Federal moves to block health care for trans youth may complicate access in Vermont – VTDigger

Report on Federal Policy Impacts on Gender-Affirming Healthcare for Minors in Vermont

Executive Summary

This report analyzes the conflict between recent federal administrative actions aimed at restricting gender-affirming care for minors and the State of Vermont’s legal and institutional framework designed to protect such care. Federal policies, particularly those enacted through the Centers for Medicare and Medicaid Services (CMS), pose a significant threat to the health, equality, and well-being of transgender youth. These actions directly contravene the principles of several Sustainable Development Goals (SDGs), including SDG 3 (Good Health and Well-being), SDG 5 (Gender Equality), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions). In response, Vermont has fortified its commitment to these goals through robust state laws and the coordinated efforts of healthcare providers, legal advocates, and community organizations to ensure care remains accessible.

Federal Policy Impact on Sustainable Development Goals

Undermining SDG 3: Good Health and Well-being

The federal administration’s policy to block gender-affirming care for minors directly undermines SDG 3, which aims to ensure healthy lives and promote well-being for all. This is being executed through several mechanisms:

• A presidential executive order declaring the U.S. government will not fund or support youth transitioning.
• Actions by the Centers for Medicare and Medicaid Services (CMS) to reclassify essential health benefits, giving insurers a basis to deny coverage.
• Directives to state Medicaid agencies suggesting that gender-affirming care for minors should not be covered.

Restricting access to medically necessary treatments such as puberty blockers and hormone replacement therapy jeopardizes the physical and mental health of transgender youth, running counter to the core mission of ensuring universal health coverage and well-being.

Exacerbating Inequalities in Contravention of SDG 10 and SDG 5

Federal policies create significant barriers to achieving SDG 10 (Reduced Inequalities) and SDG 5 (Gender Equality) by targeting a specific marginalized population.

• Increased Inequality (SDG 10): The policies systematically discriminate against transgender youth, deepening social and health-related inequalities. By creating uncertainty and denying insurance coverage, the administration fosters a two-tiered system where access to care is dependent on a family’s ability to pay, exacerbating economic disparities.
• Hindrance to Gender Equality (SDG 5): The denial of care based on gender identity is a form of discrimination that impedes progress toward gender equality. It invalidates the identity of transgender individuals and obstructs their right to healthcare that aligns with their gender.

Vermont’s Legislative and Institutional Response

Upholding SDG 16: Peace, Justice, and Strong Institutions

Vermont has established strong institutional and legal frameworks to counteract federal actions and uphold its commitment to SDG 16 by ensuring access to justice and building inclusive institutions. Key state-level measures include:

1. Shield Laws: Vermont has enacted strong shield laws that protect healthcare providers and recipients of gender-affirming care from out-of-state legal threats, civil charges, or criminal prosecution.
2. Anti-Discrimination Law: State law prohibits insurance companies from discriminating against coverage for gender-affirming care, mandating that it be treated as an essential part of healthcare.
3. Legal Action: The Vermont Attorney General has joined a multi-state lawsuit challenging the federal rule that allows insurers to drop coverage for gender-affirming care under the Affordable Care Act (ACA).

Key Healthcare Providers and Access Points

Access to care in Vermont, central to achieving SDG 3, is primarily facilitated through established health systems.

• University of Vermont (UVM) Medical Center’s Transgender Youth Program provides hormonal interventions.
• Planned Parenthood of Northern New England offers a range of gender-affirming services.
• Other therapists and providers contribute to the network of care.

Analysis of Current and Potential Challenges

Insurance Coverage and Regulatory Hurdles

Despite state protections, federal rules create significant challenges that threaten the principles of universal health access central to SDG 3.

