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The Trump administration wants to stop all medical care for transgender Americans, and it’s looking for a target like Harvard University—its foil in higher education—to make its point.
Trump’s bull’s-eye very well could be on Oregon Health & Science University, the largest provider of transgender health services in the Northwest, and one of the largest in the nation.
That’s the opinion of at least one expert on transgender rights, who discussed the situation with WW but declined to be named. Many others agree that the fiercest battle over the rights of trans people will be fought in hospitals like OHSU, which started a specialized care program in 2014 and saw 11,000 transgender adult and youth patients in fiscal year 2023 alone, according to its community benefit report to the state for that year.
OHSU has been building its practice for 11 years. Puberty specialists at Doernbecher Children’s Hospital treat hundreds of transgender youth every year, according to its website, offering puberty blockers (a treatment demonized by Trump as “chemical mutilation”), advice on chest binding, and “safe-tucking” to comfortably reduce the prominence of the penis and testicles.
Trump started his war on transgender Americans on Jan. 28, eight days after he was inaugurated to a second term, with an executive order threatening to halt federal research grants and education funding to hospitals that provide transgender care because “medical professionals are maiming and sterilizing a growing number of impressionable children.”
Then, on May 1, officials began putting sharp teeth in Trump’s anti-trans plans. The U.S. Department of Health and Human Services issued a 409-page review of medical interventions for children and adolescents with gender dysphoria, describing “serious concerns about medical interventions, such as puberty blockers, cross-sex hormones, and surgeries, that attempt to transition children and adolescents away from their sex.” The document wasn’t peer reviewed, and its authors remain anonymous.
Four weeks later, on May 28, HHS Secretary Robert F. Kennedy Jr. wrote directly to hospitals and other providers warning them to halt “harmful interventions.” Ominously, Kennedy said that HHS is “committed to protecting whistleblowers to the full extent of the law” and warned of new “oversight actions” to “hold providers that harm children accountable.”
On the same day, Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, a division of HHS, increased the pressure. He wrote to providers, giving them 30 days to furnish him with all billing codes used for “pediatric sex trait modifications” and revenue figures for those procedures since 2020. Having the codes would let HHS tally all transgender treatments done so far and track them going forward.
So far, it appears OHSU aims to please both masters.
“Oregon Health & Science University’s gender-affirming health care team follows established, evidence-based medical standards, and employs a thoughtful, multidisciplinary process that involves both patients and their support systems, in compliance with state and federal laws,” the university said in a statement. “OHSU steadfastly supports the dedicated clinicians, researchers and learners who work tirelessly every day to advance access to care for all people.”
That said, OHSU indicated it would comply with Oz’s request for data on its transgender care practice. “As noted in our statement, OHSU complies with all state and federal law and responds to requests for data, consistent with all applicable laws,” a spokeswoman wrote.
Few institutions in Oregon have suffered more from the Trump administration’s edicts than OHSU. Trump’s “big beautiful bill” would halve funding for the National Institutes of Health, a major funder of OHSU research, if it passes the U.S. Senate. Trump has ordered both the Food and Drug Administration and the NIH to slash medical research on animals, imperiling the future of the Oregon National Primate Research Center, which is run by OHSU and collects federal grants worth more than $50 million each year. Worse yet, Senate Republicans last week considered cutting Medicare, a major source of revenue for the university’s hospital system, to fund Trump’s tax cuts.
Being in Trump’s crosshairs on transgender care couldn’t come at a worse time for OHSU. Unlike the other assaults, this one could rain legal hell on Marquam Hill by forcing the university to violate either state statute or federal law, depending on how it responds. Either way, the hospital system could be breaking laws, be they federal or state, because the two codes conflict.
The Oregon Equality Act, passed in 2007, bans discrimination based on gender identity in employment, housing and public accommodations, including medical care.
Oregon added more protections in 2023, when Gov. Tina Kotek signed House Bill 2002, prohibiting insurers from denying claims for medically necessary gender-affirming treatment. Under the law, doctors who refuse such treatment can be fined or have their licenses revoked.
“Gender-affirming health care is protected under Oregon state law and continues to be available to transgender and gender-diverse people in our state,” a Kotek spokesman said in a statement to WW for this story. “Oregon’s public and regulated private health insurance plans cover medically necessary care that affirms an individual’s gender identity in accordance with accepted standards of care.”
But a not-so-close reading of the executive order from Trump and the letters from Kennedy and Oz show that the administration is wheeling up a big federal gun: the False Claims Act.
Passed during the Civil War, the act allows the federal government to sue a contractor if, say, it promised to deliver a good or service but never did, or if it knowingly delivered a good or service that didn’t match what it promised. If the government wins its case, the defendant must pay triple damages plus civil penalties of as much as $28,000 per claim. Whistleblowers who alert the feds to abuse are eligible for a portion of the spoils.
The False Claims Act is an effective tool for the government. It won $2.9 billion from all industries in fiscal 2024. Health care fraud brought in $1.7 billion, or 58% of that.
The Trump administration is repurposing the FCA to go after institutions it perceives as corrupt. On May 19, deputy attorney general Todd Blanche set up the Civil Rights Fraud Initiative to investigate recipients of federal funds who violate civil rights protections. For example, Blanche said, a university that tolerates antisemitism or promotes “divisive” diversity, equity and inclusion policies will be “putting their access to federal funds at risk,” Blanche said in a statement.
David O’Neal, a lawyer at Parker, Hudson, Rainer & Dobbs LLP in Atlanta, says the administration appears to be readying the FCA for an attack on health care practices it doesn’t like, including transgender care, by claiming violations of civil rights.
“The FCA is the biggest hammer the government wields in civil cases,” O’Neal says. “The likelihood of federal investigation along these lines seems high.”
It’s not clear what legal theory the administration would use to prosecute hospitals that provide transgender care to minors, O’Neal says. Trump’s Jan. 28 executive order contains a clue. He called out doctors who practice transgender care “under the radical and false claim that adults can change a child’s sex through a series of irreversible medical interventions.” That language suggests Kennedy and Oz will investigate transgender care providers on the belief that one can’t really change a child’s sex postpartum, making all such care a fraud.
Oregon Attorney General Dan Rayfield and AGs from Colorado, Minnesota and Washington sued to block the Trump administration from denying federal funds to providers of transgender care, and a federal judge in Washington granted a temporary injunction in their favor. If that injunction doesn’t hold up at trial, OHSU will be forced to make a choice: withhold transgender care to minors and violate state law, or provide it and risk budget-busting fines from the feds.
Rayfield is talking tough.
“Our team is carefully monitoring federal actions pertaining to access to care and gender-affirming care, and are in regular touch with OHSU and other impacted health care providers throughout the state,” Rayfield said in a statement to WW. “We will use every legal tool available to protect families from political interference in personal medical decisions. No one should be denied care, dignity or safety because of who they are.”
Given Rayfield’s resolve, OHSU may find itself in Harvard’s shoes, fighting the feds but with a much smaller war chest. Harvard has $53 billion in its endowment, the largest academic nest egg in the world. OHSU has a tenth of that in liquid assets: about $5 billion. In battles like this, cash is king.
This reporting is supported by the Heatherington Foundation for Innovation and Education in Health Care.