The Republican-led Congress is considering plans to cut Medicaid to help pay for tax cuts, with the House budget resolution targeting $880 billion or more in potential reductions to federal Medicaid spending. Medicaid is the primary program providing comprehensive health and long-term care to one in five people living in the U.S and accounts for nearly $1 out of every $5 spent on health care. Reductions in Medicaid could have implications for enrollees as well as plans, providers, and state budgets. While there are several policy options under consideration in Congress to achieve savings, it is not clear how much support there is from Republicans (including President Trump) about these specific policies. The discussions in Congress come at a time when support for the Medicaid program continues to be strong. According to KFF polling, Medicaid is viewed favorably by a large majority (77%) of the public and an even larger share of those on the program (84%). As Congress considers reducing Medicaid spending, nearly half (46%) of all people and nearly two-thirds (62%) of Medicaid enrollees believe the federal government is currently not spending enough on the program.

To better understand the experiences of Medicaid enrollees and their perceptions of potential changes to the program, KFF conducted five virtual focus groups in January, including three groups with participants who had voted for President Trump in the 2024 election and two groups with participants who had voted for Vice President Harris. Focus group participants were asked about their experiences with their Medicaid coverage, views on government’s role in health care, and perceptions of the recent election. Participants were also asked for their reaction to current proposals to reduce federal spending on Medicaid and impose work requirements. Despite differences in who they voted for in November 2024, participants had consistently favorable experiences with Medicaid and concerns with potential cuts to the program. Key findings from our groups include the following:

Many Trump and Harris voters said that their top voting issue in the 2024 election was the economy, though some Trump voters cited immigration, and some Harris voters cited women’s rights as their top issues, and most participants said they did not recall hearing about changes to health care programs (including Medicaid) during the campaign. Most participants said the government has a role to play in making health care more affordable and accessible, but some Trump voters argued the private sector does a better job of controlling costs. When asked about fraud in the Medicaid program, many participants said they thought fraud exists, but views differed on whether it is a major issue and what was the primary cause. Several Trump voters believed the problem was due to people enrolled who were not eligible; however, other participants, including both Trump and Harris voters countered that state verification procedures prevent individuals from defrauding the program on a large scale and that providers and insurance companies were more likely the main source of program fraud.

At the time of the focus groups, most participants had not heard about proposals to reduce federal spending on Medicaid, and while most did not know why the reductions were proposed, some Trump voters suggested they were part of the crackdown on illegal immigration and aimed at removing undocumented immigrants from the program (undocumented immigrants are not eligible for federally-funded Medicaid). Participants opposed cutting Medicaid funding to pay for tax cuts that they did not believe would benefit them. Both Trump and Harris voters expressed fears that these changes would jeopardize the program, take away access to health care, result in worse health outcomes, and increase out-of-pocket costs. A few Trump voters did not believe Trump would follow through on the cuts to Medicaid because they believed he understood their financial struggles.

Both Trump and Harris voters valued their Medicaid coverage and the access to health care services, mental health services, and medications for themselves and their children it provides. Participants also valued Medicaid because it helps to protect them from financial disaster, alleviates stress, improves health outcomes and often supports their ability to work. Participants said losing Medicaid would “be devastating” and lead to serious consequences for their physical and mental health and exacerbate pre-existing financial challenges.

If work requirements were introduced to Medicaid, participants who were working generally felt confident in their ability to meet the requirements; however, they worried about the burden of monthly reporting requirements when those were described to them. Many participants across parties noted that access to treatment for chronic conditions, including prescription medications and mental health treatment, were key in helping to support their ability to work. More Trump voters supported a work requirement but some who were not working were convinced they would qualify for an exemption. Other participants, including both Trump and Harris voters, who were not currently working felt they would face challenges in meeting the requirements. Those who were not working said they wanted to work (and many had been previously working for many years) but were generally unable to because of disability or because they were caring for young children or a sick parent.

Both Trump and Harris voters wanted policymakers to focus on improving Medicaid instead of cutting it. For example, some participants said they would like to see enhanced dental benefits, increased doctor availability, and fewer prior authorization requests. Focus group participants wanted policymakers to consider the implications of federal cuts to Medicaid for people, their health, financial stability, and ability to be productive members of society.

General Situation

Most focus group participants were experiencing financial challenges and were managing an array of physical and/or mental health conditions. Medicaid eligibility requirements mean those on the program, by definition, have low incomes. Most participants described struggling with high food prices and noted the past few years have been financially difficult. Some focus group participants reported difficulties with the current job market or described injuries or disabilities that made it difficult to find employment. Focus group participants were managing an array of health conditions including high blood pressure, diabetes, physical disabilities, chronic pain, asthma, and anxiety and depression. Some were managing more complex and potentially disabling conditions, such as cystic fibrosis and hidradenitis suppurativa (HS). Along with managing their own conditions, some participants were also caring for parents or other family members in nursing care.

“Times are tough right now. You know, everything’s overpriced and no one’s working and can’t afford anything and my health is terrible, so it’s kind of tough times.” 50-year-old, White female

(Trump voter, Nevada)

Experiences with Medicaid

Participants valued their Medicaid coverage and the access to health care services, mental health services, and medications for themselves and their children it provides. Along with regular physical exams for themselves and their children, focus group participants reported using Medicaid to see specialists, access mental health and substance use disorder treatment, receive necessary surgeries, and get prescription medications. Some participants with health conditions requiring frequent visits with specialists or multiple daily medications said they could not imagine day-to-day life without Medicaid.

“Doctor’s visits, I take 30 pills a day, so it covers all that, which is nice. I see the ENT like every other week.” 35-year-old, White female

(Trump voter, North Carolina) “I’m really grateful for it. When I first got on it, it covered for 90 days for me to go to a rehab and then it has covered my prescriptions with no questions asked.” 33-year-old, White female

(Trump voter, Arizona)

Participants described Medicaid coverage as affordable, noting that it protects them from financial disaster and alleviates stress. Participants expressed gratitude that they could access necessary medications with little to no cost sharing, and in general were appreciative that they had no premiums and low out-of-pocket costs. Participants said that having Medicaid reduces stress related to unexpected medical costs. Prior to enrolling in Medicaid, many participants had been uninsured and had gone long periods of time without seeing a doctor. These participants were grateful that they were now able to access regular care. Those who had previously looked into or been enrolled in private insurance described Medicaid as a more affordable source of coverage.

“I never took insurance from where I was employed at because it was always so expensive. By the time they would take out the money, there wasn’t much of a check. So I was basically gonna be paying for insurance, which I know a lot of people have to do. Went a while without anything so Medicaid’s been really great as far as helping me out with doctor appointments, used to help me out with dental. I used it a little bit for mental therapy when I lost my daughter unexpectedly. So it’s been good.” 61-year-old, White female

(Trump voter, Kentucky)

While participants said Medicaid was generally working well for them, some would like to see improvements, including enhanced dental benefits, increased doctor availability, and fewer prior authorization requests. Participants noted that it can be difficult to find doctors accepting Medicaid and frustrating to navigate prior authorizations for needed care. Other complaints included high turnover rates among providers at clinics that accept Medicaid and certain prescriptions not being covered by the program. Many focus group participants also wished that their state either covered dental benefits or had more generous dental benefits.

“There’s not like every doctor available, thankfully the doc I had before, I still am on the same doctor ’cause he is under my Medicaid, which is good. But there’s not coverage everywhere and certain things, so that’s kind of, you know, slight disadvantage there.” 59-year-old, White male

(Harris voter, Pennsylvania)

Views on Government’s Role in Health Care

Participants felt that being able to easily access affordable health care services is essential to ensuring they can work and lead productive lives. Across voting parties, most participants felt that everyone deserved access to affordable health coverage, with many saying that people should not have to pay for what they described as “life or death” care. Some participants noted that being able to access health care services helps them to work, be more productive, and contribute to society. However, a few Trump voters talked about the need for people to take responsibility for their health suggesting that they did not believe health care was a right for everyone.

“Healthcare is a right because you want the American people to work. So in order for the American people to work, they need to be healthy to work.” 52-year-old, Black female

(Trump voter, Pennsylvania) “If we’re healthier, it makes our country healthier and we produce. If you got a bunch of sick people that have no insurance, all you’re gonna do is cause debt, death, and god knows what else.” 56-year-old, White male

(Harris voter, Ohio)

Most participants said the government has a role to play in making health care more affordable and accessible; however, some Trump voters opposed government playing too large a role in running the health care system. Both Trump and Harris voters said the government has a role in making coverage more affordable, but some Trump voters noted that they felt private businesses may be more effective at keeping health care costs affordable than the federal government. More Harris voters (and some Trump voters) felt that the government should play a role in helping everyone access health care and in making the system work better. Both Trump and Harris voters compared the U.S. to other countries with nationalized health care systems, though takeaways from these comparisons differed. Some Trump voters referenced long wait times for care in other countries as evidence for why they did not think the U.S. should move to a socialized medicine model. Others (including both Trump and Harris voters) noted that the government should offer free care for all citizens, similar to other countries.

“It should be available for everybody. And it should be affordable. Because not everybody can afford the same thing… it’s usually the private sector does a better job with lowering costs and making things affordable and having options for people, not the government. I pay enough already in taxes that I don’t need to control anymore what I have to pay taxes for.” 45-year-old, Black male

(Trump voter, Kentucky) “It shouldn’t be an issue in a country this rich that people are going without it. I mean, it shouldn’t even be a question. It should be cut and dry. And we look at other countries, you know, it’s something they already have that the citizens have. And for a country that’s rich as America, it shouldn’t be your money or your life. You shouldn’t have to choose between medicine or buying food, or medicine and paying your life bill. It’s a right of an American citizen.” 61-year-old, Black female

(Harris voter, Kentucky)

Election Experiences

Many Trump and Harris voters said that their top voting issue in the 2024 election was the economy. Most Trump and Harris voters cast their ballot based on economic concerns and which candidate they thought would address their pocketbook issues, including housing costs and grocery prices. Some Trump voters noted that their standard of living was better under the first Trump administration while some Harris voters were worried that Trump would cut benefits. Immigration was a top voting issue for some Trump voters, especially for those living in border states. A few Harris voters cited women’s issues and preserving democracy as the motivations for their votes.

“When Trump was in office from ‘16 to ‘20, you know, my standard of living was better than it is now.” 43-year-old, White male

(Trump voter, Pennsylvania) “Someone who’s not about to cut food stamps, cut housing, cut WIC, cut many stuff that we everyday people need.” 45-year-old, Black female

(Harris voter, Ohio)

Most participants said they did not recall hearing either candidate mention changes to health care programs (including Medicaid) during the campaign. Because other issues, including immigration and the economy, dominated the campaign, most participants were unaware of either candidate’s health care priorities and any policy changes they planned to make. Some Harris voters recalled Harris discussing women’s health care and abortion access, and a couple of participants said they heard that Trump would either try to get rid of Obamacare (the Affordable Care Act) or would fix it. However, for the most part, health care issues were not a dominant factor in the election for these voters.

