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Tiffany Hansen: It's The Brian Lehrer Show on WNYC. Welcome back, everybody. I'm Tiffany Hansen in for Brian today. Now, we're going to take a look at a major conflict erupting between local hospitals and transgender patients here in New York City. Last week, President Trump signed an executive order titled, "Protecting Children from Chemical and Surgical Mutilation," which threatens to halt federal funding for healthcare facilities that provide gender-affirming care for transgender children.

This order is part of a larger subsect of executive actions recently and radically diminishing the rights of transgender people across the country. In response, NYU Langone canceled the appointments for two patients set to receive gender-affirming care from their providers and NewYork-Presbyterian removed language from their website surrounding care for transgender youth. These actions prompted protests from the local LGBTQ community, including Cynthia Nixon, the actress-turned-politician who ran for governor back in 2018. Her son is transgender, received care at NYU's hospitals.

Hospitals and patients are now caught in a state of confusion as New York's attorney general, Letitia James, warned healthcare providers in a letter on Monday that, "Electing to refuse services to a class of individuals based on their protected status such as withholding the availability of services from transgender individuals based on their gender identity or their diagnosis of gender dysphoria while offering such services to cisgender individuals is discrimination under New York law." Joining us now to talk about her reporting on the unfolding situation is Caroline Lewis. She's a healthcare reporter here at WNYC and Gothamist. Good morning, Caroline.

Caroline Lewis: Good morning.

Tiffany Hansen: All right, so first of all, just start off by explaining for us what the policy in the US is surrounding gender-affirming care for minors after the executive order.

Caroline Lewis: Well, I think things are evolving quickly. Trump issued, like you said, an executive order. It said that institutions that provide gender-affirming care to patients under 19 will no longer be able to get federal research or education grants. You can just imagine that. That would make a major hospital system like NYU Langone very nervous.

It also directed the Department of Health and Human Services to review the rules around Medicaid funding for gender-affirming care. Last week, a judge in Rhode Island issued a temporary restraining order blocking the federal government from freezing funds just based on Trump's executive orders. Then this week, the ACLU filed a lawsuit specifically challenging Trump's order on gender-affirming care. I think there's a legal limbo right now for healthcare providers.

Tiffany Hansen: Just for context, prior to this, what was it like in New York?

Caroline Lewis: New York is a destination for transgender people and transgender health care specifically, I would say. We have major institutions like NYU, Mount Sinai, NewYork-Presbyterian offering gender-affirming care for both adults and kids. We have specialized clinics like Callen-Lorde for the LGBTQ population. I would say, specifically, gender-affirming care really flourished in New York after 2015 when it became approved for Medicaid coverage if you have medically necessary care related to gender dysphoria. Then there was way more funding for it and all these specialized programs.

Tiffany Hansen: There were other states in which that was the case as well. California, for example, right?

Caroline Lewis: Yes, I think around 25 states have Medicaid coverage for gender-affirming care. Don't quote me on that number, but I think--

Tiffany Hansen: No, got it. No, no, no. Just to note that New York is not alone in this.

Caroline Lewis: No, no, it's not alone. Absolutely.

Tiffany Hansen: All right, let's talk about these reports from patients that you have been reporting on. New York City's private hospitals, apparently, have canceled appointments?

Caroline Lewis: I think, yes, we have to be really clear about what we know and what we don't know at this point. What really galvanized people was reports that NYU Langone had canceled appointments for two 12-year-old patients, who were scheduled to receive puberty blockers. The news outlet Hell Gate reported that their parents said they were told by the hospital that, specifically, they were pausing appointments for new patients seeking gender-affirming care who are under 19.

Tiffany Hansen: This is at what hospital again?

Caroline Lewis: NYU Langone.

Tiffany Hansen: Okay.

Caroline Lewis: I have since spoken to a trans, 16-year-old, who has gender-affirming care at NYU Langone, the parent of another teen who has gender-affirming care at NYU Langone. They said they confirmed with their providers that they will still be able to get their care, that it only applies to new patients. I think what's really tough is that the hospital itself has refused to really put out any statement clarifying its policy or what it's doing. That has really just contributed to this uncertainty and confusion.

Tiffany Hansen: Right, so we're talking about one hospital. Did you talk to other hospitals in the region?

Caroline Lewis: NYC Health + Hospitals, which is the public hospital system for New York City, has confirmed that it's continuing gender-affirming care.

Tiffany Hansen: For minors or just gender-affirming care, period?

Caroline Lewis: Well, they did not specifically say for minors, but I believe that is what they're doing. I think it's just really hard because, like I said, health systems right now are very nervous about what they say publicly. For instance, I've reached out to clinics that specifically support LGBTQ patients. They don't want to go on the record talking about their services. It doesn't mean that they're not available.

