AMNA NAWAZ: The Trump administration# today took its most significant moves## yet in a wide-ranging effort to restrict# gender-affirming medical care for minors.

GEOFF BENNETT: The Department of Health and Human## Services unveiled a series of# actions meant to effectively## ban transition-related medical treatments# nationwide for those under the age of 18.

Stephanie Sy has more.

STEPHANIE SY: Geoff and Amna,# the moves announced today include## cutting off federal Medicare and Medicaid# funding from hospitals that provide those## treatments and prohibiting Medicaid# funding from paying for such care.

Here's what Secretary Kennedy had to say.

ROBERT F. KENNEDY JR., U.S.

Health and# Human Services Secretary: This morning,## I signed a declarati.. treatment for children with gender# dysphoria.

These procedures fail to me## professionally recognize standards of care.# Medical professionals or entities providing## sex-rejecting procedures to children are out of# compliance with these standards of health care.

STEPHANIE SY: We will delve into those# controversial assertions in a moment,## but we should say that, before these policies# are enacted, there's a lengthy rulemaking## process that has to take place and groups such# as the ACLU are already threatening lawsuits.

To break some of this down, I'm# joined now by Selena Simmons-Duffin,## who covers health policy for NPR# and was at today's announcement.

Selena, thank you so much for joining us.

We know that about 45 percent of hospital# spending comes from Medicare and Medicaid,## so threatening to cut that off# would be existential, I imagine,## for most hospitals.

Even though these# are only proposed rule changes now,## are we going to see widespread stoppage# in this care?

What might the impact be?

SELENA SIMMONS-DUFFIN, NPR: Yes, I mean,# children's hospitals have been pioneers in## this treatment for transgender young people,## which can include puberty blockers, hormone# therapy.

Very rarely, it can include surgery.

But part of the reason why children's# hospitals are attractive to parents,## children who are considering this treatment,# is because they're interdisciplinary and they## have really high-quality teams,# that you can talk to therapists,## you can talk to psychiatrists, you can# really get that full spectrum of care.

And I think that if these rules are# enacted, this care will no longer## happen at hospitals across the country.

And# that includes in places where it is legal,## even though there are 25-plus states that# have banned the care at the state level.

STEPHANIE SY: Help us understand how unprecedented# it is to have the government tell hospitals## they won't have access to federal funding if# they provide a certain kind of medical care.

SELENA SIMMONS-DUFFIN: It# is extremely unprecedented.

This type of rule is called the condition# of participation.

And it's used to create## kind of a bare minimum of standards for# health and safety in hospitals normally,## so rules such as you must have a crash# cart available if you're providing care## for people in emergencies, you must have a# certain number of staff-to-patient ratio,## those kinds of things, very, very, very# basic, kind of the floor of health and safety.

And you could imagine that the same approach,# using conditions of participation, as you say,## this kind of existential tool# to -- over hospital budgets,## you could use it for any variety of care that any# health secretary now or in the future disfavors.

And we're talking about Robert F. Kennedy# Jr., the current health secretary,## who has talked skeptically about a host# of medical care that is regarded as the## standard of care and regarded as safe and# effective, from antidepressants to vaccines.## So it really opens up an enormous can of# worms if this -- these rules take effect## and are allowed to stand through the legal# challenges that will for sure be coming.

STEPHANIE SY: For all the talk of gold standard# science at the announcement today, there were a## few nonscientists who made declarative statements# dismissing gender dysphoria altogether.

I want to play what Jim O'Neill, deputy secretary# at HHS, who has no medical degree, had to say.

JIM O'NEILL, U.S.

Health and Human# Services Deputy Secretary: Men are men.## Men can never become women.

Women are# women.

Women can never become men.

JIM O'NEILL: At the root of the evils we# face, such as the blurring of the lines## between sexes and radical social agendas,# is a hatred for nature as God designed it.

STEPHANIE SY: Both sides, Selena, of# the treatment debate claim to have## science on their side and accuse the# other side of acting ideologically,## in a way that harms children.

How are we# to separate the science from ideology?## Is anything definitively known# about safe and effective treatment?

SELENA SIMMONS-DUFFIN: Well, I think you## can really hear ideology at play in# those stat.. I mean, he did not say that evidence doesn't# support the use of threat treatments among the## pediatric patients because they have these# side effects, et cetera, et cetera.

No,## he was saying men cannot become women, women# cannot become men.

He's speaking about adults.

And that is kind of the foundation of# understanding what it means to be transgender.## So there was that thread throughout the whole# event today that transgender people don't exist## in the world view that you were hearing from the# health officials in this Trump administration.

What you see in the materials from this HHS is# kind of a rejection of the premise that there## are people for whom there might be benefit# from this care.

And so I don't think that## there -- this is really a good-faith debate about# whether the care works or not or what the protocol## should be.

It's really kind of more of a bigger# picture conversation, like Jim O'Neill said,## about God and about gender and about sex# and what's changeable and what's not.

And so I do think that it is striking# that, even under immense pressure,## the American Academy of Pediatrics, the American# Medical Association, the Endocrine Society,## all of these organizations that are composed# of doctors that actually see these patients and## engage with this care don't agree and really# roundly reject this characterization and the## way that this administration and this health# department have been presenting the evidence.

STEPHANIE SY: That is Selena# Simmons-Duffin with NPR joining us.

Thank you.

SELENA SIMMONS-DUFFIN: You're welcome.