“I didn’t hear a peep about healthcare. Nope. It’s immigration for me.” 56-year-old, White male

(Trump voter, Arizona) “I think Kamala talked about healthcare like for women’s rights a lot. I feel like that was kind of one of her main points… I had never really heard Donald Trump talk about it. I heard about it in like Project 2025.” 25-year-old Black female

(Harris voter, Pennsylvania)

Proposals to Reduce Federal Medicaid Spending

At the time of the focus groups, most participants had not heard about proposals to reduce federal spending on Medicaid, but Trump and Harris voters had different opinions on why the cuts were being proposed. No Trump voters and only a very few Harris voters said they were aware of proposals in Congress to reduce federal spending on Medicaid, and many were surprised to hear of the proposed cuts. Although most participants were not sure why the spending reductions had been proposed, some Trump voters theorized that it was part of the administration’s crackdown on illegal immigration and an effort to remove undocumented immigrants from the program (undocumented immigrants are not eligible for federally-funded Medicaid). A few Trump voters did not think Trump would follow through on the cuts because they believed he understood their financial struggles. Some Harris voters felt the proposals reflected a pattern by Republican lawmakers to reduce benefits for poor Americans.

“I’m a border state, so we’ve had so many illegals coming through and the previous administration they got all free social services. So I imagine that’s part of the thing that we were giving Medicaid to people who have been here hours and stuff. And so it’s one way to prevent or to get some cost cutting.” 59-year-old, Hispanic female

(Trump voter, Arizona) “Their goal is to make sure that we don’t have anything. So why they’re taking everything outta everything because the rich wanna get richer.” 58-year-old, Black female

(Harris voter, Ohio) “I think Trump knows that people are struggling right now, and I don’t think he’s gonna do, at least not right now, cut anything Medicaid because he just knows people’s financial problems right now.” 45-year-old, Hispanic male

(Trump voter, Arizona)

When asked specifically about fraud and abuse in Medicaid, some participants across both groups believed there is fraud and abuse in the Medicaid program, but opinions were mixed on whether the source of the fraud is people enrolled who should not be or providers and insurance companies taking advantage of the system. The Trump administration has tied current actions to reduce federal spending to eradicating fraud, waste, and abuse within government programs. Many focus group participants agreed there was fraud in the Medicaid program; however, some described fraud as a major problem in the program and others reasoned there is fraud in Medicaid because there is fraud everywhere. When identifying the source of fraud in Medicaid, several Trump voters believed fraud was primarily due to people enrolled who were not eligible. Other participants, including both Trump and Harris voters countered that it would be too difficult for individuals to defraud the program on a large scale, describing how their states verify their income and other information at application and renewal. Some participants believed that providers and insurance companies overcharging the program or billing for services they did not provide were to blame rather than individuals. These participants offered examples of providers in their states who were convicted of fraud.

“Fraud is probably pretty prevalent, just like it was in everything else… People can abuse anything, so. If they have access to that, I’m sure there’s been some fraud over the years with Medicaid.” 56-year-old, White male

(Trump voter, Arizona) “I think it’s organizations more than people. I think it’s kind of hard to defraud with Medicaid. I mean, what are you doing going and asking for prescriptions and then selling them on the side? I mean, I don’t know how you would or having a high paying job and pretending you don’t work. I mean everything is available now on the internet. Everything’s tied in. Like me, our local Medicaid in Arizona was able to access my paychecks even before I saw what I was going to get one time they had it already on their screen.” 59-year-old, Hispanic female

(Trump voter, Arizona) “Most of the fraud that I’ve heard about comes from the actual provider billing for things they didn’t do.” 45-year-old, Black female

(Harris voter, North Carolina)

Both Trump and Harris voters opposed cuts to the program fearing that Medicaid spending reductions would jeopardize the program and take away access to health care for poor people. Likely because of their reliance on the Medicaid program, participants opposed reducing spending on Medicaid, and many used strong language to describe the dire consequences of making major cuts to the program. Some participants predicted people would lose coverage if cuts were made to the program, and one participant suggested the economy would suffer because many of the people currently on the program would no longer be able to get the care they need. Others anticipated that states would cut benefits, particularly for prescription medications and mental health care, and that providers would stop participating in the program.

“We shouldn’t have to suffer because of somebody wanting to propose cuts to it, you know, because we, we didn’t do anything. So, you know, let it, it can come from somewhere else. I just, I would oppose it.” 60-year-old, Black male

(Trump voter, Missouri) “People would be unable to take care of themselves and be healthy and get mental health issues taken care of, to get vision and dental; people would suffer. They wouldn’t be able to work. And the economy would suffer.” 55-year-old, White female

(Trump voter, Oklahoma) “I would oppose [cutting Medicaid] just because there’s a lot of people who need it, who would be affected by it negatively.” 29-year-old, White male

(Trump voter, Pennsylvania)

Participants opposed cutting Medicaid funding to pay for tax cuts that they did not believe would benefit them. Participants explained that because they had low incomes and were already in a low tax bracket, they did not expect their taxes would change much under any tax cut proposal. Both Trump and Harris voters said they would prefer Medicaid coverage to continue unchanged, arguing that the negative consequences of any changes to Medicaid would outweigh any small benefits they would experience from tax cuts. They said other government spending should be targeted to finance tax cuts.

“I don’t make much money to get my taxes affected by that. It would hurt my Medicaid, my medical more.” 50-year-old, White female

(Trump voter, Nevada) “They need to start taxing the right people properly first and then we can discuss that matter. Because we’re the only ones that are paying the taxes… They could put more into the programs if they tax the proper people properly.” 56-year-old, White male

(Harris voter, Ohio)

Participants expected significant changes to the Medicaid program if federal funding were reduced and they worried they would lose coverage or face higher costs. Possible Medicaid spending cuts felt very personal to participants who expected they would be negatively affected by the proposed changes. Participants expressed anxiety over how reduced federal spending may affect out-of-pocket expenses, doctor availability, and covered benefits. Some described life and death consequences of not being able to access mental health care and prescription medications to manage their chronic conditions. Others focused on the financial implications of losing coverage and the impact that would have on their ability to work as well as on out-of-pocket costs for needed care. For participants with family members in nursing homes, the challenge of caring for them at home seemed daunting.

“I would be very worried. It would [mean] not being able to get my antidepressants [and] see a psychiatrist. Yeah, it would, it might crush me.” 45-year-old, Hispanic male

(Trump voter, Arizona) “States are gonna have to start dropping people off the rolls. People like us who are probably single and childless.” 45-year-old, Hispanic male

(Harris voter, Arizona) “It’s gonna be higher out of pocket costs for sure. You know, and that’s something I can’t afford. It’s not just me, it’s me and five other people, you know. So I can’t afford that for me, nonetheless them.” 45-year-old, Black female

(Harris voter, Ohio)

Work Requirements

While some participants were working full-time, many who were working part-time or not working said they wanted to work or work more hours but were unable to because of disability or because they were caring for young children or a sick parent. Participants were working a variety of jobs, including home health aide, dental assistant, tax preparer and gig and contract work, but they needed Medicaid because they were not offered insurance through their work. Several said they were working part-time or not working because of illness or disability or because they were caring for young children or aging parents. Others said that they wanted to be working but have been unable to find employment. For those who were not working for a reason other than disability or illness, several said that to be able to work, they would need supports like affordable childcare, transportation, internet access, or better opportunities in their communities.

“I do self work with Instacart because …I get to pick and choose the days I’m able to work and dealing with my dad, getting in that nursing home and also dealing with my mom now because she’s getting into that phase where she’s needing more doctor appointments.” 52-year-old, Black male

(Trump voter, Missouri) “I can’t work right now because of my back. And I mean, I believe that my back got as bad as it did because I couldn’t go to the doctor when I didn’t have insurance.” 41-year-old, White female

(Trump voter, North Carolina) “Ever since I haven’t been working, I haven’t been able to find a job that’s legal or decent enough for working from home…They all want somebody in the office to stand up or sit down for long periods of time. I can’t even walk to my vehicle without being in pain. Or get into a vehicle and drive that vehicle because of the stress all behind that.” 51-year-old, Black female

(Harris voter, Oklahoma)

Participants who were working said having Medicaid meant they could get the care they needed, especially medications, and provided financial peace of mind that enabled them to work. With high rates of chronic disease among focus group participants, the ability to manage their conditions was described as critical to their ability to work. This was especially true for participants who said their work sometimes exacerbated their health conditions, such as asthma or chronic pain. Keeping Medicaid was important to participants who were working, and several participants noted the challenge of managing work hours to maintain eligibility. One participant described how she lost coverage for one month because she worked too many hours. The income volatility that many workers on Medicaid experience can put them at risk of losing coverage and access to needed prescriptions and health care for a month or longer.

“I can say that even doing the part-time work, if I did not have Medicaid or wasn’t able to do pain management, I wouldn’t even be able to do those, those small amount of hours.” 45-year-old, Black female

(Harris voter, North Carolina) “It would be really hard for me to work a full-time, 9-5 job with all my doctor’s appointments as well as I’m immunocompromised. It’s definitely positive that I can do something I like, something I wanna do and not work as much and still be able to get insurance.” 35-year-old, White female

(Trump voter, North Carolina) “I found out with Medicaid that there’s a cap on how much I can earn. I wasn’t aware of that. And so actually in the fall I was kicked off for about a month because I apparently had earned too much.” 59-year-old, Hispanic female

(Trump voter, Arizona)

Some participants who were not currently working expressed concerns about imposing work requirements in Medicaid, saying they would face challenges meeting the requirements, while others who supported the policy were convinced they would qualify for an exemption. While most participants had not heard about proposals to introduce work requirements for Medicaid, many Trump and Harris voters who were not working said they did not think they would be able to meet the requirements because of chronic pain or other disabilities. Although not currently working, several of these participants described the high demands of jobs they previously held, noting they had to leave those positions because of injuries or other health conditions. More Trump voters than Harris voters supported a work requirement policy, but several Trump voters who were not working and supported the idea of work requirements strongly believed they would qualify for an exemption because they have a disability or caregiving responsibilities. However, most participants with a disability were not receiving disability income and, therefore, may not meet disability exemptions, which in past proposals have been based on receiving Supplemental Security Income (SSI).

