The Insidious Reason Blue State Hospitals are Abandoning Trans Kids

And what it means for the future of trans health care.

A local group of concerned citizens showed up at the Chestnut St. entrance to Baystate Medical Center in Springfield, MA Saturday to protest and draw attention to a recent decision by the hospital system to end its provision of gender affirming care to trans youth.

Baystate sent a letter out in mid-February, notifying families with trans kids who are patients there that the hospital system would no longer be providing hormones or puberty blockers for trans youth under the age of 18. The patients were referred to a local trans-specific clinic to continue the international best standard for treating gender dysphoria.

The protest art installation on site Saturday featured a bright blue bus marked with the Baystate name and logo on a white canvas metaphorically running over several sets of stuffed clothes meant to represent trans kids along with several signs which together said "Baystate throws trans kids under the bus".

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The protest, which was attended by about a dozen concerned citizens, was not meant to be a rally, but rather something to draw the public's attention to what is happening to trans kids even in a bright blue state like Massachusetts.

"Exposing injustice is the first step, people have to see it to reconcile what they're going to do about it," said Ali Wicks-Lim, a spokesperson for the group who spoke with Burns Notice after the action.

The action lasted for about an hour until, while the group was already packing up to leave, a Baystate security guard walked down the lawn of the hospital to let the group know it is private property and that they had to leave.

Baystate's decision to cut off that critical care came after the Trump administration proposed a Health and Human Services rule that would suspend Medicare and Medicaid payments to any health care provider that also provides gender affirming care for youth.

The proposed rule is one of the final steps the Trump administration needs to make it practically illegal to exist as a trans kid in the United States of America. Dozens of red states have already banned the care, which is the internationally recognized best standard for treating youth with gender dysphoria, and the Trump administration move is designed to use the brute force of the federal government to get blue state hospital systems to comply with the administration's political demands.

According to a January report, over 40 blue state hospitals have already announced that they would comply with the proposed rule, which hasn't yet been implemented and carries no force of law until it is finalized. Notable blue state providers to have already complied in advance to the Trump proposal include Fenway Health in nearby Boston, NYU Langone in NYC, Lurie Children's Hospital in Chicago, and Colorado Children's Hospital in Denver.

Each hospital's decision has been met with local with protest from the public and some threats from blue state AGs warning that the providers are required by law not to discriminate against trans people in health care.

A federal court last week issued a ruling against the proposed rule, blocking it from being finalized while the case works its way through the legal system.

It was Baystate's early compliance that rankled the citizen protestors who showed up Saturday. "[Baystate] really went out of their way to make trans kids expendable earlier than they had to," said Wicks-Lim. "That hit hard and I do think healthcare systems are going to have to be consistently trying to reconcile what it means to deliver healthcare under a fascist government that leverages money for care. Our position is just that you cannot take vulnerable children and make them the cost for that challenge."

The financial calculation for a provider like Baystate is stark. According to the Daily Hampshire Gazette, about 70% of Baystate's patients depend on Medicare and Medicaid to pay for their health treatments, meaning the system cannot afford to lose payments from those federal agencies.

The fact that this has become such a hot button political issue for Republicans means that establishing a permanent and consistent federal policy on it is unlikely in the next few decades. Conservatives control the Supreme Court, which would be the final legal arbiter for the Trump proposed rule.

Even if a Democrat manages to win back the White House in 2028 and reverses all of the anti-trans rules, Republicans can just reimplement them again whenever they win back the executive branch. That puts trans care, and more specifically, trans care for youth, in a state of permanent limbo.

It's likely that executives and decisionmakers at hospitals like Baystate look at this reality and decide it's better to just wash their hands of it now rather than stressing over what might happen in the future.

But this puts their patients at real risk, especially in places other than Western Massachusetts, which might be the most LGBTQ friendly local region in the country. Baystate patients are being transferred to a local clinic that does not depend at all on federal funding, which means it has nothing to lose from the proposed rule.

But transferring all of the patients previously treated by hospitals into local clinics will strain those clinics' resources and extend wait times for life-saving care that children urgently need.

This is also exactly what happened with abortion care in the early seventies when it was first legalized. Conservatives rallied and cut off federal funds to abortion providers, pushing the care out of hospitals and into smaller clinics that were easier to bully with political actions like passing TRAP laws that made providing basic care so expensive for the provider that they were forced to close down.

Folks like Wicks-Lim fear the same fate for trans kids. "We want [Baystate] to stand up against any policy that tells them that they can't give kids the medical care that they need or adults for that matter," they told Burns Notice. "We think it's a very slippery slope. Once we allow the federal government to make decisions about health care, we are in a very vulnerable position."

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