Protecting Children from Chemical and Surgical Mutilation

January 28, 2025

Presidential Actions

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Action Summary

Policy & Purpose: Prohibits funding, sponsorship, promotion, or assistance for the use of chemical and surgical procedures to alter the sex of children (under 19 years), labeling such procedures as “mutilation” with lifelong consequences.
Definitions:
- Child/Pediatric: Individuals under 19 years; medical care specific to minors.
- Chemical and Surgical Mutilation: Includes puberty blockers, hormone treatments, and surgical interventions aimed at altering natural sexual characteristics, commonly known as “gender affirming care.”
Rejection of Junk Science:
- Directs agencies to rescind or amend policies based on World Professional Association for Transgender Health (WPATH) guidance, including the “Standards of Care Version 8.”
- Mandates a comprehensive review of literature on practices for minors with gender dysphoria, with findings published by the Secretary of Health and Human Services (HHS) within 90 days.
Defunding Measures: Executive departments and agencies providing research or education grants must ensure that institutions cease performing these procedures on children.
Directives to HHS:
- Implement regulatory and sub-regulatory actions across multiple healthcare programs (e.g., Medicare, Medicaid, Section 1557 of the Affordable Care Act).
- Withdraw the March 2, 2022, guidance on gender affirming care and issue new guidance protecting whistleblowers.
TRICARE Amendments: The Department of Defense is directed to initiate rulemaking to exclude these procedures from TRICARE coverage and update provider guidelines accordingly.
Insurance Carrier Requirements:
- FEHB and PSHB programs must exclude pediatric transgender surgeries or hormone treatments, with negotiations aiming to reduce corresponding premiums.
Department of Justice Directives:
- Review and enforce laws against female genital mutilation and consumer fraud regarding misleading information about long-term side effects.
- Coordinate with state Attorneys General on enforcement and work to draft legislation for a private right of action for affected children and their parents.
- Investigate child-abusive practices, including those involving state actions on custody issues.
Reporting & Coordination: Requires a consolidated report from agency heads within 60 days detailing progress and timelines for further action.
General Provisions:
- Includes severability, ensuring the order’s provisions remain effective even if parts are invalidated.
- Clarifies that the order does not create any enforceable substantive or procedural rights.

Risks & Considerations

The Executive Order’s directive to defund chemical and surgical interventions for minors could significantly impact medical research and educational programs at institutions like Vanderbilt University, particularly those involved in pediatric care and gender studies.
There is a potential risk of reduced federal funding for research and educational grants if Vanderbilt is perceived as supporting or conducting research related to gender-affirming care for minors.
The order may lead to increased scrutiny and regulatory compliance requirements for medical and educational institutions, necessitating a review of current practices and policies related to pediatric care and gender dysphoria.
Vanderbilt University may face ethical and reputational challenges, as the order could conflict with the institution’s values or existing policies on diversity, inclusion, and support for transgender individuals.
The order’s emphasis on ending reliance on certain medical guidelines could affect the university’s partnerships and collaborations with organizations that support gender-affirming care.

Impacted Programs

Vanderbilt University Medical Center may need to reassess its protocols and funding sources for pediatric care, particularly those involving gender dysphoria and related treatments.
Peabody College of Education and Human Development might experience changes in research focus and funding opportunities related to child development and gender studies.
The Office of Research may need to evaluate and potentially adjust its grant application strategies to align with the new federal directives.
Vanderbilt’s LGBTQI Life could be affected in terms of advocacy and support services, requiring adjustments to ensure compliance with federal policies while maintaining support for students.

Financial Impact

The potential loss of federal funding for research and educational programs related to gender-affirming care could impact Vanderbilt’s financial resources and necessitate the exploration of alternative funding sources.
Changes in insurance coverage policies, as directed by the order, may affect the financial planning and healthcare benefits offered to university employees and their families.
Vanderbilt may need to allocate additional resources to ensure compliance with new regulatory requirements and to manage potential legal challenges or reputational risks.
There could be a shift in the demographics of students and faculty interested in gender studies and related fields, potentially affecting enrollment and recruitment strategies.

Relevance Score: 5 (The order presents critical risks involving legal or regulatory issues that could significantly impact university programs and funding.)