“I can’t because I have chronic pain and I just can’t. I worked until I couldn’t work no more.” 57-year-old, White female

(Trump voter, Missouri) “There’s nothing out here from miles and miles. I live in between two towns and it’s still nothing, you know, so people don’t always have the resources or availability to do what they ask.” 39-year-old, Black female

(Harris voter, North Carolina) “I mean, if you’re able bodied then, then you should still be working and trying and proving to them that you’re able to, ’cause like I said earlier, I want to work, but because of daycare costs, financially I can’t.” 34-year-old, White female

(Trump voter, Kentucky) “I already know I am exempt because I’ve seen this proposal and I already know I was exempt from it. But no, I wouldn’t be able to meet it if I wasn’t exempt.” 57-year-old, White male

(Harris voter, Pennsylvania)

Participants who were working generally felt confident in their ability to meet the requirements; however, some worried about the burden of monthly reporting requirements. Given the number of hours they were working, most participants who were working felt that they would be able to meet any new requirements. But on the issue of reporting on work status monthly, participant opinions diverged. Some said that they were already submitting this information regularly to programs such as SNAP, so they were not worried about this requirement also being required in Medicaid. Others, however, expressed concern about having to report to the state each month, noting that they are human and prone to forget and that reporting requirements can be onerous. They also worried about the consequences of losing coverage for a month if they forget to report their work information in a month. As an alternative to submitting additional paperwork, some suggested an automated system, similar to how income is verified at renewal, would be more efficient.

“Required? Oh yeah. Easy. Oh yeah, absolutely. Mind you, I can’t do certain jobs. I can’t drive, if you will, but yeah, I can, I could do it. I can make it work.” 45-year-old, Hispanic male

(Harris voter, Arizona) “It’s gonna be devastating and upsetting to, you know, if you lose your health insurance if I forget as we tend to, we are only humans, sometimes we forget things. So if I don’t do this [report work hours], it affects the rest of my household and I don’t like that.” 45-year-old, Black female

(Harris voter, Ohio) “I would be very worried about them making mistakes. There’s been many times I’ve sent in paperwork and they didn’t get it and coverage was stopped. You know, a lot of room for clerical error and things like that.” 50-year-old, White female

(Trump voter, Nevada)

Consequences of Losing Medicaid Coverage

Both Trump and Harris voters said that losing Medicaid coverage would be “devastating” and would lead to serious consequences for their physical and mental health. Participants emphasized that the health care services and prescriptions they and their children receive through Medicaid helps them “survive.” Across groups, participants said that losing their Medicaid coverage would create financial challenges and expressed anxiety at the thought of being unable to afford prescriptions, doctor visits, or higher premiums on top of pre-existing financial challenges if there were major changes to Medicaid. Although focus group participants were not aware of the nuances of congressional proposals, all participants were residing in Medicaid expansion states and those who were eligible due to Medicaid expansion could be especially vulnerable to proposed changes in the program.

“I think obviously, not having access to healthcare, or having to have the financial ability to pay for your medical needs, your basic medical needs, is something that we shouldn’t have to worry about because we worry about how we’re going to eat. We worry about how we’re gonna pay our bills… Not having Medicaid would be, not distressful, it would be detrimental because I need to see a primary care doctor, I need to see my specialist.” 58-year-old, Black female

(Harris voter, Ohio) “For me it would, it would probably lead to death, and that’s kinda harshly speaking, but it’s the way that it would be. I’ve relied upon Medicaid for myself in order to survive. For my son, it would be survivable, but it would be difficult. He has real bad allergies, he wouldn’t be able to hear.” 55-year-old, White female

(Trump voter, Oklahoma)

When asked to respond to proposals to reduce federal Medicaid spending, participants appealed to policymakers to consider how these changes would negatively impact people. Participants felt that reducing federal funding for Medicaid would have serious consequences and hurt many people on the program. Some participants pointed out that many people enrolled in Medicaid could not afford any other alternatives and would have no way to access care if they were to lose coverage. The message of several Trump voters to policymakers was to focus on improving Medicaid instead of cutting it. Across groups, participants asked policymakers to remember the human impact of potential changes to the program.

Initial Rescissions of Harmful Executive Orders and Actions, January 20, 2025

Purpose: Initial rescissions of Executive Orders and Actions issued by President Biden. Among these orders are several that addressed LGBTQ+ equity including “Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation” (Executive Order 13988) and “Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals” (Executive Order 14075). The order establishing the White House Gender Policy Council (Executive Order 14020) and several Orders related to diversity, equity, and inclusion were also rescinded, as were orders related to nondiscrimination and equity in schools. Implications: This order could lead to less oversight, reduced health programing, and fewer policies protecting LGBTQ+ people, which could negatively impact access to care and well-being. Of particular note: Rescinds orders that had called for LGBTQ+ people’s health equity, the national public health needs of LGBTQ+ people, LGBTQ+ data collection, and nondiscrimination protections, including in health care.

Rescinds orders that had called for nondiscrimination protections for LGBTQ+ young people in school, which could contribute to stigma and worsened mental health.

Defending Women From Gender Ideology Extremism and Restoring Biological Truth to The Federal Government, January 20, 2025

Purpose: To define sex as an immutable binary biological classification and remove recognition of the concept of gender identity, including in sex protections and in agency operations. The order states that “It is the policy of the United States to recognize two sexes, male and female” and directs the Executive Branch to “enforce all sex-protective laws to promote this reality”. Elements of the order that may affect LGBTQ people’s health are as follows: Defines sex as “an individual’s immutable biological classification as either male or female.” States that “’sex’ is not a synonym for and does not include the concept of ‘gender identity’” and that gender identity “does not provide a meaningful basis for identification and cannot be recognized as a replacement for sex.”

Defines male and female based on reproductive cell production.

Introduces the term “gender ideology” which is defined to inlcude “the idea that there is a vast spectrum of genders that are disconnected from one’s sex” and “maintains that it is possible for a person to be born in the wrong sexed body.”

Directs the Secretary of Health and Human Services (HHS) to provide the U.S. government, external partners, and the public guidance expanding on the sex-based definitions set forth in the order within 30 days.

Directs each agency and all federal employees to “enforce laws governing sex-based rights, protections, opportunities, and accommodations to protect men and women as biologically distinct sexes,” including “when interpreting or applying statutes, regulations, or guidance and in all other official agency business, documents, and communications.”

Directs each agency and all Federal employees, “when administering or enforcing sex-based distinctions,” to “use the term ‘sex’ and not ‘gender’ in all applicable Federal policies and documents.”

Directs agencies to “remove all statements, policies, regulations, forms, communications, or other internal and external messages that promote or otherwise inculcate gender ideology, and shall cease issuing such statements, policies, regulations, forms, communications or other messages.” Directs agency forms to exclude gender identity and directs agencies to “take all necessary steps, as permitted by law, to end the Federal funding of gender ideology.”

Requires that federal funds “not be used to promote gender ideology” and directs agencies to ensure “grant funds do not promote gender ideology.”

Directs the Attorney General to ensure the Bureau of Prisons revises policies to prohibit federal funds from being expended “for any medical procedure, treatment, or drug for the purpose of conforming an inmate’s appearance to that of the opposite sex.”

Rescinds multiple executive orders issued by President Biden, including: “Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation” (13988), “Establishment of the White House Gender Policy Council” (14020) (which is also dissolved), and “Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals” (14075).

Also directs agencies to rescind certain guidance documents, including, “The White House Toolkit on Transgender Equality”; “The Attorney General’s Memorandum of March 26, 2021 entitled “Application of Bostock v. Clayton County to Title IX of the Education Amendments of 1972,″” and range of orders related to LGBTQ+ students in schools. Implications: This order is broad, directed to all federal agencies and programs. Because federal health programs reach LGBTQ+ people, and some are specifically designed to be inclusive of the LGBTQ+ community, or account for gender identities in addition to biological sex, this Order could widely affect program funding, guidance, and access. It has several possible implications: The terms used in the Order include several biological and social inaccuracies which could perpetuate misinformation about LGBTQ+ people and transgender people’s health needs. It also takes steps towards ban gender care in certain area, most explicitly in prisons. Requiring that federal funds are not used to “promote gender ideology” has caused significant confusion. Since this order was issued, there have been multiple reports of HIV programs and community health centers that have lost funding as a result of supporting programs inclusive of transgender people. In addition, there have been reports that some health care facilities paused providing youth with gender affirming care, fearing that federal funding would be withheld according to this and another Order relating to youth access to gender affirming care (see separate entry). (See court decisions below.) Withholding care could lead to negative health outcomes for those that require it. Data collection and data presentation/distribution have been impacted. At first some data was removed from federal websites, though due to court order this appears to have been restored. If public health messaging and services related to the health needs of transgender people, or other specific populations, are unavailable, this may result in adverse health outcomes such increased disease prevalence, greater difficulty with care engagement, and poor mental health outcomes. There have been reports that gender identity questions will be removed from federal surveys which makes tracking the experiences and well-being of LGBTQ+ people more difficult. The order directs the HHS Secretary to take action to end gender affirming care through Section 1557 of the Affordable Care Act (ACA), the law’s major nondiscrimination provision, which includes protections on the basis of sex. While the Biden administration interpreted sex protections to include sexual orientation and gender identity, it is expected that the Trump administration will seek to remove these protections, as was the approach during his first term. Despite the Executive Orders and any future guidance, courts could continue to rule that such protections exist in statute. On March 17th the VA announced that it would phase out providing gender affirming care to comply with this Executive Order. Exceptions include Veterans already receiving hormone therapy from the VA or Veterans “receiving such care from the military as part of and upon their separation from military service” who are eligible for VA health care. The VA will not provide other gender affirming medical services. The statement writes that historically the VA had provided a range of gender affirming services and “letters of support encouraging non-VA providers to perform sex-change surgeries on Veterans.” These services had been authorized under the now rescinded Veterans Health Administration Directive 1341(4). There have been multiple legal challenges to this Order with some judicial actions that have paused aspects of implementation: On February 4, 2025 a lawsuit was filed in federal court challenging the Order on the grounds that it usurps Congressional power, violates Sec. 1557 of the ACA, and is unconstitutional and on February 11 a temporary restraining order and memorandum opinion was issued requiring restoration of webpages, datasets, and any other resources needed to provide medical care, identified by the Plaintiffs.

On February 4, 2025, a separate federal lawsuit was filed challenging this Order and the Executive Order on “Protecting Children from Chemical and Surgical Mutilation” (see separate entry), asserting they are openly discriminatory, unlawful, and unconstitutional. On February 13, a federal judge issued a temporary restraining order preventing the federal government from withholding or conditioning funding on the basis of providing this care.

temporary restraining order An additional suit was filed on February 19, 2025 by the National Urban League, National Fair Housing Alliance, and AIDS Foundation of Chicago challenging three Executive Orders: “Ending Radical and Wasteful DEI Programs and Preferencing”, “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” and the “Ending Illegal Discrimination and Restoring Merit-Based Opportunity” as usurping the power of Congress, violating the Constitution and the Administrative Procedures Act, and, seeking declaratory and injunctive relief. In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ+ communities and the programs that serve them.