It just means they aren't saying it. You mentioned NewYork-Presbyterian. I know the news outlet, The City, reached out to them about what they're doing. They basically said, "Okay, even though we changed some of the language on our website, we're still providing gender-affirming care to adolescents." I think that this mealy-mouthed moment just creates a lot of confusion for people.

Tiffany Hansen: Well, I wonder, we're talking about these two instances where we know that appointments were canceled ostensibly because these folks were to be new patients. In reality, there could be other people with other canceled appointments that we just don't know about.

Caroline Lewis: Exactly. I think that's what's so hard is we don't know how widespread this is. It's interesting because I went to the protest that was held near NYU Langone. One of the speakers said was, "We don't want to give an inch." We may only know about these two canceled appointments, but I think people are being very vigilant right now about not succumbing at all to Trump policies because they are worried that things will escalate and that it'll be a slippery slope.

Tiffany Hansen: I want to invite listeners into this conversation, Caroline. Are you a patient of transgender child who's looking to begin gender-affirming care at one of New York City's private hospitals? Did your appointment get canceled? Are you a healthcare provider? You can call us. You can text us. 212-433-9692, 212-433-WNYC. Caroline, let's bring Leah in Manhattan into the conversation. Good morning, Leah. Leah, are you there? All right. Well, Caroline, Leah had, it looks like, a question around what exactly we mean when we say "gender-affirming care" because it's not specifically care only for transgender people, question mark, I think, was what she was asking.

Caroline Lewis: Yes, that's a great question. Specifically, it typically refers to things like hormone blockers for kids who are trying to delay puberty or actual hormones like estrogen and testosterone. It can also include surgery like removing breast tissue or things like that. The surgery specifically is very rare for patients under 18. That's not common. Some of these things can be prescribed to other people for other reasons besides gender dysphoria, which I think is part of why Letitia James, the state attorney general, said, "If you are providing certain care, certain services to patients in general, you can't deny it just to trans patients because of something that the President said."

Tiffany Hansen: Right. Let's talk about this language that has been removed from websites. First of all, I'm assuming, Caroline, that you've gone on, you've logged on to some of these websites. Is there some little notice that you have seen or is it just that you've tried to find certain pages and that they're gone?

Caroline Lewis: I will give a shout-out to The City for this one. They are the ones who detected a change on the NewYork-Presbyterian website for their Compass program, which is a program providing gender-affirming care for adolescents. They noticed that, first, it was temporarily taken down. Then when it was put back up, it was missing certain language like the term "transgender" or "gender-diverse." Then they reached out to the spokesperson there and they said they were just navigating the complexities of this moment, but they weren't changing their services.

Tiffany Hansen: Right, because there is a list of approved, I'm using in quotes, words by the Trump administration and words that are not allowed any longer under this executive order. Some of those words that you just mentioned are on that list. I guess what I'm wondering is, is it a case where these hospitals, in order to comply with that language issue, we're not going to say this word or that word, are still able to provide the care and that maybe there's just a disconnect between what's available online and what's available in person?

Caroline Lewis: No, I really do think it's about the care specifically. There is a separate order that Trump issued saying, "We only recognize two sexes and we will not use language around different genders." That's a whole separate order. I think a lot of people are worried about how that will affect research around, for instance, gender-affirming care. How do you do research around it when you can't talk about it? Then in this order on gender-affirming care specifically, which he refers to as chemical mutilation, it really does say that they are threatening to pull federal funding from organizations that offer those services.

Tiffany Hansen: Federal funding to private hospitals in general.

Caroline Lewis: I think any healthcare provider is at risk, yes.

Tiffany Hansen: Let's go back and talk about that statement by Letitia James citing New York State's anti-discrimination law. I read a similar statement from the attorney general in California basically saying, "If you deny this care, you are in violation of the state's anti-discrimination law." Just, again, reiterate for us how she is able to bring that forward to perhaps buttress these hospitals who are wanting to continue care. Is that the case or is it carrot or stick? Is she saying, "Look, here's the opportunity for you to say, 'You know what? I can't be in violation of this organization, cannot be in violation of New York State's anti-discrimination laws,'" or is she saying, "If you do this," or is it both?

Caroline Lewis: I think it sticks from all sides. It's like the federal government threatening to revoke funding and then Tish James saying, "Well, if you follow the executive order, then you could be in violation of the state human rights law," which protects people based on gender expression and things like that. They're just like, "Which one am I going to follow?"

Tiffany Hansen: I like that, "sticks on all sides."

Caroline Lewis: Yes. [chuckles]

Tiffany Hansen: All right, let's talk about this difference between state and federal law. It is a tricky situation. Do you anticipate seeing more around the conflict between what's the state is able to do to act against these federal recommendations, these federal mandates, these federal executive orders, all of this stuff? Do you expect to see more of this?