Key Actions

Vanderbilt University Medical Center should review its current practices and policies regarding pediatric transgender care to ensure compliance with the new federal directives. This includes evaluating any reliance on WPATH guidance and adjusting protocols to align with the latest federal guidelines.
The Office of Federal Relations should engage with federal agencies to understand the implications of the defunding of chemical and surgical interventions for minors. This will be crucial in assessing the impact on research funding and educational grants related to medical and health sciences.
Vanderbilt’s Legal and Compliance Office should monitor developments in federal and state legislation related to gender-affirming care to ensure that the university’s policies remain compliant with evolving legal standards.
The Department of Health Policy should conduct research on the impact of these policy changes on healthcare access and outcomes for transgender youth. This research can inform public policy discussions and contribute to evidence-based advocacy.

Opportunities

The executive order presents an opportunity for Vanderbilt’s School of Medicine to lead in developing alternative care models for minors with gender dysphoria that comply with new federal guidelines. This could position the university as a leader in innovative pediatric care.
Vanderbilt can leverage its expertise in health policy to influence national discussions on the ethical and medical implications of gender-affirming care. Hosting conferences and publishing research on these topics can enhance the university’s reputation as a thought leader.
The focus on data quality and best practices offers an opportunity for Vanderbilt’s Data Science Institute to collaborate with federal agencies in improving data collection and analysis related to pediatric health outcomes.

Relevance Score: 4 (The order necessitates major process changes in medical and research practices at Vanderbilt, particularly in pediatric care and compliance with federal funding requirements.)

Average Relevance Score: 4

Timeline for Implementation

Within 90 days of January 28, 2025: The Secretary of Health and Human Services must publish a review of the existing literature on best practices.
Within 60 days of January 28, 2025: Heads of agencies with responsibilities under this order must submit a combined progress report to the Assistant to the President for Domestic Policy.

The shortest timeline is 60 days, which falls in the 60–89 days category.

Relevance Score: 3

Impacted Government Organizations

Department of Health and Human Services (HHS): Responsible for reviewing medical guidance, rescinding policies based on WPATH’s standards, and publishing a literature review on practices in pediatric care.
Office of Management and Budget (OMB): Required to coordinate with executive departments and agencies to ensure that research or education grants to medical institutions are aligned with the new directives.
Executive Departments/Agencies Providing Research or Education Grants: Mandated to take steps to end funding for practices involving chemical and surgical interventions on children.
Department of Defense: Instructed to amend TRICARE coverage to exclude procedures defined under chemical and surgical mutilation.
Office of Personnel Management (OPM): Tasked with adjusting the Federal Employee Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs to exclude coverage for pediatric gender-affirming procedures.
Department of Justice (DOJ): Charged with reviewing enforcement mechanisms, prioritizing investigations, and coordinating with state authorities regarding applicable laws and potential abuses.

Relevance Score: 3 (Six key Federal agencies are directly impacted by the executive order.)

Responsible Officials

Secretary of Health and Human Services (HHS) – Charged with publishing a review of the existing literature on best practices, increasing data quality, rescinding or amending policies based on WPATH guidance, and issuing new regulatory guidance related to chemical and surgical mutilation of children.
Heads of Executive Departments or Agencies – Responsible for ensuring that institutions receiving Federal research or education grants end the practice of chemical and surgical mutilation, as well as submitting a combined progress report on this order.
Secretary of Defense – Directed to initiate a rulemaking or sub-regulatory action to exclude chemical and surgical mutilation of children from TRICARE coverage and amend the TRICARE provider handbook accordingly.
Director of the Office of Personnel Management – Tasked with embedding exclusion provisions in the Federal Employee Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs and negotiating for premium reductions.
Attorney General – Required to review and enforce relevant legal statutes regarding chemical and surgical mutilation, coordinate with States’ Attorneys General on enforcement, and develop proposals for new legislation protecting affected children and their parents.
Assistant to the President for Domestic Policy – Will receive the aggregated report from agency heads detailing the progress of implementing this order and coordinate further actions.

Relevance Score: 5 (Directives affect key Cabinet-level officials and heads of major agencies with high-level policy and regulatory responsibilities.)