In a scathing ruling describing Health and Human Services Secretary Robert F. Kennedy Jr. as an “unserious” and “unsafe” leader, a federal judge in Oregon issued an order that will protect doctors and hospitals, and the transgender kids they treat, from the federal crackdown on gender-affirming care.
On Saturday, US District Judge Mustafa T. Kasubhai ruled that Kennedy was acting illegally when he attempted last December to unilaterially cut off federal funding for healthcare providers treating kids with gender dysphoria. “Unserious leaders are unsafe,” Kasubhai wrote in his ruling, adding that Kennedy’s actions “caused chaos and terror for all those people and institutions of our great nation.”
The case began last December, when Kennedy issued a declaration falsely claiming that gender-affirming medical treatments for trans youth “fail to meet professional recognized standards of health care.” In reality, such treatments—including puberty blockers for kids entering adolescence and cross-sex hormones for older teens—are considered necessary for some patients under mainstream medical guidelines, and they’re supported by virtually the entire medical establishment. (And it’s worth noting that the treatments are actually quite rare, despite the amount of political attention paid to them.) Kennedy dubbed the treatments “sex-rejecting procedures” and claimed the right to pull all federal funding from any hospital, clinic, or doctor, found to be providing them. Soon, his department had referred over a dozen children’s hospitals for potential defunding, and hospitals hoping to avoid the federal crackdown began preemptively cutting off treatments for kids with gender dysphoria.
“I will go forward and issue a declaration and see if we can get away with it’ is not a principle of governance that adheres to the overarching commitment to a democratic republic.”
A coalition of 21 mostly Democratic-led states and Washington, DC, immedialy sued, arguing Kennedy had skipped the legally required procedures for such a drastic policy change. Last month, Kasubhai agreed that Kennedy had overstepped his authority and issued an order temporarily blocking the declaration. “The notion that ‘I will go forward and issue a declaration and see if we can get away with it’ is not a principle of governance that adheres to the overarching commitment to a democratic republic that requires the rule of law to be regarded and respected and honored as sacred,” the judge said at the time.
But Kasubhai’s first order wasn’t stopping the Trump administration. While the court case played out, HHS began going through the formal rule-making process, proposing a sweeping regulation that would strip federal Medicaid and Medicare funding from any hospital that provides trans youth health care, which I wrote about in depth last week. Such a regulation, if implemented, would force hospitals nationwide to cut off trans kids’ care or else face financial devastation. A former Trump policy aide has referred to the proposed rule as a “nuclear weapon.” A second proposed policy would ban federal insurance programs for kids in low-income families from covering the treatments.
Now, Kasubhai has thrown a new wrench in the administration’s plans. His ruling on Saturday makes permanent his prior order blocking Kennedy’s declaration. But the judge also went further, prohibiting HHS from enacting any similar policy “which supercedes or purports to supercede the professionally recognized standards of care” in the states that sued. “Despite repeatedly emphasizing their commitment and obligation to protect children, Defendants have sweepingly wielded the Kennedy Declaration to threaten children’s hospitals that provide life-saving care to children,” Kasubhai wrote.
Such a broad order was necessary, Kasubhai wrote, because the Trump administration has a track record of “evading or flouting” prior court orders.
The judge also took particular exception to an argument made by HHS that Kennedy’s declaration couldn’t be blocked because it was simply an example of the secretary exercising his right to free speech. The department’s arguments are based on “the bald-faced lie that the Kennedy Declaration amounts to nothing more than one man’s musings on gender-affirming care,” Kasubhai thundered. “Defendants cannot bully or gaslight this Court into ignoring the many procedural and legal flaws of the Kennedy Declaration by invoking one of the most sacred principles of our constitutional democracy—the freedom of speech—when that principle comes nowhere close to being implicated.”
Kasubhai’s order is sweeping enough that it likely blocks not just Kennedy’s declaration but also the soon-to-be-finalized Medicaid and Medicare regulations, according to Jennifer Levi, senior director of transgender and queer rights at GLAD Law. “This administration has tried to come back multiple times and do the same thing and then try to characterize it as something new,” she explains. “The court wanted to prevent that from happening.”
The Trump administration could appeal Kasubhai’s ruling. But now, if it tries to finalize its regulations in their current form, the states defending trans youth health care can go back to Kasubhai and argue that HHS is violating the injunction, Levi says. As a result, it seems likely that the regulations will be promptly blocked—if the Trump administration does decide to finalize them.
And that matters because hospitals across the country are watching this legislation closely to figure out if it’s financially and legally safe enough for them to offer trans youth health care. Could those hospitals who ended treatments restart them on the strength of Kasubhai’s new ruling? “I think they certainly could, and I think they should,” Levi tells me.