On February 20, a separate case was filed th , 2026, the court in federal court by multiple LGBTQ+ health care and service organizations, challenging the “Ending Radical and Wasteful DEI Programs and Preferencing”, “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” and the “Ending Illegal Discrimination and Restoring Merit-Based Opportunity” Orders claiming they usurp the power of Congress and violate the Constitution. In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ communities and the programs that serve them. On June 9, 2026, the court issued a preliminary injunction, blocking in part key provisions in this EO and in the DEI EO including those that instruct agencies to remove and cease to issue materials and “communications…that promote or otherwise inculcate gender ideology” and instructing agencies to “end the Federal funding of gender ideology”; prohibit federal funds from being “used to promote gender ideology,”; and direct agencies and departments to terminate DEI offices and positions, materials, initiatives, performance requirements, and grants or contracts.

On March 12, 2025 two physician and academic plaintiffs filed a lawsuit challenging the Order and related OPM memo when their articles were removed from HHS’ Agency for Healthcare Research and Quality (AHRQ)’s Patient Safety Network (PSNet), a federal online patient-safety resource. The reason for the removal articles was for their inclusion of passing references to transgender patients. On May 23, a MA district court found the plaintiffs would likely succeed on their constitutional 1st amendment claims and granted a preliminary injunction requiring HHS to republish the censored content.

Ending Radical and Wasteful Government DEI Programs and Preferencing, January 20, 2025

Purpose: To limit diversity, equity, inclusion, and accessibility (DEIA) activities in government and by government contractors and grantees. Directs each agency, department, or commission head to take the following actions (among others): terminate, to the maximum extent allowed by law, all DEI, DEIA, and “environmental justice” offices and positions…; all “equity action plans,” “equity” actions, initiatives, or programs, “equity-related” grants or contracts…

provide the Director of the OMB with a list of all “federal grantees who received Federal funding to provide or advance DEI, DEIA, or “environmental justice” programs, services, or activities since January 20, 2021,” among other actions. Implications: As with the other DEIA related Order (see separate entry), these efforts could make reaching populations with unique health needs in culturally competent ways more challenging, including in programs related to LGBTQ+ health and HIV. It could also jeopardized programs and funding for agencies reaching these communities.

As with the other DEIA related Order (see separate entry), these efforts could make reaching populations with unique health needs in culturally competent ways more challenging, including in programs related to LGBTQ+ health and HIV. It could also jeopardized programs and funding for agencies reaching these communities. There have been multiple legal challenges to this Order:

On February 3, a lawsuit was filed by four diverse plaintiffs challenging the constitutionality of this Order and the Order, “Ending Illegal Discrimination and Restoring Merit-Based Opportunity”.

An additional suit was filed in federal court on February 19, 2025 by the National Urban League, National Fair Housing Alliance, and AIDS Foundation of Chicago challenging this order as well as the “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” and the “Ending Illegal Discrimination and Restoring Merit-Based Opportunity” ” as usurping the power of Congress, violating the Constitution and the Administrative Procedures Act, and, seeking declaratory and injunctive relief. In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ communities and the programs that serve them.

On February 20, a separate case was filed th, 2026, the court in federal court by multiple LGBTQ+ health care and service organizations, challenging the “Ending Radical and Wasteful DEI Programs and Preferencing”, “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” and the “Ending Illegal Discrimination and Restoring Merit-Based Opportunity” orders claiming they usurp the power of Congress and violate the Constitution. In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ communities and the programs that serve them. On June 9, 2026, the court issued a preliminary injunction, blocking in part key provisions in this EO and in the “gender ideology” EO including those that instruct agencies to remove and cease to issue materials and “communications…that promote or otherwise inculcate gender ideology” and instructing agencies to “end the Federal funding of gender ideology”; prohibit federal funds from being “used to promote gender ideology,”; and direct agencies and departments to terminate DEI offices and positions, materials, initiatives, performance requirements, and grants or contracts.

Ending Illegal Discrimination and Restoring Merit-Based Opportunity, January 21, 2025

Purpose: Order seeks to end federal “preferencing” through DEIA efforts within government and through contracting to the extent that they do not comply with the Administration’s view of civil rights law. The order is broad and non-specific but includes the following directives: Orders all executive departments and agencies “to terminate all discriminatory and illegal preferences, mandates, policies, programs, activities, guidance, regulations, enforcement actions, consent orders, and requirements. I further order all agencies to enforce our longstanding civil-rights laws and to combat illegal private-sector DEI preferences, mandates, policies, programs, and activities.”

Orders agency heads to include in every contract or grant award “a term requiring the contractual counterparty or grant recipient to agree that its compliance in all respects with all applicable Federal anti-discrimination laws is material to the government’s payment decisions for purposes of section 3729(b)(4) of title 31, United States Code; and…A term requiring such counterparty or recipient to certify that it does not operate any programs promoting DEI that violate any applicable Federal anti-discrimination laws.” Implications: As with the other DEIA related Order (see separate entry), these efforts could make reaching populations with unique health needs in culturally competent ways more challenging, including in programs related to LGBTQ+ health and HIV. It could also jeopardized programs and funding for agencies reaching these communities. There have been multiple legal challenges to this Order: On February 3, a lawsuit was filed by four diverse plaintiffs challenging the constitutionality of this and the “Ending Radical and Wasteful Government DEI Programs and Preferencing” Order.

An additional suit was filed in federal court on February 19, 2025 by the National Urban League, National Fair Housing Alliance, and AIDS Foundation of Chicago challenging this order as well as the “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” and the “Ending Radical and Wasteful Government DEI Programs and Preferencing” as usurping the power of Congress, violating the Constitution and the Administrative Procedures Act, and, seeking declaratory and injunctive relief. In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ communities and the programs that serve them.

On February 20, a separate case was filed in federal court by multiple LGBTQ+ health care and service organizations, challenging the “Ending Radical and Wasteful DEI Programs and Preferencing”, “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” and the “Ending Illegal Discrimination and Restoring Merit-Based Opportunity” orders claiming they usurp the power of Congress and violate the Constitution. In their complaint, plaintiffs highlight the potential harm this Order could bring to people with HIV and LGBTQ communities and the programs that serve them.

Protecting Children From Chemical and Surgical Mutilation, January 28, 2025

Purpose: Order directs agencies and programs to work towards significantly limiting access to gender affirming care for young people (defined as those under age 19) nationwide. Directs agencies to rescind and amend policies that rely on guidance from the World Professional Association for Transgender Health (WPATH).

Directs the HHS Secretary to conduct and publish a review of existing literature and best practices related to gender affirming care and gender dysphoria and to “increase the quality of data to guide practices“ in this area.

Directs executive department and agency heads “that provide research or education grants to medical institutions, including medical schools and hospitals”, “in coordination with the Director of the Office of Management and Budget” to “immediately take appropriate steps to ensure that institutions receiving Federal research or education grants end the chemical and surgical mutilation of children” (which is how the Order defines gender affirming care).

Directs the HHS Secretary to take action to end gender affirming care for children “including [through] regulatory and sub-regulatory actions, which may involve the following laws, programs, issues, or documents: Medicare or Medicaid conditions of participation or conditions for coverage clinical-abuse or inappropriate-use assessments relevant to State Medicaid programs mandatory drug use reviews section 1557 of the Patient Protection and Affordable Care Act quality, safety, and oversight memoranda essential health benefits requirements; and the Eleventh Revision of the International Classification of Diseases and other federally funded manuals, including the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.”

Withdraws Biden Administration “HHS Notice and Guidance on Gender Affirming Care, Civil Rights and Patient Privacy” and directs the Secretary of HHS “in consultation with the Attorney General [to] issue new guidance protecting whistleblowers who take action related to ensuring compliance with this order.”

Directs the Secretary of the Department of Defense to “commence a rulemaking or sub-regulatory action” restrict access to gender affirming care for children in the TRICARE program.

Directs the Director of the Office of Personnel Management to limit access to care in coverage for federal employees’ families by requiring “provisions in the Federal Employee Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs call letter for the 2026 Plan Year” that would require eligible carriers to exclude “coverage for pediatric transgender surgeries or hormone treatments…”

Directs the Attorney General to review Department of Justice laws on female genital mutilation and “prioritize enforcement of protections” and “to convene States’ Attorneys General and other law enforcement officers to coordinate the enforcement of laws against female genital mutilation.”

Directs the Attorney General to “prioritize investigations and take appropriate action to end deception of consumers, fraud, and violations of the Food, Drug, and Cosmetic Act by any entity that may be misleading the public about long-term side effects of chemical and surgical mutilation.”

Directs the Attorney General “in consultation with the Congress” “to draft, propose, and promote legislation to enact a private right of action for children and the parents” who have received gender affirming care “which should include a lengthy statute of limitations.

Directs the Attorney General to “prioritize investigations and take appropriate action to end child-abusive practices by so-called sanctuary States that facilitate stripping custody from parents who support the healthy development of their own children, including by considering the application of the Parental Kidnapping Prevention Act and recognized constitutional rights.”

Directs agency heads included in this executive order to “submit a single, combined report to the Assistant to the President for Domestic Policy, detailing progress in implementing this order and a timeline for future action” within 60 Days of its issuance. Implications: If fully implemented, the Order would broadly and extensively limit access to gender affirming care for young people, across a range of payers and providers. Access to gender affirming care is associated with improved mental health outcomes for transgender people and limiting this care with negative ones, including poorer mental health outcomes. Additional impact includes: The executive order includes details about sex, gender identity, gender affirming care, and transgender people that conflict with science and evidence. These inaccuracies include suggesting that large shares of youth are seeking gender affirming medical care, that regret rates among those seeking care are high, and conflating “female genital mutilation” and gender-affirming care. This has the potential to promote hostility, stigma, and discrimination, and can lead to care denials.

It seeks to remove Federal reference to one of the standards of evidence-based care for transgender people in the US. Directing the HHS Secretary to develop new guidance without this standard, and in accordance with this and other orders, could limit agency ability to identify standards that adequately meet the needs of transgender people.

It also seeks to condition federal research and education grants on grantees not providing young people with gender affirming care.

There has already been some confusion with certain states and providers looking to preemptively comply with the order and another Order relating to “gender ideology” (see separate entry).

The order lays groundwork for the Administration remove explicit protects for LGBTQ+ people in health care, including with respect to accessing gender affirming care. Specifically, the Order suggests a reinterpretation of sex protections in Section. 1557 of the Affordable Care Act void of explicit protections on the basis of sexual orientation and gender identity.

