by Mamdani. Over 90,000 New Yorkers are now going door-to-door canvassing for him (including my 17-year-old granddaughter). Why is he so inspiring? Again, watch our conversation. It’s not only his authenticity but also his energy, his good-heartedness, and his optimism. At a time when so many of us are drenched in the daily darkness of Trump, Mamdani’s positivity feels like sunshine. It lifts one up. It makes politics almost joyful. He gives it a purpose and meaning that causes people to want to be involved.
5. Cheerfulness. Which brings me to the fifth quality that has made this improbable candidate into a front-runner: his remarkable cheerfulness. Watch his face during our discussion. He smiled or laughed much of the time. This wasn’t empty-headed euphoria or “morning in America” campaign rubbish. It’s directly connected to a thoughtfulness that’s rare in a politician, especially one nearing the end of a campaign — who’s had to answer the same questions hundreds if not thousands of times. He exudes a buoyancy and hope that’s infectious. It’s the opposite of the scowling Trump. It is what Americans want and need, especially now.

There’s obviously much more to it, but I think these five qualities — authenticity, a focus on the needs of average working families, a willingness to take on the rich and powerful in order to pay for what average working families need, the capacity to inspire, and a cheerfulness and buoyancy — will win elections, not only in New York City but across America.

Mamdani hasn’t won yet, and New York’s Democratic establishment is doing whatever it can to stop him (Michael Bloomberg, New York City’s billionaire former mayor, just put $1.5 million into a super PAC supporting Cuomo’s bid and urged New Yorkers to vote for Cuomo).

If Mamdani wins, his success should be a lesson for all progressives and all Democrats across America.

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• Robert Reich is a professor of public policy at Berkeley and former secretary of labor. His writings can be found at https://robertreich.substack.com/.
• Robert Reich's new memoir, Coming Up Short, can be found wherever you buy books. You can also support local bookstores nationally by ordering the book at bookshop.org.