Potential Changes to Telemedicine and Gender-Affirming Care Under New Administration
With the new administration coming into office, there's a growing discussion about the potential impact on telemedicine and mental health practices, especially those offering gender-affirming care.
The American Telemedicine Association (ATA) published a news brief the day after the election. "President-elect Trump and his administration were strong proponents of telehealth during his first stay in the White House," said Kyle Zebley, SVP of public policy for ATA and executive director of ATA Action. "It is our sincere hope that Congressional leaders on both sides of the aisle act swiftly to advance a bill extending telehealth flexibilities and get it to President Biden's desk for signature before year-end."
Meanwhile, one organization whose leaders foresee potential challenges down the road under the new administration is the California-based Klarity, a healthcare marketplace experience platform. Jessica Doonan, CHC and VP of compliance for Klarity, said in a statement: "A Trump presidency could significantly impact telemedicine and mental health practices offering gender-affirming care, especially for minors."
"Trump's 2025 platform includes a core promise to 'End Left-Wing Gender Insanity,'" Doonan added, "which could restrict mental health professionals from discussing certain topics or providing specific treatments, including hormone therapy, psychiatric support, and prescriptions."
Doonan continued, "Restrictions like these would conflict with clinical standards in the Diagnostic and Statistical Manual of Mental Disorders (DSM)....If forced to diverge from DSM guidelines, providers may have to create treatment plans that lack the backing of clinical research and best practices, potentially harming patients and undermining standardized care."
Healthcare Innovation Associate Editor Pietje Kobus recently spoke with Jessica Doonan, who oversees the compliance program for private practices. She explained gender-affirming care as any care someone was receiving that reaffirms their gender identity. The majority of this care, she said, in particular with minors, is talk therapy, hormone therapy, and different types of mental healthcare.
What kind of policy changes are you anticipating with the new administration?
Their platform orients around 24 principles. And one of those, I think it's principle number nine, is to, this is a direct quote, "end left-wing gender insanity." They're going to likely limit, to some extent, or even eliminate or restrict gender-affirming care for minors. The majority of that care is really just talk therapy and psychiatry, and sometimes hormone therapy.
I think what we're going to see next is all going to be a matter of enforcement. Similar to when Roe versus Wade was overturned, quickly, the Office of Civil Rights (OCR) came out and said, "Even if it's legal to prosecute someone for pursuing reproductive care outside of their state....nobody's allowed to share those records for the purposes of enforcement."
They would have to have an alternative mechanism or way to enforce the ban. I'm not sure how they would get around such robust privacy limitations.
How would these policy changes affect patients?
I compare it to the reproductive care issue just because providers then get caught between what they were trained to do and what all their clinical reference documents tell them to do and the law. That naturally creates harmful outcomes for patients. I would imagine that the mental health of these people will be impacted negatively because they're not receiving what the DSM would prescribe as adequate or appropriate care for their condition.
Do you expect changes in the provision of gender-affirming care in telemedicine?
There's a rush right now in states like California to make sure that they've kind of cemented their protections before the new administration comes in.
I'm very curious to see if gender-affirming care eliminations or restrictions are put in place and if they are interpreted and administered differently depending on whether you're in a red or blue state. If it's very conservative in your state, you might be reaching out via telemedicine to get the therapy, the diagnosis, and the prescription you need. That's where I think it's really going to. We're going to see an uptick in states with more repressed care and people reaching out. That's where the enforcement issue comes into play.
How much concern is there that these policy changes will be implemented?
It looks like the administration is going to come in with a lot of power. I'm not entirely sure what barriers would be in place to prevent something like this from being rolled out. After the overturning of Roe versus Wade, the OCR was very passionate about protecting the patients in this scenario.
The Drug Enforcement Administration (DEA) is requesting a third extension for telehealth flexibilities going into next year. Since the COVID-19 era, they had suspended the Ryan Haight act, allowing controlled substances to be prescribed without holding an in-person consultation. It was only supposed to be temporary. The DEA was congressionally mandated to develop a special registration pathway for telemedicine providers so that they could easily fulfill a prescription by a pharmacist. We're going to be kind of in this holding pattern of a lack of regulation going into next year. It's created huge challenges in terms of justification and legitimacy for getting telemedicine prescriptions filled.
The ATA considers Trump a very strong proponent of telemedicine. He was in his past administration, and likely he will be again. It's going to be in the details, where the general ideologies diverge around gender, affirm care, etc.