The order leans on laws and policies unrelated to gender affirming care in an effort to limit access to those services including by erroneously conflating gender affirming care and female genital mutilation, using the FDA regulatory process to limit access, and suggesting kidnapping protections be applied to parents in certain circumstance. On February 19, 2025, additional guidance was released relating to this order, providing new and refined definition of terms “ which directs the Department of Health and Human Services (the Department) to promulgate clear guidance to the U.S. Government, external partners, and the public, expanding on the sex-based definitions set forth in the Executive Order.” On February 20, 2025, pursuant to this Order, HHS issued a “Recession of ‘HHS Notice and Guidance on Gender Affirming Care, Civil Rights, and Patient Privacy’ issued by the Biden Administration” which had stated the Administration “stands with transgender and gender nonconforming youth” and that medically necessary for gender affirming care for minors improves physical and mental health. It also reiterated that administration’s view that Sec. 1557 of the ACA includes protections on the basis of sexual orientation and gender identity. There have been multiple legal challenges to this Order with some judicial actions that have paused aspects of implementation: On February 4, 2025, a federal lawsuit was filed challenging this Order and the Executive Order on “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to The Federal Government,” asserting they are openly discriminatory, unlawful, and unconstitutional. On February 13, a federal judge issued a temporary restraining order preventing the federal government from withholding or conditioning funding on the basis of providing this care. On March 4th, the court issued a preliminary temporary injunction.

An additional federal lawsuit was filed on February 7 th challenging this executive order with a separate temporary restraining order being issued on the 14th preventing the conditioning of federal funds and also applying to a condition linking gender affirming care to female genital mutilation. The restraining order was extended through March 5th on February 26th. On June 1, the FBI posted on social media urging the public to “report tips of any hospitals, clinics, or practitioners performing these surgical procedures on children,” despite pediatric gender affirming care being permitted in about half of states and not prohibited by the federal government.

Ending Radical Indoctrination in K-12 Schooling, January 29, 2025

Purpose: Directs agency heads in consultation with the Attorney General, to develop an “Ending Indoctrination Strategy” aimed at ensuring federal funds do not fund or support “gender ideology or discriminatory equity ideology.” Directs the Secretary of Education, the Secretary of Defense, and the Secretary of HHS, in consultation with the Attorney General, to develop an “Ending Indoctrination Strategy” within 90 days. Among other requirements, the strategy must include agency processes for preventing or rescinding Federal funds from being used by K-12 schools to: “support or subsidize the instruction, advancement, or promotion of gender ideology or discriminatory equity ideology in” curriculum, instruction, programs, or activities teacher certification, licensing, employment, or training. “directly or indirectly support or subsidize the social transition of a minor student including through school staff or teachers” “deliberately concealing the minor’s social transition from the minor’s parents.”

Implications: Should the federal government proceed with conditioning federal funding for schools on whether or not they support transgender students, it could exacerbate existing mental health disparities, contribute to stigma and discrimination, and reduce school connectedness. For example, the policies detailed in the Order could prevent schools from recognizing transgender students’ identities (e.g. their names and pronouns), allow schools to withhold mental health services, to out students to (potentially unsupportive) families, and to restrict facility use and activity participation.

Memorandum For The Heads Of Executive Departments And Agencies, February 6, 2025

Purpose: The memorandum seeks to “stop funding Nongovernmental Organizations that undermine the national interest and administration priorities.” The memorandum states: It is Administration policy “to stop funding [Nongovernmental Organizations] NGOs that undermine the national interest.”

Direct heads of executive departments and agencies to review all funding that agencies provide to NGOs and “to align future funding decisions with the interests of the United States and with the goals and priorities of my Administration, as expressed in executive actions; as otherwise determined in the judgment of the heads of agencies; and on the basis of applicable authorizing statutes, regulations, and terms.” Implications: This memo aligns with other administrative efforts to stop current and future funding from being provided to NGOs that do not align with administrative priorities and could impact funding to health organizations or programs aimed at serving transgender people or research funding inclusive of trans and gender diverse people. It could also potentially impact care for LGBTQ+ people more broadly if services aimed directly at this population are considered DEIA efforts.

DOJ Letter to the Supreme Court: United States v. Jonathan Skrmetti, Attorney, February 7, 2025

Purpose: “To notify the Court that the government’s previously stated views” on a case challenging a state’s ban on gender affirming care “no longer represents the United States’ position.” Notifies the Court that “following the change in Administration, the Department of Justice has reconsidered the United States’ position in” the case brought by the Biden Administration challenging Tennessee’s ban on gender affirming care for minors. The letter states, that their view is that the Tennessee law being challenged “does not deny equal protection on account of sex or any other characteristic,” which is the question before the Court.

Despite this change in perspective, the Trump Administration encouraged the Court to resolve the questions presented without granting certiorari to the original plaintiffs. Implications: There are 26 states with bans on gender affirming care for minors and litigation challenging these bans is ongoing. At the request of the Biden Administration, who brought the plaintiff’s case from the lower courts, the Supreme Court agreed to examine whether the Tennessee ban violates Equal Protection constitutional protections under the 14th Amendment. The case was briefed and argued prior to the administration change. Upon taking office, the Trump Administration wrote this letter to the Court stating that the Biden Administration position no longer represented that of the U.S. government but nevertheless asked the court to decide the case. The court will likely issue a decision in the case and technically, the Trump Administration letter should not have bearing on the court’s decision. The court is expected to issue a decision in the case this summer (2025).

Quality and Safety Special Alert Memo on Provision of Gender Affirming Care to Children, March 5, 2025

Purpose: To alert providers to the administration’s approach to children’s access to gender affirming care and serve as notice “that CMS may begin taking steps in the future to align policy, including CMS-regulated provider requirements and agreements…” to limit such care. The memorandum states: That “CMS renews its commitment to promoting evidence-based standards through health quality and safety improvement activities, and reminds hospitals and other applicable facilities and providers of the obligation to prioritize the health and safety of their patients, especially children.” It questions evidence around gender affirming care for young people and states “CMS may begin taking steps in the future to adjust its policies to reflect this…” Implications: The CMS memo aligns with policies put forward in the Executive Order, “Protecting Children From Chemical and Surgical Mutilation,” related to limiting young people’s access to gender affirming care, provisions of which are subject to a nationwide preliminary injunction (described in above entry). However, this is not explicitly stated in the memo.

On March 6 th the Health Resources & Services Administration (HRSA) and Substance Abuse and Mental Health Services Administration (SAMHSA) released additional guidance stating that they would review policies, grants, and programs for consistency with the CMS memo (SAMHSA letter unavailable but described in this filing). HRSA also specifically notes the agency will review its Children’s Hospitals Graduate Medical Education (CHGME) Payment Program for consistency with the memo.

the Health Resources & Services Administration (HRSA) and Substance Abuse and Mental Health Services Administration (SAMHSA) released additional guidance stating that they would review policies, grants, and programs for consistency with the CMS memo (SAMHSA letter unavailable but described in this filing). HRSA also specifically notes the agency will review its Children’s Hospitals Graduate Medical Education (CHGME) Payment Program for consistency with the memo. While the memo does not specifically refer to the Executive Order, on March 7 th , plaintiffs in a case challenging the order sought enforcement of the preliminary injunction claiming that the CMS memo and HRSA/SAMHSA guidance violate its terms because by “threatening to withhold federal funding, the Executive Orders coerced hospitals into immediately shutting down gender affirming medical care for people under nineteen to avoid potential loss of funds.”

, plaintiffs in a case challenging the order sought enforcement of the preliminary injunction claiming that the CMS memo and HRSA/SAMHSA guidance violate its terms because by “threatening to withhold federal funding, the Executive Orders coerced hospitals into immediately shutting down gender affirming medical care for people under nineteen to avoid potential loss of funds.” Depending on how future policy is implemented, CMS could seek to significantly limit access to gender affirming care for young people.

National Child Abuse Prevention Month, 2025, April 3, 2025

Purpose: Issued to proclaim April as National Child Abuse Prevention Month. Describes “the sinister threat of gender ideology” as “one of the most prevalent forms of child abuse facing our country today.” Erroneously conflates youth access to gender affirming care with child abuse.

References other efforts (see above) aimed at “prohibiting public schools from indoctrinating our children with transgender ideology” and “taking action to cut off all taxpayer funding to any institution that engages in the sexual mutilation of our youth.”

Promises legal action against those perpetrating child abuse. Implications: The proclamation includes details about gender affirming care and transgender people that conflict with science and evidence, including that children are being “indoctrinated” “with the devastating lie that they are trapped in the wrong body,” referring to gender affirming surgery (which is very rare among young people) as “sexual mutilation surgery,” and suggesting that such care inhibits “happiness, health, and freedom,” for young people and creates “heartbreak” for parents and families.

By erroneously conflating gender affirming care and abuse, potentially threatens those providing or facilitating access by stating, “we affirm that every perpetrator who inflicts violence on our children will be punished to the fullest extent of the law.”

Ryan White Letter to Awardees and Stakeholders Relating to Gender Affirming Care, April 7, 2025.

Purpose: Reverses a Biden Administration policy that had permitted the Ryan White HIV/AIDS Program to cover certain gender affirming care services as a part of whole person care to transgender people with HIV. Referring to a policy on gender affirming care from the Biden administration, the letter states that “under the previous administration, certain interpretations of RWHAP’s allowable uses…co-opted the program’s patient centered mission in favor of radical ideological agendas and policies.”

The letter further states “that RWHAP funds shall be marshaled exclusively toward evidence-based interventions proven to combat HIV, sustain viral suppression, and improve the quality of life for those living with the disease” and reaffirms the prohibition on funding services outside the scope of outpatient care, including “surgeries and inpatient care, irrespective of setting or anesthesia” Implications: Previously, Ryan White funds were permitted to be used to support gender affirming care within core medical and support service categories, including through the provision of hormones via ADAP programs. Additionally, funds could be used to “provide behavioral and mental health services to clients experiencing gender dysphoria and social and emotional stress related to transgender discrimination, stigma, and rejection.” The policy under the prior Administration prohibited surgery, as does the new one, so that does not represent a change.

Prohibiting use of funds to support certain gender affirming care services may make care engagement more challenging for transgender Ryan White clients. In some cases, gender affirming care may have helped to connect clients with HIV services and thus improve HIV outcomes.

Purpose: HHS issued this notice “to clarify the non-enforceability of certain language that was included in the preamble to—but not the regulatory text of” the final rule on Section 504, “titled ‘Nondiscrimination on the Basis of Disability in Programs or Activities Receiving Federal Financial Assistance.’ The clarification states that language in the preamble concerning gender dysphoria, which is not in the regulatory text, does not have the force or effect of law and cannot be enforced. Implications: Section 504 prohibits recipients of federal funding, including publicly-subsidized health payers and health care providers who accept Medicare or Medicaid, from discriminating against people on the basis of disability. The Biden Administration’s final rule on Sec. 504 included in the preamble that HHS would “approach gender dysphoria as it would any other disorder or condition. If a disorder or condition affects one or more body systems, or is a mental or psychological disorder, it may be considered a physical or mental impairment.”

