The costs of banning gender-affirming care

Summary

Marketplace Morning Report

Episode: The Costs of Banning Gender-Affirming Care
Date: January 29, 2026
Host: David Brancaccio

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Episode Overview

This episode examines the economic and human ramifications of President Trump's executive order aiming to end gender-affirming care for transgender individuals under 19. It explores the impact on healthcare providers, patients, and families as hospitals react to new policies and looming federal funding restrictions. The piece features on-the-ground reporting from Colorado, notable insight from front-line healthcare providers, and national context around policy changes.

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Key Discussion Points & Insights

1. Government Shutdown Negotiations (00:31–01:52)

• Democrats and President Trump are nearing a deal to avert a partial government shutdown. The crux: separating funding for the Department of Homeland Security (DHS) to allow more time for debate over immigration enforcement reforms.
• Contention centers on ICE practices, with proposed changes including bans on agents wearing masks, mandatory body cameras, and limits on arrest practices. Any reforms need both Senate and House approval.

2. Markets Update (01:52–02:51)

• Stock futures saw slight gains, with Dow futures up 0.5%.
• The Federal Reserve is holding interest rates steady at 4.25%—no rush to lower them.
• Crude oil prices rose, especially Brent crude nearing $70 a barrel amid U.S.-Iran tensions.

3. Main Focus: The Human & Economic Costs of Banning Gender-Affirming Care (03:51–07:59)

Federal Policy Shifts and Immediate Impacts

• Background: President Trump's executive order, issued a year ago, targets end of gender-affirming care for transgender youth under 19.
• The Dept. of Health and Human Services is now seeking to cut Medicaid and Medicare funding for hospitals offering such care (though not yet in effect—legal challenges underway).
• Some hospitals have already preemptively stopped care for minors, including Colorado Children’s Hospital and Denver Health.

Front-Line Healthcare Providers’ Response

• Case Study: IRIS Center in Colorado

  • Founders: Nurse practitioner Casey Cash and Dr. Stacey Johns.
  • Opened in November to provide primary care, including gender-affirming care for minors.
  • Since hospital closures, they've seen a surge in requests—“about 20 an hour” soon after, compared to “that many calls a week” before (Dr. Stacey Johns & Casey Cash, 05:35–05:48).

• Emotional and Operational Toll

  • Cash and Johns are struggling to balance the needs of all patients with increased demand from trans youth seeking care.
  • “We are only two people and we are primary care...balancing the need has been challenging.” (Dr. Stacey Johns, 06:17)

Broader National Context

• 27 states have banned transition-related care for minors in recent years.

• Providers are relocating careers and families or suspending care, even where legal, due to administrative threats and investigations.

• “Emotionally, providers are distraught.” (Dr. Stacey Johns, 06:55)

Impact on Patients & Providers

• Abrupt care discontinuation: Providers feel devastated at being forced to abandon patients.
• Widespread fear over job security, institutional support, and being targeted by federal authorities.
• Yet, strong motivation persists: “It is amazing to watch the progression of a child who didn’t make eye contact, finally sit up, smile, push their hair out of their face, tell me about band that they joined...” (Casey Cash, 07:25)
• Providers acknowledge the life-saving nature of gender-affirming care: “There are a lot of providers that are desperate to continue this care and they want to because we know it saves lives.” (Casey Cash, 07:50)

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Notable Quotes & Memorable Moments

• Casey Cash (on hearing news of hospital closings)

  “My phone blew up at 8am and that's how I found out, and I was like, what? What are you talking about?”
  (04:44)

• Dr. Stacey Johns (on expected vs. actual timeline for hospital closures)

  “We thought we had at least till April.”
  (05:29)

• Casey Cash (on surge in demand)

  “We have been really over overwhelmed by parents of children under the age of 18 who are no longer feeling safe to get care.”
  (05:48)

• Dr. Stacey Johns (on emotional toll to providers)

  “To have to be forced so abruptly to abandon them is really devastating to a lot of them. And a lot of them have their own fear about what's going to happen to them.”
  (07:02)

• Casey Cash (on the significance of the work)

  “It is amazing to watch the progression of a child...finally sit up, smile...I get goosebumps. I have goosebumps right now.”
  (07:25)

• Casey Cash (on what motivates providers)

  “There are a lot of providers that are desperate to continue this care and they want to because we know it saves lives.”
  (07:50)

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Important Timestamps

• 00:31–01:52: Government shutdown update and immigration enforcement debate
• 03:51–07:59: Deep dive on gender-affirming care bans—the main segment
• 04:44: Provider reaction to abrupt hospital closures
• 05:35: Influx of new patient requests
• 06:55: Emotional impact on healthcare workers

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Flow & Takeaways

This episode builds a vivid picture of how federal policy changes ripple through local communities, affecting both those who need essential care and those committed to providing it. The reporting foregrounds real-time dilemmas for practitioners under siege, underscores the emotional and logistical burdens of sudden system shifts, and amplifies first-person accounts of resilience and fear within the transgender healthcare ecosystem.
For listeners, it’s a bracing, nuanced look at the intersection of healthcare policy, politics, and lived experience—capturing not just numbers, but the profound human cost.

Transcript

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[David Brancaccio]

On government shutdown Watch with the deadline less than two days away, I'm David Brancaccio in Los Angeles. Published reports today suggest that Democrats and President Trump are moving closer to a deal to avert a partial government shutdown. Starting the stroke of midnight Friday to Saturday, Democrats are pushing reforms for immigration enforcement. Marketplace's Nancy Marshall Genzer has an update.

