December is normally a month when people ease up for the holidays. This is not the case for the federal government, however, which last week continued its unrelenting campaign against transgender people across the country.
First, on Dec. 16, the House of Representatives moved forward with HR 3492 — titled the “Protect Children’s Innocence Act” — which would make it a felony for health care providers across the country to provide gender-affirming health care to minors. The bill, introduced by soon-to-be-former Rep. Marjorie Taylor Greene, R-Ga., is rife with typical fearmongering language, referring to gender-affirming care, including both hormone replacement therapy (HRT) and gender-affirming surgeries, as “chemical castration,” “genital mutilation” and “bodily mutilation.” This ban would impose a prison sentence of up to 10 years on health care providers prosecuted under this law.
The bill is unsurprising to anyone who has been paying attention. Trans youth receiving gender-affirming care has become the great boogeyman of the Christian nationalist movement in recent years. Bans on gender-affirming care were a key goal of the Christian nationalist manifesto Project 2025, and more than half of U.S. states are continuing to ban gender-affirming care for minors. It was only a matter of time before the federal government took a crack at it. The precise formulation of the ban is also not surprising, including its exemptions for procedures that seek to bring a child in line with their assigned sex at birth, and especially its extra emphasis on characterizing gender-affirming surgeries as a form of Female Genital Mutilation (FGM). Since January, we’ve seen a massive uptick in the federal government characterizing gender-affirming care as “genital mutilation” and specifically seeking to prosecute it under anti-FGM in order to provide greater legitimacy to these unscientific bans.
This is a radical and dangerous legal conflation — and a slap in the face to the women and girls who have been victims of actual FGM practices. FGM is a cultural tradition practiced in many parts of the world that is justified by the stigmatization of women’s sexuality, often in the name of religion. According to UNICEF, FGM “refers to all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for nonmedical reasons” and impacts over 230 million girls and women worldwide. The term FGM has never been widely understood to include gender-affirming care, which for decades has been considered best practice medical treatment.
The congressional bill, which passed the House by a five-vote margin, is fortunately expected to fail in the Senate. Attacks on trans youth have been politically unpopular with voters since before the 2024 election, and the fatigue has only grown as extremists continue to push anti-trans hysteria as a proxy issue for a wealth of other harmful policies. As Rep. Sarah McBride, D-Del., remarked ahead of the vote: “All Republican politicians care about is making the rich richer and attacking trans people. They are obsessed with trans people. I actually think they think more about trans people than trans people think about trans people.” That being said, there will still be consequences from this bill making it even this far, including the growing normalization of criminal penalties for evidence-based medical care.
Not to be outdone, the executive branch also got its moment in the anti-trans sun in the back half of the week, as the Department of Health and Human Services proposed a new rule that would prohibit any hospital receiving Medicare/Medicaid funding from providing minors with “sex rejecting procedures” — the newest characterization of gender-affirming care meant to delegitimize transgender existence. The new proposed rule relies heavily on anti-trans pseudoscience, including the United Kingdom’s infamous and widely debunked “Cass Review,” along with other studies that have been heavily promoted by Christian nationalist outfits (such as the Alliance Defending Freedom). The HHS rule explicitly rejects the opinions of mainstream medical organizations like the American Medical Association, which has supported the gender-affirming model for decades. HHS claims that a small group of trans activists has somehow managed to manipulate these institutions into consensus, silencing dissent.
This new proposed rule builds upon the abortion playbook, which has always been the framework for attacking access to gender-affirming care thanks to its identical goal of policing womanhood and restricting bodily autonomy. Where in the past we saw blocks on federal funds going toward abortion services, we are now seeing attempts at blocking federal funds from going to any institution where gender-affirming care services are provided, regardless of whether federal funds are actually being spent on it.
The HHS rule is rife with legal and constitutional issues.
It directly contradicts Section 1801 of the Social Security Act, which explicitly bars the federal government from using Medicaid funds to “exercise any supervision or control over the practice of medicine.” There is also a major overreach of executive power. The administrative system cannot be weaponized to institute sweeping bans on medical care that Congress has declined to act on itself, an especially glaring issue with the Senate’s likely blockage of HR 3492. Additionally, the executive action would massively override extremely basic principles of state sovereignty, triggering 10th Amendment issues. This is because it would apply not only to hospitals in states that have passed bans on gender-affirming care, but also states that have no such bans in place, as well as states like California, Minnesota and New York, all of which have passed shield laws meant to protect the right to gender-affirming care.
We should be alert as to why such measures are being put forward in the first place. For years now, the Christian nationalist movement has made clear that anti-transgender policies are a key part of its foundation for a theocratic society. Transness and gender nonconformity in general are some of the greatest threats to the growing theocratic order, because conservative and fundamentalist Christianity rely on strict gender hierarchies to function. The strict insistence on these sex-based gender roles also serves as a form of psychological control within these communities, creating binaries that limit a person’s ability to question authority and stifle their ability to see the world complexly.
Authoritarian-tending regimes, religious or otherwise, use the exact same tactics of logistical and psychological control on a much larger scale through the strict enforcement of gender, race and class-based hierarchies. But this can only last as long as people buy into those hierarchies. Trans and gender nonconforming people directly contradict this system, making their arbitrary nature increasingly obvious, even to people who are comfortable with their assigned social roles. These laws, the rhetoric they use, and the consequences they attempt to impose are meant to intentionally frighten the American public into buying into the hierarchies necessary to implement widespread Christo-fascism throughout the United States.
This is why there is a large network of shared funding, staff and data among Christian nationalists creating anti-transgender pseudoscience masquerading as legitimate data. This is why since at least 2019, there has been a coordinated effort by Christian nationalist organizations to make these health care bans a priority.
This is a well-funded propaganda machine, intended to trick even secular Americans into complying with the Christian nationalist vision for society. We don’t have to fall for it. We can choose to make decisions based on medical consensus and legitimate medical science. We can choose to reject fearmongering and scapegoating and religious hysteria masked as “just asking questions.” We just have to have the courage to do so.
Disclaimer: The views in this column are of the author and do not necessarily reflect those of the Freedom From Religion Foundation.