This new interpretation could weaken certain protections for transgender and gender non-conforming people.

Purpose: “The purpose of this letter is to ensure that state Medicaid agencies are aware of growing evidence regarding certain procedures offered to children, and to remind states of their responsibility to ensure that Medicaid payments are consistent with quality of care and that covered services are provided in a manner consistent with the best interest of recipients.” States that “medical interventions for gender dysphoria in children have proliferated” and that “several developed countries have recently diverged from the U.S. in the way they treat gender dysphoria in children.”

CMS reminds states of the following federal Medicaid requirements: Program “responsibility to ensure that payments are consistent with ‘efficiency, economy, and quality of care.’” Requirement for states to “provide such safeguards as may be necessary to ensure covered care and services are provided in a manner consistent with the best interests of recipients.” Prohibition on “federal funding for coverage of services whose purpose is to permanently render an individual incapable of reproducing. Federal financial participation (FFP) is strictly limited for procedures, treatments, or operations for the purpose of rendering an individual permanently incapable of reproducing and…prohibited for such procedures performed on a person under age 21.” Drug utilization review (DUR) program requirements “to assure that prescribed drugs are appropriate, medically necessary, and are not likely to result in adverse results.” CMS encourages “states to review their DUR programs to ensure alignment with current medical evidence and federal requirements, including the evidence outlined above. Notes that “additional guidance on DUR approaches is forthcoming.”

Implications: Letter appears to encourage states to take steps to limit gender affirming care for youth within their state Medicaid programs and suggests that not doing so could put them out of compliance with federal law. It does not immediately change policy. Letter misrepresents certain information about gender affirming care including its frequency and the approach in international settings. Letter leverages a law aimed at addressing discrimination/unwanted sterilizations among people with disabilities to limit gender affirming care. The letter could lead to changes in state policy-making or make providers and/or employers less likely to cover services which could ultimately lead to more limited access to GAC. CMS issued a press release along with the letter. The letter stated “Medicaid dollars are not to be used for gender reassignment surgeries or hormone treatments in minors.”

Purpose: An internal Department of Justice (DOJ) memorandum seeks to implement, in part, an executive order aimed at limiting minor’s access to gender affirming care (GAC) (see above). The memo is an internal document that was leaked. It is not law but provides guidance relating to an earlier executive order aimed at limiting minor access to gender affirming care (see above). The memo reportedly: The internal document was leaked and is not law but provides guidance relating to an earlier executive order aimed at limiting minor access to gender affirming care.

Puts providers “on notice” that “it is a felony to perform, attempt to perform, or conspire to perform female genital mutilation (“FGM”*) on” minors and states that the FBI “alongside federal, state, and local partners, will pursue every legitimate lead on possible FGM cases.”

States DOJ “will investigate and hold accountable medical providers and pharmaceutical companies that mislead the public about the long-term side effects of chemical and surgical mutilations.” Directs “investigations of any violations of the Food, Drug, and Cosmetic Act by manufacturers and distributors engaged in misbranding by making false claims about the…use of puberty blockers, sex hormones, or any other drug” in GAC.

Directs “investigations under the False Claims Act of false claims submitted to federal health care programs for any non-covered services related to radical gender experimentation.” Gives example of prescribing puberty blockers to a minor for GAC but reporting the service as being for early onset puberty. States Department will work with whistleblowers “with knowledge of any such violations” under The False Claims Act. Following prior direction “that Department employees shall not rely on”… the World Professional Association for Transgender Health ( WPATH)… “guidelines, and that they should withdraw all court filings” doing so, “expressly extend[s] that direction to all Department employees.” Directs department to “purge all…policies, memoranda, and publications and court filings based on WPATH guidelines.”

WPATH)… “guidelines, and that they should withdraw all court filings” doing so, “expressly extend[s] that direction to all Department employees.” Directs department to “purge all…policies, memoranda, and publications and court filings based on WPATH guidelines.” Launches “the Attorney General’s Coalition Against Child Mutilation” to “partner with state attorneys general to identify leads, share intelligence, and build cases against…” providers “…violating federal or state laws banning female genital mutilation and other, related practices…[and] support the state-level prosecution of medical professionals who violate state laws “prohibiting gender affirming care.

Instructs Office of Legislative Affairs to draft legislation “creating a private right of action for children and the parents of children” who have had gender affirming care with “a long statute of limitations and retroactive liability” and work with Congress “to bring this bill to President Trump.” Implications: The memo directs action but is not law. It seeks to implement an executive order that is, in part, currently enjoined in court.

The memo includes inaccuracies relating to gender identity, gender affirming care, and transgender people that conflict with science and evidence. These inaccuracies include suggesting that being transgender is a harmful medical condition, that large shares of youth are seeking gender affirming medical care, that regret rates among those seeking care are high, and conflating “female genital mutilation” and gender-affirming care. This has the potential to promote hostility, stigma, and discrimination, and can lead to care denials.

Seeks to discredit WPATH’s widely relied on standard of care guidelines which providers look to deliver best practices gender affirming care and is regularly referenced by major medical associations including the American Psychological Association.

While nothing in the memo prohibits provision of gender affirming care, its emphasis on litigation and enforcement of existing law that do not necessarily implicate this care, could have a chilling effect on providers.

HHS Report “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” May 1, 2025.

Purpose: To develop an evidence review around pediatric gender affirming medical care as commissioned by the executive order on Protecting Children From Chemical and Surgical Mutilation (see above entry). “This Review of evidence and best practices was commissioned pursuant to Executive Order 14187, signed on January 28, 2025. It is not a clinical practice guideline, and it does not issue legislative or policy recommendations. Rather, it seeks to provide the most accurate and current information available regarding the evidence base for the treatment of gender dysphoria in this population, the state of the relevant medical field in the United States, and the ethical considerations associated with the treatments offered. The Review is intended for policymakers, clinicians, therapists, medical organizations and, importantly, patients and their families.” Among the report’s findings: Report concludes that the quality of evidence on the effects of gender affirming intervention is low but also that evidence on harms is “sparse.”

Cites “significant risks” of medical transition, departing from most medical associations and widely used guidelines in the U.S.

In addition to a focus on medical intervention (e.g. surgery, puberty blockers, and hormones) report discusses role of psychotherapy in gender affirming care, supporting the use of psychotherapeutic approaches, including an approach termed “exploratory therapy”, which can include conversion therapy. Conversion therapy is a practice that seeks to change an individual’s sexual orientation or gender identity. These practices contrast with recommendations from major medical associations, which criticize conversion efforts for their lack evidence, ineffectiveness, and because they can cause harm. Additionally, many states ban these practices for the same reasons. Implications: Review could be used as support for other actions the administration seeks to take (some described here) aimed at limiting minor access to gender affirming care. Outside experts, including from the American Academy of Pediatrics, have raised concerns that the “report misrepresents the current medical consensus and fails to reflect the realities of pediatric care.”

With respect to therapeutic practices, it could shift how some practitioners approach gender affirming care or potentially provide support to those using conversion related approaches.

The report could also fuel misinformation in other areas, particularly around regret rates (which the report states are high when they are actually very low) and the share of young people seeking a medical transition (which the report states is large, when the share is small). On May 28, 2025, HHS sent a letter to an unspecified group of providers, state medical boards, and health risk managers urging providers to update treatment protocol to align with the review’s findings and avoid relying on the WPATH Standards of Care (which are seen by gender affirming care providers as valuable and trusted source of guidance.) The letter points to risk but not benefits of gender affirming medical care and highlights the report’s promotion of psychotherapy as an alternative to other medical care.

Purpose: The letter from the Center for Medicare and Medicaid Services (CMS) is directed at “select hospitals” providing minors with gender affirming care services including puberty blockers, hormones, and surgeries. The aim of the letter is to collect information on the delivery of these services and their associated costs and revenue. CMS states they are collecting this data to “ensure quality standards at institutions participating in the Medicare and Medicaid programs” and because “CMS has an obligation to be a good steward of taxpayer dollar.” In the letter CMS asks for information on the following within 30 days: consent protocols for children with gender dysphoria, including when parental consent is required

changes to clinical practice guidelines and protocols in light of the HHS Review (see above entry)

adverse events, particularly children who later look to detransition

billing codes utilized for gender affirming care

facility and provider-level revenue and profit margins data related to these services Implications: If facilities or providers believe HHS is excessively engaged in oversight of their practice of this area of medicine, it could have a chilling effect on willingness to provide these treatments. Depending on what the Administration does with data collected, this effort could represent a significant step in the administration’s aim to limit GAC for minors. The effort to collect this level of information is likely burdensome for providers, particularly within a 30-day period. The letter appears to stoke misinformation in its suggestion that there is a lack of parental involvement or consent in the practice of gender affirming care and that regret is a serious problem in this field. It also appears to question the validity of using federal dollars to provide this care and possibly that delivering these services to minors is a significant cost-burden to the federal government. Because just a small share of the population is transgender, and not all trans people seek medical intervention, costs are likely very low.

Purpose: To rescind a bulletin from the Biden administration that provided state Medicaid programs with guidance on implementing optional sexual orientation and gender identity (SOGI) questions on their applications for coverage. The Trump administration bulletin states that “CMS no longer intends to collect this information from state Medicaid and Children’s Health Insurance Program (CHIP) agencies as part of Transformed Medicaid Statistical Information System (T-MSIS) data submissions.” Implications: Collection of SOGI health data plays a role in documenting the health experiences and status of LGBTQ+ people. Data collection can reveal disparities and gaps in access, which can, in turn, inform policy making to address these challenges. Without this data, addressing these disparities is more challenging. SOGI Data collection expanded under the Biden administration and has retracted under the Trump administration.

What is the ADA?

The most important legal protection for workers with ADHD is the federal Americans with Disabilities Act, or ADA. The original version of the ADA was passed by Congress in 1990 and was amended in 2008 to expand and clarify its application.

The ADA is essentially a civil rights law that prohibits discrimination against individuals with “a physical or mental impairment that substantially limits one or more major life activities of such individual.” The law goes on to state that “major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, bending, speaking, learning, reading, concentrating, thinking, communicating, and working.”

There is also a separate section of the ADA that further discusses what is included in the definition of disability under the law by listing the bodily systems that are affected, which include: “neurological [and] brain systems…”

Is ADHD covered by the ADA?

Yes. Whether you view ADHD as neurological — affecting how the brain concentrates or thinks — or consider ADHD as a disability that impacts working, there is no question that the ADA covers individuals with ADHD.