• The CMS rule change allowing insurers to remove gender-affirming care from the list of “essential health benefits” on ACA marketplace plans creates a direct conflict with Vermont’s anti-discrimination laws.
• Employer-sponsored insurance plans, which are federally regulated, are not subject to state mandates, leaving a gap in coverage.
• A case study involving a Washington County family demonstrated this vulnerability when their primary insurer, Blue Cross Blue Shield of Vermont, denied coverage for hormone injections, forcing their daughter to switch treatments and illustrating a direct failure to uphold SDG 10.

The Threat to Medicaid and Medicare Participation

A proposed CMS “conditions of participation” rule represents the most severe threat to SDG 3 for the entire population of Vermont. The rule would disqualify any healthcare provider from participating in Medicare and Medicaid if they provide gender-affirming care to minors. The implications are profound:

• UVM Medical Center, where nearly two-thirds of patients receive Medicare or Medicaid, would face a choice between ceasing gender-affirming care for minors or losing the funding required to serve the majority of its patient population.
• This would effectively dismantle the state’s largest health system, jeopardizing healthcare access for hundreds of thousands of residents and creating a public health crisis that would reverse decades of progress on SDG 3.

Strategies for Ensuring Continued Access to Care

Mitigating Financial Barriers and Upholding SDG 3

In anticipation of federal funding cuts, Vermont stakeholders are exploring alternative models to ensure the continuity of care, in line with the principles of SDG 3 and SDG 10.

1. State Funding: If federal Medicaid funds are withheld for gender-affirming care, Vermont would be obligated by state law to cover the costs using state funds.
2. New Provider Models: The creation of new public-private partnerships or dedicated organizations that do not rely on Medicare or Medicaid funding is a potential long-term solution.
3. Philanthropic Support: Private funding and philanthropy, such as the donor-supported fund operated by Planned Parenthood of New England, will become critical to covering gaps in care for those who lose insurance coverage.

The Role of Advocacy and Community Resilience

Community organizations are central to developing a resilient response that upholds the rights and well-being of transgender youth.

• Advocacy groups like the ACLU of Vermont and Outright Vermont are actively monitoring federal actions, engaging with state government and healthcare leaders, and preparing contingency plans.
• These efforts reflect a grassroots approach to achieving SDG 16 by building community-led systems of safety and care.
• However, the recent closure of the Pride Center of Vermont due to a loss of federal and state funding highlights the fragility of these community support systems and the need for sustainable funding models.

Conclusion

The federal administration’s efforts to restrict gender-affirming care for minors represent a direct assault on the principles of the Sustainable Development Goals, particularly those related to health, equality, and justice. While Vermont’s strong legal protections provide a critical defense, the state’s healthcare system remains vulnerable to federal regulatory and financial pressures. Continued vigilance, legal opposition to discriminatory policies, and the development of resilient, community-supported care models are essential to ensure Vermont does not move backward and continues to uphold its commitment to health and dignity for all its residents.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article discusses issues related to healthcare access, discrimination, and legal frameworks, connecting directly to several Sustainable Development Goals (SDGs).

• SDG 3: Good Health and Well-being

  The core theme of the article is the provision and protection of “gender-affirming care” for transgender youth. It details specific healthcare services like hormone replacement therapy and puberty blockers and discusses the profound impact that access to this care has on the well-being of transgender individuals. The potential loss of this care due to federal policy changes is presented as a direct threat to their health.

• SDG 5: Gender Equality

  The article addresses gender equality by focusing on the rights and needs of transgender individuals, a group that faces significant discrimination based on gender identity. The conflict described is about ensuring that healthcare is not denied based on one’s gender identity. The article explicitly mentions Vermont’s state law, which “requires that people not be denied care because of their gender identity,” directly aligning with the goal of ending discrimination and achieving equality.

• SDG 10: Reduced Inequalities

  This goal is central to the article, which highlights the inequality in healthcare access faced by a specific marginalized group—transgender youth. The federal administration’s actions are shown to create and exacerbate inequalities by targeting this group and attempting to remove insurance coverage for their essential care. The article contrasts this with Vermont’s efforts to protect this group and reduce inequality through state-level legislation.