[Nancy Marshall Genzer]

The final six spending bills needed to fund the federal government are packaged into one big measure. One of those bills bills would fund the Department of Homeland Security, which includes ice. In his speech on the Senate floor yesterday, Senate Democratic leader Chuck Schumer called on Republicans to split off the DHS bill so the Senate can pass the other five spending bills and send them on to President Trump for his signature. The New York Times is reporting that Schumer and Trump are talking about a deal that would separate the DHS bill as Schumer requested. Then the Times says Congress would vote on a short term extension for dhs. That would allow time for more negotiations on change Democrats want for ice. Among them. ICE agents couldn't wear masks and would have to wear body cameras. They would also have to stop making arrests and entering homes without warrants. But all these changes would also have to be approved by the House. I'm Nancy Marshall Genser for Marketplace.

[David Brancaccio]

Let's do the numbers up. Music S and P and Nasdaq futures are up by less than a 10th percent. Dow futures are up half a percent at the this point. The 10 year interest rate steady this morning so far 4.25% after the federal Reserve yesterday, no surprise, decided to keep its interest rates steady. Fed Chair Powell seems in no rush to lower rates anytime soon, given tentative signs that the US Economy may be healing. Crude oil traded in New York is up 2.2% to around 64.50 a barrel now. But the European price Brent crude got very close to $70 a barrel for the first time since September. This after President Trump told Iran to make a nuclear deal or face military strikes.

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[David Brancaccio]

The many effects of President Trump's executive order from a year ago aimed at ending gender affirming care for transgender people under the age of 19. The administration has since launched investigations of several hospitals, and last month the Department of Health and Human Services proposed a rule to turn off Medicaid and Medicare funding for hospitals that deliver that care. Now, that rule is not yet in effect. Some states have sued. All of this is taking a big toll on transgender young people and their families. And as Marketplace's Samantha Fields reports, it's also taking a toll on healthcare providers.

[Samantha Fields]

Even though the new rule is not in effect yet, a number of hospitals around the country have already stopped offering gender affirming care to minors, including two in Colorado Children's Hospital and Denver Health. Casey Cash, a family nurse practitioner in Fort Collins, was on vacation with her family for the new year when the news broke.

[Casey Cash]

My phone blew up at 8am and that's how I found out, and I was like, what? What are you talking about? What do you mean? Denver Health what? Children's? No. What?

[Samantha Fields]

Cash is not affiliated with either hospital. She and her longtime colleague Dr. Stacey Johns just opened a non profit primary care practice in November called the IRIS Center. Among the services they offer is gender affirming care, including for kids and teenagers, which is backed by major American medical associations that can include prescribing puberty blockers or hormones at their practice. It does not include surgery. John says they knew local hospitals might stop offering transition related care to kids at some point because they can't afford to lose Medicare Medicaid funding, but they didn't think it would happen so soon.

[Dr. Stacey Johns]

We thought we had at least till April.

[Samantha Fields]

Instead they only had until January 2nd, a Friday.

[Dr. Stacey Johns]

I think that Monday we were getting an average of about 20 requests an hour of people calling us.

[Samantha Fields]

Specifically parents looking for providers for their trans kids before Cash says they might have gotten that many calls a week.

[Casey Cash]

We have been really over overwhelmed by parents of children under the age of 18 who are no longer feeling safe to get care.

[Samantha Fields]

Cash and John's practice is not specifically for gender affirming care, but they offer it. And John says in recent days they've been doing a lot of triage, trying to help as many transgender kids as they can get the care they need.

[Dr. Stacey Johns]

But we are only two people and we are primary care. We have a lot of patients that are cisgendered and also need care. So kind of balancing the need all of our patients has been challenging.

[Samantha Fields]

It's also just a challenging time to be a doctor or nurse caring for trans kids in this country. 27 states have banned transition related care for minors in the last few years. Some providers in those states have uprooted their families and careers to move to places where they can still practice. And now, even in states where it is still legal to offer that care to kids, a growing number of hospitals are shutting it down, at least temporarily, over investigations and threats from the Trump administration.

[Dr. Stacey Johns]

Emotionally, providers are distraught.

[Samantha Fields]

Dr. Johns says everyone she knows who does this work cares deeply about their patients.

[Dr. Stacey Johns]

And to have to be forced so abruptly to abandon them is really devastating to a lot of them. And a lot of them have their own fear about what's going to happen to them.

[Samantha Fields]

As providers fear about whether their employers will continue to support them, fear of losing their jobs, fear of being targeted by the administration. But Cash says they're also committed to continuing to support and care for trans kids.

[Casey Cash]

It is amazing to watch the progression of a child who didn't make eye contact, finally sit up, smile, push their hair out of their face, tell me about band that they joined or whatever. And it is, I get goosebumps. I have goosebumps right now.

[Samantha Fields]

It is the most rewarding work she's ever done in more than 20 years. In medicine, there are a lot of.

[Casey Cash]

Providers that are desperate to continue this care and they want to because we know it saves lives.

[Samantha Fields]

Cash says she and Johns have been hearing from lots of providers who are working hard to find ways to keep offering it. I'm Samantha Fields for Marketplace, the new.

[David Brancaccio]

Tax favored investment vehicle for babies born in this presidential term. Trump accounts. The Marketplace morning podcast will have a closer look. If you missed it on the air, it's the Morning Report from apm. American Public Media.

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