[Get This Free Download: Choosing Your Best Career]

Courts, including the U.S. Supreme Court, initially applied the ADA quite narrowly. This was not what Congress had intended when it first passed the law, so it amended the ADA to clarify that it should be broadly applied and to change the “legal environment in which individuals must demonstrate an inappropriately high degree of functional limitation in order to be protected from discrimination under the ADA.”

The 2008 ADA Amendments ACT – the ADAAA – now provides the following:

The ADA should be interpreted broadly, in favor of providing protections to individuals.

Someone can be disabled in one major life activity without being disabled in all activities. So, someone can have difficulty with work tasks and qualify for ADA protection, even if they can handle tasks at home.

The use of mitigating measures – medications, mobility devices, hearing aids, cochlear implants, and prosthetics — do not disqualify someone for protection under the ADA. But ordinary glasses and contact lenses are not covered by this section.

Other measures, including assistive technology, reasonable accommodations, services such as a sign language interpreter, or learned behavioral or adaptive modifications also don’t disqualify someone for ADA protections.

Individuals with episodic conditions, such as epilepsy, diabetes, or multiple sclerosis are protected if their impairments are considered disabling in their “active” state.

Do ADA protections apply to all workers with ADHD?

To be covered by the ADA, an individual with ADHD must work in a setting that employs more than 15 people. However, many cities and states have laws that mirror the ADA and cover smaller employers and even independent contractors.

As an aside, the ADA does not apply to members of the armed forces. For employees of the executive branch of the federal government, federal contractors, and employees of programs receiving federal funds, the ADA does not apply. Instead, employees are protected by The Rehabilitation Act of 1973, which is very similar to the ADA and was the law upon which the ADA was originally based.

[Read: The Real-Life Risks and Rewards of Disclosing ADHD at Work]

What are the employee’s obligations and considerations?

First, the employee must be qualified for the job. Just because they have a disability does not mean that they are protected from being fired – or not hired in the first place. They are obligated to meet the legitimate skill, experience, education, or other job requirements and be able to perform the essential functions of the position with or without reasonable accommodation. Requiring the ability to perform “essential” functions assures that they will not be considered unqualified simply because of their inability to perform marginal or incidental job functions.

What is essential to a job will differ from workplace to workplace and position to position. Getting to work on time is a crucial part of some jobs, like teaching. (Who will cover a teacher’s class if the teacher is late?) But if an individual worked in a design firm where people came and went from the office or even worked from home, getting to the office at a particular time might be far less important. Some fields, like medicine or quality control in a factory, are unforgiving of mistakes due to inattention. Others will be less so. Employees will do best if they understand how ADHD affects their work and choose a field and a workplace that values their strengths and not their challenges.

Finally, employees must consider whether or when to disclose the fact that they have ADHD. Unlike an individual who uses a wheelchair or has another “visible” disability, someone with ADHD may decide not to disclose this information. If they choose not to disclose their diagnosis, the employee cannot expect his employer to provide ADHD accommodations.

Must an employee reveal their ADHD to be covered by ADA?

Yes. Several courts have already ruled that, in these situations, lack of knowledge of the condition or of how the disability may affect the employee may be used as a legitimate defense for the employer.

Can an employer or potential employer ask whether I have ADHD?

No. Your employer or potential employer cannot ask questions about your medical or psychiatric history. The only exception is if an applicant asks for reasonable accommodation for the hiring process. If the need for this accommodation is not obvious, an employer may ask an applicant for reasonable documentation about the covered disability.

Most often a note from a doctor confirming an ADHD diagnosis and, ideally, noting the kinds of accommodations needed to “level the playing field” at work will meet this requirement.

Note that the employer is not entitled to request the employee’s full medical records, just what is needed to verify a diagnosis of ADHD and the need to accommodate it. Not all employers seek this formal confirmation of disability; many simply discuss with an employee the nature of their disability and the limitations they face as a result. This informal conversation would include a discussion of reasonable and effective accommodations.

When should an employee disclose their ADHD?

There is no specific stage in the employment process when ADHD disclosure is required. An employee does not lose the right to request accommodations by not disclosing during the hiring process or at any point during employment. However, if an employee does not disclose and fails to meet job expectations because of the condition (since the employee would be working without accommodations), that employee will not have recourse if penalized or fired because of such failure.

What are reasonable accommodations?

An employer is required to provide a reasonable accommodation to a qualified applicant or employee with a disability. Let’s assume that an employee has disclosed her ADHD to her employer and provided medical documentation or discussed with HR or management how ADHD affects her in the workplace. What kinds of accommodations might she seek and might her employer provide? Note that the employer is not required to provide accommodations that are unreasonable – or that may incur substantial costs or be disruptive to the business.

What is reasonable will differ from job to job, but some of the most common “reasonable” accommodations for ADHD include the following:

Providing a quiet workspace

Allowing noise-canceling headphones or white noise

Working from home some or all of the time

Taking allotted breaks as needed

Minimizing marginal functions to allow focus on essential job duties

Allowing assistive technology (timers, apps, calendars, etc.)

Adjusting or modifying examinations, training materials, or policies

Reassignment to a vacant position

Job restructuring

Can an employer dock my pay or reduce my salary because I require reasonable accommodation?

No. An employer cannot make up the cost of providing a reasonable accommodation by lowering your salary or paying you less than other employees in similar positions.

Do I qualify for accommodations if I take ADHD medication?

Yes. In addition, some other protections afforded by the ADA include accommodating side effects from medication taken to treat a disability. If an employee were trying a new ADHD medication that induced lethargy or tics, he would be entitled to accommodations from his employer – perhaps a few days of working from home or a quiet room where he could lie down when he needed a break — to enable him to deal with the effects of his medication. Remember, he still needs to be able to perform the essential aspects of his job and will have to disclose to his employer that he is having side effects from medication.

What should I do if I think I’m being discriminated against?

What can an employee do if they believe their employer is violating its obligations under the ADA or its local equivalent? What remedies does they have? The employee should certainly begin by discussing the issue with their supervisor and, if that isn’t practical or successful, with the company HR department. If that is not helpful and they want to take further action to ensure they receives the accommodations to which they are entitled, they can bring a claim before the appropriate agency.

If the employee’s claim is against a private employer with 15 or more employees, they should contact the federal U.S. Equal Employment Opportunity Commission (EEOC). If the EEOC dismisses the complaint or fails to take action within 180 days, the EEOC will issue the employee a “right to sue” letter, upon request, and then the employee may file a lawsuit within 90 days of the date of the notice.

If an employee is making a claim against a public entity, such as an arm of a state or local government, they can bring the complaint to the EEOC or the U.S. Department of Justice, which shares enforcement in these situations.

An employee may have up to 300 days to file a charge if there is a state or local law that provides relief for discrimination on the basis of disability. However, to protect the employee’s rights, it is best to contact EEOC promptly if discrimination is suspected.

To file a charge of discrimination on the basis of disability, an employee may contact any EEOC field office, located in cities throughout the United States. To contact the EEOC, look in your telephone directory under “U.S. Government.” You can also call (800) 669-4000 for more information.

Remember, many states and cities have prohibitions against employment disability discrimination and claims can be filed with either a city or state agency.

ADHD Accommodations at Work: Next Steps

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As part of President Donald Trump’s attempt to remake the federal workforce, several directives have been issued to terminate recently hired employees and gut entire agencies. Many federal workers have also been urged to resign under the premise that they will be paid through September 2025. The federal workforce includes hundreds of thousands of well-qualified disabled employees who work at all levels of the federal government. Some disabled employees receive accommodations in the workplace, including an elevated desk that a wheelchair can fit under, interpreters for deaf and hard of hearing employees, or screen readers for people who are blind or low vision. The entire federal workforce is facing unprecedented fear and uncertainty, but disabled workers face additional struggles as executive orders and damaging rhetoric question their right to receive needed accommodations. At the ACLU, we know that directives from the Trump administration do not change the law. It is still illegal to discriminate against a federal employee because of a disability and the federal government is still required to provide reasonable accommodations that do not cause undue hardship.

Video ASL Interpretation of the introduction of this blog, Rights of Federal Employees with Disabilities, Explained.

What Are My Rights as a Federal Government Employee with a Disability?

Section 501 of the Rehabilitation Act of 1973 protects qualified individuals with disabilities from discrimination based on disability, specifically in hiring, advancement, discharge, compensation, training, or other terms, conditions, and privileges of employment. It also requires that, unless it would be an undue hardship, agencies must provide reasonable accommodations for the known physical and mental limitations of a qualified individual with a disability.

Do the Trump Administration’s Policies and Orders Change the Law on Disability Discrimination or Reasonable Accommodation?

No, the new orders and policies cannot change the requirements of the Rehabilitation Act, which a memo from the Office of Personnel Management (OPM) acknowledges. OPM states that “agencies should not terminate or prohibit accessibility or disability-related accommodations, assistance, or other programs that are required by [the Rehabilitation Act] or related laws.”

Can Federal Agencies Review or Change My Accommodations?

Reviewing an accommodation is permitted, but a reasonable accommodation should not be changed unless an accommodation is no longer necessary, the original accommodation is no longer effective for the employee, or another reasonable and effective accommodation exists. Despite the Trump administration’s efforts to bring federal workers back into offices for in-person work, if working remotely is needed as a disability accommodation, the employer must still provide it. OPM recognizes this in another memo, writing that federal agencies should require in-person work unless remote work is “due to a disability [or] qualifying medical condition.”

Can I Be Pressured to Return to In-Person Work or Quit? Can I Be Targeted for Layoffs Because of a Disability? Can They Ask for Medical Documentation for an Accommodation?

Being pressured by supervisors or co-workers to quit or return to work in-person despite an approved accommodation may be illegal workplace harassment, retaliation for requesting an accommodation, or illegal interference with your right to seek an accommodation. It would also be illegal disability discrimination to target federal employees for layoffs based on their disabilities or need for accommodations. Similarly, an employer should only ask for medical documentation if the disability or the need for the accommodation is not known or obvious. Such requests are normally made at the time of the original accommodation request. Further documentation may be requested if the disability is one that changes over time. When the employer has a good reason for seeking more documentation, the employer should only ask for reasonable documentation about the disability and about its functional limitations that require reasonable accommodation. Employers must treat any such health information as a confidential medical record.

What Should I Do if I Think My Federal Employer is Violating My Rights? How Can I Learn More?

If you can’t work it out directly with your employer, employees can file a complaint. There are very short deadlines to complain, and you should assume they cannot be extended. The first step in the complaint process is to make and document an informal complaint with your agency’s Equal Opportunity Employment officer. This must be done within 45 days of the date of the failure to accommodate or other discrimination. But there are also deadlines for each step after that. The full complaint process is summarized in the Overview of Federal Sector EEO Complaint Process on the EEOC website. It is illegal to retaliate against an employee for making a complaint of discrimination, including a complaint about the failure to accommodate. You should file a separate complaint about any retaliation. There is more information about your rights on the EEOC website. You might start by looking at the EEOC Disability-Related Resources. If you are worried that the information there may have recently changed or may no longer be accurate, you may want to consult a lawyer. Disabled people belong in the federal workforce and in every part of the political, civic, and economic life of our communities. Donald Trump can’t undo that by fiat – and he hasn’t.

