Smoke and Mirrors: The Right's Latest Attacks Against Trans People

The MAGA movement is redoubling its attacks on trans healthcare in an attempt to win votes this November. In the final weeks of the 2024 election, the refrain “Kamala is for They/Them, Trump is for You ” blared from TVs in the battleground states during NFL and college-football games.

Seeking to capitalize on voters’ frustrations after several years of inflation, the campaign ad warned that a Harris presidency would mean government-funded transition surgeries for children and migrants amid soaring food and housing costs for Americans. This wasn’t the first time that the MAGA movement concocted a blend of populist resentment and anti-trans sentiment.

That summer, Trump posted a video on social media in which he pledged to “investigate Big Pharma and the big hospital networks to determine whether they have deliberately covered up horrific long-term side effects of sex transitions in order to get rich at the expense of vulnerable patients. ” Since retaking office, the president has made good on that promise.

The Department of Justice has issued subpoenas to doctors and clinics providing gender-identity care to children, while the Trump administration has moved to implement an executive order directing the Department of Health and Human Services and the DOJ to investigate and restrict such care. More recently, the federal health bureaucracy issued a report , “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited From the Fraud of ‘Gender Medicine,’” alleging potentially fraudulent insurance-coding practices in gender-affirming care for minors.

The report itself presents what one could call a trans-exceptionalist view of the US healthcare system’s flaws. It portrays the real deficiencies of a highly privatized approach to care as a problem of “ideological capture” and radical transgender activism rather than one of marketized medicine.

The report attempts to shock readers with sensationalized language about the “unique and lifelong revenue streams” that “sex-rejecting procedures” afford providers. Those relatively low-paid and prestige-hungry pediatricians, the report’s authors claim, stumbled upon a “strategic area of growth” in gender-affirming care, one that greedy “elite” hospital administrators were more than happy to encourage.

However, there is truth but far more fiction in this account of trans medicine. While medical transition does indeed require the persistent use of hormonal medications, these are often available as cheap generics.

Yet the report explicitly alleges that pediatric gender-medicine programs generated substantial revenue and created groups of “captive patients” requiring long-term care. There is limited evidence, in the report or elsewhere, that leaders of hospitals consider gender-identity clinics, with their tiny patient populations, to be an especially lucrative “growth area.

The authors of the report, mainly conservative women’s groups and Christian policy shops, have a striking provenance. The most decorated author, May Mailman, is a veteran of the first Trump administration’s immigration team who returned to the White House to orchestrate the 2025 executive order “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.

” The few medical experts on the report are Quentin Van Meter, the former president of the fringe American College of Pediatricians, and Eithan Haim, who previously collaborated with the conservative activist Christopher Rufo to expose Texas Children’s Hospital’s defiance of the state’s criminalization of trans healthcare as potential child abuse. The report itself presents a trans-exceptionalist view of the US healthcare system’s flaws, portraying the real deficiencies of a highly privatized approach to care as a problem of “ideological capture” and radical transgender activism rather than one of marketized medicine.

At its worst, “Wolves in White Coats” takes real problems in healthcare billing and attributes them to providers of trans care. The authors make a scandal of how some providers used creative diagnostic codes to convince insurers to pay for medically necessary treatment.