On January 28, President Donald Trump signed an executive order ending federal funding for all American medical institutions that provide gender-affirming care to people under the age of 19.

The order, titled “Protecting Children from Chemical and Surgical Mutilation,” was quickly challenged on constitutional grounds by doctors and Democratic state attorneys general, and temporarily blocked nationwide by federal judges in both Baltimore and Seattle. Last week, a federal judge extended the injunction. 

But the order, and the possibility that a higher court could allow it to stand, is already having serious consequences for people who need to access gender-affirming care. A number of medical institutions, including Seattle Children’s Hospital, have halted or postponed gender-affirming procedures. 

So far, that has not happened in the Portland area. OHSU President Steve Stadum wrote in an email to the Mercury that the hospital “has not made any policy changes” in response to the executive order. 

“OHSU has a process in place for monitoring, evaluating and responding to any federal actions or legislation that may directly impact our programs and services,” Sara Hottman, associate director of media relations, wrote. “The executive order on gender-affirming care is very scary for patients and their families. We are continuing to provide this care.”

Legacy Health says it hasn't made any changes in its gender care services, either. "We remain committed to our mission of good health for our people, our patients and our communities," an emailed statement from the organization reads.

The Cascade AIDS Project and its Prism Health clinics are similarly continuing to offer gender-affirming services to people of the age of medical consent in Oregon as they track the ongoing legal developments. 

“As is our current policy, we will continue to follow federal and state laws regarding the services we provide,” a spokesperson for the organization wrote in an email to the Mercury. “We will continue to monitor any changes that develop, and partner with local and state officials to seek guidance as needed.”

The threat to federal funding for institutions that provide gender-affirming care to people under 19 is just one part of the executive order, which is just one aspect of a broader Trump administration assault on the rights of transgender and gender non-conforming Americans. 

The executive order also directs federally-run insurance programs like Medicaid to stop covering gender-affirming care, characterizing it as “mutilation.” The order builds on a January 20 executive order that federal government policy will only recognize two sexes, male and female, which are “not changeable” and “grounded in… incontrovertible reality.”

So far, however, judges have been skeptical that at least parts of the executive order are constitutional. 

“The [court found that] the President doesn’t have the power to cut off funding, and the court also found that the executive order discriminates against transgender people on its face and violates federal law and the Constitution,” Eri Andriola, the litigation manager at the ACLU of Oregon, said. “These are very strong opinions.”

William Funk, an emeritus professor of law at Lewis & Clark, said a court could ultimately allow the part of the executive order that ends federal funding for gender-affirming care depending on how civil rights law regarding transgender people is interpreted, but that entirely cutting federal funding to institutions that provide that care is legally more dubious. 

“There’s Supreme Court case law that suggests that would not be alright, at least if the entity could successfully separate the funds they get from the federal government to ensure they don’t go to that kind of treatment,” Funk said. 

That, of course, could be challenging—particularly for organizations who use federal funding to cover overhead or administrative costs. Part of the aim of the executive order, Funk posited, is simply to make life difficult and uncertain for medical institutions that provide gender-affirming care.

“The question is are hospitals and doctors going to be intimidated to say, ‘Okay, I don’t want to worry about anything else, I’m just going to stop doing this stuff,” Funk said. “And the answer is, it’s entirely possible.” 

Andriola agreed and said that, given the government’s intent, it is important that providers “don't obey the cruel and discriminatory orders in advance.”

In the meantime, gender-affirming care remains legal in Oregon. Cascade AIDS Project (CAP) leaders are in communication with the Oregon Health Authority and other state officials regarding the situation. 

Oregon is among the states suing over the president’s executive order. State Attorney General Dan Rayfield joined with Washington and Minnesota to sue the Trump administration r in February, saying in a statement that his office is “vigorously exploring all legal options to challenge any policies or actions that hinder access to the care Oregonians need and their rights to make their own medical decisions.” 

If the executive order is allowed to stand, however, the effects on the local healthcare landscape could be devastating.

CAP, which provides care to more than 20,000 people in the Portland metro area each year, would face a budget shortfall of “millions of dollars” if it loses its access to direct federal funding and Medicaid billing, potentially resulting in an “across-the-board severe reduction in all the services we provide, including gender-affirming care at our Prism Health clinics.”

That could mean potential closure of some of the organization’s longest-running programs, including emergency rental, mortgage, and utility assistance, free HIV and STI testing, and HIV medical case management. 

In response to the upheaval and uncertainty of the last month-plus, CAP has launched a resilience fund in an effort to secure the kind of emergency funding that would allow the organization to continue providing care in the case of a sudden loss of federal funding sources. 

That fund got a major boost in February when The Heatherington Foundation made a $1 million donation. The organization has estimated it would need to cover some $3.5 million in its yearly budget if it lost its federal funding. 

It remains to be seen whether the CAP will need the emergency funding. Funk said the case could get all the way to the conservative-dominated Supreme Court, but said that if the federal government appeals and loses several times, it’s unlikely the requisite number of Supreme Court justices would agree to review the case even if the federal government appealed to them. 

Nevertheless, the administration may feel it will have better odds with a more conservative set of justices than the judges who have heard the case so far. The two judges who granted temporary restraining orders were both appointed by former President Joe Biden, with the challenges being brought in Democratic strongholds. 

Given that, and the volume of executive orders issued over the Trump administration’s first weeks in office, the battle over funding and legal protections could continue for months. 

“This is just part of a war against gay, lesbian, transgender [people],” Funk said. “That’s what it is. It’s just a war against them. And I don’t know whether a majority—or a plurality—of the people of the United States really want that.”