Universal Health Care Should the U.S. Government Provide Universal Health Care? Ask the Chatbot a Question Contents Ask the Chatbot a Question Universal health care Should the U.S. government provide universal health care? (more)

Some 25.3 million non-elderly Americans did not have health insurance in 2023, a decline from 28.9 million uninsured Americans in 2019. The largest group of Americans, 154 million non-elderly people, were covered by employer-sponsored health insurance. Less than 1 percent of Americans over 65 were uninsured, thanks to Medicare, a government provided insurance for people over 65 years old. [162][163] According to the Commonwealth Fund’s health survey, reported in 2023, the United States among “high-income countries” has “the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates.” The country also has the highest rate of people with multiple chronic conditions and an obesity rate nearly twice the average of other high-income countries. Given these medical challenges, it is not surprising that health care spending has remained far higher in the U.S. than in other high-income countries. “Yet the U.S. is the only [high-income] country that doesn’t have universal health coverage.”[171][178] Instead, health care in the United States is largely a private system, through employer-sponsored plans from private insurance companies; it is not a public, universal system. The U.S. does offer universal health care through special programs for certain segments of the population with special needs, such as Medicare for seniors age 65 or older, Medicaid for low-income individuals under age 65, and TRICARE for past and present military members and their families. For this reason, U.S. health care, though fundamentally a private affair, is often called a mixed system.[171][178][184]

What Is Universal Healthcare? Universal health care is an umbrella term for “a system that provides medical services to all people. The government offers it to everyone regardless of their ability to pay, and largely funds it through taxes,” according to economic expert Kimberly Amadeo. [178] Single-payer health care is one type of universal health care in which the “government provides free health care paid for with revenue from income taxes.… Every citizen has the same access to care”; service providers may be public or private health care facilities, but the care is free at the point of service. Contrary to a multipayer system, in which various entities—such as employers, individuals, or private insurance companies—can pay for the health care, a “single-payer” system is so-called because only one entity (the federal government) pays for the health services; a single-payer system eliminates the role of private insurance companies and replaces them with government-funded services. The United Kingdom, Spain, New Zealand, and Cuba have single-payer systems. In the U.S., military personnel and veterans have access to a single-payer system via the armed services and the Department of Veterans Affairs. [178][225][226] Social health insurance is also a kind of universal health care in which “everyone [is required] to buy insurance, usually through their employers. Employers deduct taxes from employee payrolls to cover the costs, and the taxes go into a government-run health insurance fund that covers everyone. Private doctors and hospitals provide services. The government controls health insurance prices.” Germany, France, Belgium, the Netherlands, Japan, and Switzerland use the social health insurance model. Obamacare was originally modeled on social health insurance, however the program has changed. [178] National health insurance is yet another kind of universal health care, one that “uses public insurance to pay for private-practice care. Every citizen pays into the national insurance plan. Administrative costs are lower because there is one insurance company. The government also has a lot of leverage to force medical costs down.” Canada, Taiwan, and South Korea all have national health insurance. In the U.S., Medicare, Medicaid, and TRICARE function similarly.[178][184] Countries with universal healthcare include but are not limited to Australia, Brazil, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and Taiwan. [178][179] A December 29, 2024, Gallup poll found that 62 percent of Americans believed that it is the U.S. government’s responsibility to “ensure all Americans have healthcare coverage,” compared to 36 percent who do not believe health care coverage is the federal government’s responsibility. Americans are split—46 percent to 49 percent respectively—on whether that healthcare should be a national, government-run system or a private insurance system. [224]

Health Care Spending U.S. health care spending rose 2.7 percent in 2021 to a total of $4.3 trillion nationally and accounted for 18.3 percent of the U.S. Gross Domestic Product (GDP). Of the $4.3 trillion, health insurance paid 71 percent (with private insurance paying 28 percent, and government programs covering the rest via Medicare, Medicaid, and other programs), patients paid 10 percent as did other third party payers (such as the Indian Health Service), investment covered 5 percent, and government public health activities accounted for 4 percent. Per person, health care costs averaged $12,914. [164][165] [166] 56 percent of Americans were worried about “paying medical costs for serious illness or accident” in 2022. As a financial worry, it was only topped by the worry of “not having enough money for retirement.” Additionally, 43 percent were worried about “paying medical costs for normal healthcare,” which was the fourth most prevalent financial worry in 2022. Meanwhile, 20 percent of American adults reported “major, unexpected medical expenses” with an average cost of $1,000 to $1,999 between May 2021 and May 2022. [167][168] In 2022, 41 percent of American adults, about 100 million people, were in medical debt. Over 50 percent of American adults reported going into debt because of medical (or dental) bills. 25 percent of those with medical debt owe more than $5,000 and about 20 percent don’t believe they will ever be able to pay off the debt. [169] A March 2025 Gallup poll found 12 percent of American adults (about 31 million people) borrowed an estimated $74 billion collectively to cover medical costs in 2024. [223] People in medical debt cut spending on basics like food and clothing (63 percent), exhausted their savings (48 percent), had to take on extra work (40 percent), delayed a home purchase or their education (28 percent), asked for help from a charity (24 percent), and/or changed their living situation (19 percent). And, 17 percent of those in medical debt filed bankruptcy or lost their home as a result. A 2019 study found that of people who file for bankruptcy, about 67 percent file due to medical debt, with about 530,000 families in the United States filing for bankruptcy annually because of medical debt. [169][170]

Health Care in a Global Context The World Health Organization ranked the U.S. health care system at 37 out of its 191 member countries, between Costa Rica and Slovenia, in a landmark 2000 report. [108] In 2005 the United States and the other member states of the World Health Organization signed the World Health Assembly resolution 58.33, which stated that nations should “transition to universal coverage of their citizens… with a view to sharing risk among the population and avoiding catastrophic health-care expenditure and impoverishment of individuals as a result of seeking care.” [16][107] The Commonwealth Fund ranked the United States last in overall health care among 11 high-income countries based on access to care, care process, administrative efficiency, equity, and health care outcomes. Norway, the Netherlands, and Australia were the top three countries. [172] The United States spends $11,912 per person on health care, the most of any OECD country. Germany follows the U.S. with $7,382 per person, while South Korea spent the least at $3,914 per person. [173] A January 31, 2023, Commonwealth Fund report found that the United States “spends nearly 18 percent of GDP on health care, yet Americans die younger and are less healthy than residents of other high-income countries” and “[n]ot only does the U.S. have the lowest life expectancy among high-income countries, but it also has the highest rates of avoidable deaths.” According to the report, the U.S. spends much more than the other 37 OECD (Organisation for Economic Co-operation and Development; members are countries generally considered “high-income” or “developed”) countries, per person and as a percentage of GDP, and is the only OECD country that does not have universal health care. [171] Further, the U.S. has the highest maternal and infant mortality rates, among the highest suicide rate, the highest rate of patients with multiple chronic illnesses, and the highest obesity rate. And yet the U.S. also has one of the lowest levels of doctors and hospital beds, and Americans are least likely to visit a doctor. The Commonwealth Fund concluded, “Not only is the U.S. the only country we studied that does not have universal health coverage, but its health system can seem designed to discourage people from using services.” [171]

Obamacare and Medicare for All During an October 7, 2008 election debate, then-Senator Barack Obama stated that health care should be a “right for every American.” In a June 15, 2009 speech as U.S. President delivered to the American Medical Association (AMA), Obama urged Congress to craft legislation that would ensure coverage for all Americans. After intense debate, lawmakers passed the Patient Protection and Affordable Care Act (PPACA), also called the Affordable Care Act (ACA) or Obamacare, which was signed into law on March 23, 2010. According to a 2013 White House estimate, 27 million previously uninsured people would gain coverage under Obamacare. [22][34][35][36][46] About 8 percent of Americans remained uninsured in 2022, about 26 million people, the lowest percentage in decades due largely to changes in policy during the COVID-19 (coronavirus) pandemic. By 2023, more than 16 million Americans had health insurance via Obamacare, the highest number since the PPACA was signed in 2010. The 2023 enrollees included about 3.6 million people who were not previously enrolled in Obamacare. As of January 8, 2025, almost 24 million people had health insurance under the PPACA. More than 300 million Americans were covered by health insurance, or about 92 percent according to the U.S. Census. [176][177][222] The PPACA did not institute universal health care, and some members of Congress, including Senator Bernie Sanders (I-VT) and Representative Jim McDermott (D-WA), and organizations, including Physicians for a National Health Program (PNHP) and the American Nurses Association, continued to advocate for the implementation of a “single-payer” health care system in the United States that would guarantee universal health care for all Americans under a federally run health insurance plan. [27][28][39][40] On September 13, 2017, Senator Sanders introduced a Medicare for All bill that would have created a single-payer health care system in the United States. His bill, which had been introduced previously without any co-sponsors, drew at least 15 Senate co-sponsors. However, the plan did not pass Congress. [116] Medicare for All became a hot button topic in the 2020 presidential election. Only the Green Party candidate, Howie Hawkins, supported the plan, while Joe Biden (D), Donald Trump (R), and Libertarian candidate Jo Jorgensen did not.

Public Opinion Gallup has asked Americans whether the government should ensure health care since 2000. The first year (2000), 59 percent agreed that the government should ensure health care. Support hit a low in 2013, when 43 percent agreed, but support rebounded and, by 2022, 57 percent supported government ensured heath care. 53 percent were partial to a private insurance based system, while 43 percent were partial to a government-run system. [175] The partisan divide is stark, however: 88 percent of Democrats and 59 percent of Independents agreed that “it is the responsibility of the federal government to make sure all Americans have healthcare coverage,” while only 28 percent of Republicans agreed. Further, 72 percent of Democrats, 46 percent of Independents, and 13 percent of Republicans support a government-run health care system. [175]

Pros and Cons at a Glance PROS CONS Pro 1: The U.S. already has universal health care for some. The government should expand the system to protect everyone. Read More. Con 1: Universal health care would be marred by government inefficiency and ignore the realities of the country and free market. Read More. Pro 2: Universal health care would lower costs and prevent medical bankruptcy. Read More. Con 2: Universal health care would raise costs for the federal government and taxpayers alike. Read More. Pro 3: Universal health care would improve individual and national health outcomes. Read More. Con 3: Universal health care would increase wait times for basic care and worsen Americans’ ill-health. Read More.