Caroline Lewis: Yes, absolutely. During the first Trump administration, for instance, they pulled Title IX funding from organizations that offered referrals to abortion providers. Planned Parenthood lost federal Title IX funding and that was restored by the state government. They stepped up and said, "We'll create this funding pool for healthcare providers that are affected by that loss of funding." I think there's going to be advocacy from healthcare providers to say, "Hey, if we lose federal funding, we want the state to step up and restore it." I think, right now, there's potentially a much, much bigger pool of federal funding that's on the line than what was from that specific program.

Tiffany Hansen: Do we know if Letitia James has said, "If you withhold services, if you withhold care, XYZ is going to happen to you?" "You," organization.

Caroline Lewis: I don't think she's gone that far, but it seems like she's serious about enforcing the state's anti-discrimination laws, yes.

Tiffany Hansen: Caroline, I just want to take a quick break and remind our listeners, we're talking about stories that have come out regarding two patients, two minors, right? We know they were minors.

Caroline Lewis: Two 12-year-olds, yes.

Tiffany Hansen: Okay, two 12-year-olds who were denied gender-affirming care at local hospitals. Let's talk about the public response. What have you been hearing?

Caroline Lewis: Like I said, I went to a rally that was held in a park near NYU Langone the other day. The outpouring of support for trans youth in the city was enormous. A ton of people came. They were packed into this park. A lot of people were parents of trans teens, but a lot of people were just there to support and stand up for them. I think the trans young people who were scattered throughout the crowd were a little overwhelmed by how many people showed up. I think one thing that I heard from, for instance, one trans young person who is 17, they said, "I had been thinking about getting gender-affirming care. Now, I feel like it's urgent. I need to try to get it in under the wire or something because I don't know what's going to happen."

Tiffany Hansen: Is this the rally where Cynthia Nixon was--

Caroline Lewis: Yes.

Tiffany Hansen: Okay, we have a clip from her, so let's listen to that, or maybe we don't. That's all right. I can summarize. She says, "My trans kid had his top surgery at NYU. The idea that the city is filled with young people who thought they had a place to go where they could receive the highest care, and that place has now been shut down sickens me. The last two weeks have been an assault, a barrage. So many horrific things coming at us from every direction." Did you hear a lot of that?

Caroline Lewis: Yes, I think it's like there were these two cancellations at NYU Langone, but it's like more the moment in general. People being told, "We don't recognize more than two genders, so basically, we don't recognize you exist." People being just worrying about what's going to happen, but it wasn't necessarily a moment of just people expressing fear, but more so saying, "We're here. We're defending New York City's care," and that kind of thing.

Tiffany Hansen: Other than just this is an awful situation, did you hear any of like, "This is what we're going to do. This is the plan of action"?

Caroline Lewis: I think it was more a moment of getting prepared for that.

Tiffany Hansen: "Let's just gather together"?

Caroline Lewis: "We need a plan of action," kind of. I think people are really affected. I spoke to one person who had just gotten top surgery at NYU Langone, had gotten all their care there. He also worked at a different NYU institution and had quit when he heard that they canceled two appointments for minors. Even though his care wouldn't be affected, he said, "That's it. I'm out." I think people feel really betrayed. They feel like, "Why capitulate so quickly?"

Tiffany Hansen: I wonder, did you hear any hand-wringing from folks about the ability of the state to protect some of these care options for them? I can imagine, there are some folks in, let's say, reproductive rights arena who might also now be worried because their state's governor, Governor Hochul, just this week signed some legislation to help protect reproductive care in our state. I think the question might be, can my state really even do that at this point?

Caroline Lewis: Yes. Actually, a lot of people at the rally were referencing the things that the state has already done to try to protect this care, which is, one, Tish James was involved in the lawsuit that got the temporary restraining order on federal funds being frozen based on Trump's executive orders. She sent out the notice reminding people about the anti-discrimination laws. People were saying, "Actually, it's illegal for hospitals to stop offering this care right now based on what we're hearing." Like I said, there's conflicting legal standards, but I think people do feel New York has protections in place and that it needs to remain a destination.

Tiffany Hansen: It's hard to predict this, I know because we are living in a fire hose of information coming at us from the federal level. What's on your radar for this weekend, next week? Anything that you can see bubbling up in terms of your reporting?

Caroline Lewis: Well, I think one thing that will be coming up is the executive order on gender-affirming care also directed the federal government to review Medicaid and Medicare conditions. I think we have to see whether there are further efforts they're going to make to revoke funding for this care. I think there will be additional policies coming down the line as they try to implement this executive order. Also, I think that the state will continue coming out with efforts to counter that. I think we have to see what happens in this federal case that was filed to challenge the executive order, whether there's a temporary restraining order--

Tiffany Hansen: This is the one in Delaware you were talking about?

Caroline Lewis: Yes, it's the case that was filed by the ACLU on behalf of several trans young people and family members of trans young people, basically challenging the order on gender-affirming care.

Tiffany Hansen: Got it. We've been talking with Caroline Lewis this morning. Caroline covers health care for WNYC and Gothamist. Caroline, thanks for your--

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