During the barrage of anti-trans ads that the Trump campaign ran in the run-up to the election, some people pointed out that the ads may not be persuading likely voters, and others called the strategy a distraction from more important issues. But the ads are in keeping with the anti-trans sentiment that former President Donald Trump displayed when he was in office — when his administration proposed or passed anti-trans rules in nearly every federal department — and suggest that trans people should expect a second Trump administration to do as much as it can to restrict gender-affirming care.
Trans people should expect a second Trump administration to do as much as it can to restrict gender-affirming care.
With the right-wing media in a full court press, the conservative base goes wild for transphobic content, and conservative politicians have responded in kind. At the Conservative Political Action Conference last year, Daily Wire host Michael Knowles got onstage and declared that conservatives must “eradicate transgenderism,” meaning trans people. He was just the most vitriolic speaker at a conference where nearly everyone took swipes at the trans people who make up just 1% of the population.
Given the attention rhetoric like this has gotten, it’s no wonder the Trump campaign and other conservative groups have spent millions on those anti-trans ads. But what does it mean for the future of trans people in America?
During Trump’s first term, when trans issues weren’t nearly as front and center as they are now, his administration proposed or passed anti-trans rules in nearly every federal department. We should expect that and more in a potential second Trump term.
Beyond the trans athlete issue, the most serious potential Trump intervention into trans lives is in our health care. Trump has promised to ban trans teens from accessing puberty blockers and hormonal treatment. Trump himself has repeated wild and false ideas that children are getting “sex change operations” at school, as obviously false as that claim is. On the campaign trail, Trump has said he would punish doctors who provide gender-affirming care. “Under my leadership, this madness will end,” he said in a video just a few months after announcing his campaign.
Gender-affirming surgery is rarely performed on those under 18 years old, and if it is, it’s usually top surgery, or removal of breasts from trans guys. Bottom surgery is generally not performed on minors, in schools or in hospitals.
In conservative Florida, the government’s anti-trans health care stance has bled into restricting adult care, as well. A second Trump administration, like the first one, would be likely to make serious attempts to restrict access to gender-affirming care for trans adults.
In October 2018, Trump’s Health and Human Services Department proposed and later implemented a rule that redefined how Section 1557 of the Affordable Care Act is interpreted, effectively shutting trans people out of the sex-based nondiscrimination protections that every other American enjoys. This was later rolled back to protect us again under President Joe Biden, but look for Trump to act early again to flip it back and once again allow health care providers to turn away trans people.
A Trump win and an accompanying Republican-controlled Congress would be likely to try to nationalize the anti-trans efforts that were previously undertaken at the state level. The Trump administration also took steps to restrict coverage of gender-affirming care on Medicare and Medicaid and has promised that in a second term, taxpayer dollars would not be used to pay for such treatments. This is important not just for retired and poor trans people, but also for private health insurance carriers, which look to what the government covers as guidance for their own coverage decisions. Beyond the executive branch, a Trump win and an accompanying Republican-controlled Congress would be likely to try to nationalize the anti-trans efforts that were previously undertaken at the state level. Over the last several years, hundreds of anti-trans bills have been proposed and passed in red states. We should expect all this and more in a second Trump administration. I worry about my friends. Heck, I worry about myself, being a lefty MSNBC columnist under a president who has promised to use the military to attack political enemies after an election in which my identity was made to be one of his top targets. Vice President Kamala Harris might be largely reluctant to make a full-throated defense of trans people, but the next four years would be significantly more survivable under her than Trump. I hope your trans friends come to mind as you enter the voting booth on Tuesday. We need a president who respects and protects us.
Katelyn Burns is a freelance journalist based in New England. 