• SDG 16: Peace, Justice and Strong Institutions

  The article is heavily focused on the role of institutions, laws, and justice systems. It describes a conflict between federal institutions (the Trump administration, Centers for Medicare and Medicaid Services) and state institutions (Vermont’s legislature, Attorney General’s Office). The use of legal mechanisms, such as the “lawsuit challenging the rule” filed by 20 states, demonstrates the pursuit of justice through institutional channels to protect rights and uphold non-discriminatory laws.

2. What specific targets under those SDGs can be identified based on the article’s content?

Several specific SDG targets are relevant to the challenges and responses described in the article.

1. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   This target is directly addressed through the discussion of insurance coverage for gender-affirming care. The article explains how federal rule changes allow insurers on the Affordable Care Act (ACA) marketplace to drop coverage for this care by removing it from the list of “essential health benefits.” The personal story of Michelle, whose daughter was denied insurance coverage for hormone injections and “cannot afford the cost of the hormones without insurance,” is a clear example of a failure to provide financial risk protection and access to affordable essential healthcare.

2. Target 5.1: End all forms of discrimination against all women and girls everywhere.

   While this target names “women and girls,” its principle extends to ending all gender-based discrimination. The article’s focus on preventing discrimination based on gender identity aligns with this target. Vermont’s “anti-discrimination law,” which “prohibits insurers from discriminating against covering this care,” is a direct policy measure aimed at achieving this target for transgender individuals.

3. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.

   The article presents a clear case of this target in action. The federal executive order and the proposed CMS rules are identified as “discriminatory… policies and practices.” In response, Vermont’s “strong shield laws” and the multi-state lawsuit are examples of “promoting appropriate legislation, policies and action” to eliminate discrimination and ensure more equal health outcomes for transgender youth.

4. Target 16.b: Promote and enforce non-discriminatory laws and policies for sustainable development.

   The central conflict described in the article is a struggle over the promotion and enforcement of non-discriminatory laws. The Trump administration’s policies are designed to enable discrimination in healthcare. Conversely, the article highlights how Vermont is enforcing its non-discriminatory laws, which “classify gender-affirming care as an essential part of health care that in-state health insurance plans must cover.” The legal and advocacy efforts described are all aimed at upholding and enforcing these non-discriminatory principles.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article contains several explicit and implicit indicators that could be used to measure progress.

• Proportion of population with health insurance coverage for essential gender-affirming care.

  This is a key implied indicator. The article discusses how insurance companies like Blue Cross Blue Shield of Vermont are denying coverage, and how federal rules for the ACA marketplace and Medicaid could impact coverage. The story of Michelle’s daughter being denied coverage by her primary insurer is a specific data point for this indicator. Tracking the number of plans that cover or deny this care would measure progress toward Target 3.8.

• Existence of legally enforceable non-discrimination laws and policies.

  This is an explicit indicator. The article directly refers to Vermont’s “strong shield laws” and “anti-discrimination law” as existing legal frameworks. The presence or absence of such laws at the state and federal level is a clear measure of progress toward Targets 5.1, 10.3, and 16.b.

• Number of legal challenges filed against discriminatory policies.

  The article provides a concrete example of this indicator by stating, “Vermont Attorney General Charity Clark joined 20 states in a lawsuit challenging the rule.” This is a quantifiable action taken to uphold justice and fight discrimination, relevant to measuring efforts under Target 16.3.

• Financial barriers to accessing essential healthcare services.

  This is an implied indicator of financial risk protection under Target 3.8. The statement that a family “cannot afford the cost of the hormones without insurance” demonstrates a direct financial barrier. The creation of a “donor-supported fund” by Planned Parenthood to help people afford care is another sign that financial barriers exist and are being addressed through alternative means.

4. Table of SDGs, Targets, and Indicators

Source: vtdigger.org