Could Trump stop gender-affirming care in SLO County? Patients ‘really scared,’ doctor says
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How will a second Trump term impact SLO County?
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Editor’s note: This is thefifth in a series of stories in the lead-up to President Donald Trump’s inauguration aimed at exploring how a second Trump administration could impact SLO County, with coverage spanning key policy areas such as immigration, tariffs, education and more.
As presidential results rolled in, Willow Kawamoto grew worried wondering how the incoming Trump administration would change the trajectory of her gender transition.
Since Kawamoto, 54, came out as a transgender woman in San Luis Obispo County six years ago, her life has been centered around a flurry of doctors visits, psychiatrist appointments, hormone treatments and surgeries.
In that time, her path to transition was marked with disdain from some local physicians, she told The Tribune.
Kawamoto was met with a “cold rudeness” when she first mentioned her gender dysphoria to her primary care doctor, she said.
Last year, when she underwent a breast augmentation surgery, she was filled with panic and anxiety after weeks of billing woes and dealings with a surgeon who was “indifferent to me as a person,” Kawamoto said.
Now that Donald Trump has been reelected to the highest office in the nation, Kawamoto said she was “absolutely scared” these would no longer be isolated incidents and her care could come to a halt.
President-elect Trump ran on a platform to revoke gender-affirming care and “stop the chemical, physical and emotional mutilation of our youth.”
Kawamoto pointed to Trump’s recent rhetoric on transgender youth and adults as the basis for her alarm, fearing that his administration would enact policies to erase LGBTQ+ communities.
“California still has more leverage than other states, but I’m still scared that it could be pulled and my gender-affirming operations could be denied,” she said.
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Trump’s plan to ban gender affirming care
Throughout his presidential campaign, Trump promised to cut funding and ban some forms of gender-affirming care to “protect children from left-wing gender insanity,” according to a February 2023 proposal.
Trump promised to sign an executive order directing every federal agency to stop programs that “promote the concept of sex and gender transition at any age.”
Sure enough, during his presidential inauguration address Monday, Trump proclaimed that “it will henceforth be the official policy of the United States government that there are only two genders, male and female.” Later that day — his first day in office — he signed an executive order to that effect, rolling back federal protections for transgender people.
Additionally, Trump said he would proclaim that “any hospital or healthcare provider participating in the chemical or physical mutilation of minor youth will no longer meet federal health and safety standards for Medicaid and Medicare — and will be terminated from the program,” according to his online platform.
The president-elect’s pick for health secretary, Robert F. Kennedy Jr., also said he was opposed to gender-affirming care for youth, including puberty blockers and “surgical mutilation” in a May post on X.
“People with gender dysphoria or who want to change their gender deserve compassion and respect, but these terribly consequential procedures should be deferred till adulthood,” he said. “We must protect our children.”
Once in office, Trump said he would call on Congress to permanently eliminate federal funds from being used to pay for gender-affirming treatment or procedures, as well as ask lawmakers to pass a ban on all gender-affirming surgeries for youth in the United States.
Under these proposals, even transgender adults who rely on public programs like Medicaid, Medicare and Veterans Affairs benefits could be at risk of losing access to gender-affirming care if their health insurance can no longer cover treatment, said Dr. Denise Taylor, a gender-affirming care specialist in San Luis Obispo.
“(Trump) could write that out, and then all of a sudden, people can still access care — because it’s not illegal — but then there’s the trick of paying for it, right? That’s where things get tricky,” she said.
The state’s Medicaid program, called Medi-Cal, is a public health insurance program that provides services for eligible low-income residents, according to the county of San Luis Obispo.
Medicaid benefits must comply with provisions in the Affordable Care Act, including non-discrimination protections, that require medical treatment to be given regardless of gender or sexual orientation.
However, 26 states have already implemented laws limiting youth access to gender-affirming care as of November 2024, according to KFF’s policy tracker.
Could gender affirming care be cut in California?
Over the years, SLO County has evolved to offer more medical resources for those experiencing gender dysphoria, with transgender youth and adults no longer having to drive long distances to see a doctor, Taylor said.
The gender-affirming care specialist is Kawamoto’s doctor and has treated other transgender patients for the past 25 years, but it’s only in the past few months that practically every patient who enters her office has asked the same question: Will my care continue?
She said patients’ mental health have degraded, with some sinking into depression or turning to drinking or smoking to alleviate anxieties about the incoming Trump administration.
“They are really scared,” she said. “A lot of my patients already assumed that as soon as Trump’s in office, that that’s the end of all their care,” Taylor said.
However, there are protections already in place for the estimated 220,000 transgender adults living in California.
In 2023, the state implemented Senate Bill 923, the Transgender, Gender Diverse, and Intersex Inclusive Care Act, which protects the right of Californians to access gender-affirming health care services, including setting quality standards for patient experiences.
Gov. Gavin Newsom also signed Senate Bill 107 into law in 2022.
The legislation protects transgender youth and their families who are coming from out of state to receive gender affirming care. The law put safeguards in place to prevent families from being penalized for obtaining medical care in California, even if it is banned in their home state.
The California Legislature is currently in a special session to equip the state’s Department of Justice with the financial resources to “protect the most vulnerable Californians” from the incoming Trump administration, including women, transgender people and members of the LGBTQAI+ community, Assemblymember Dawn Addis, D-30, told The Tribune.
Despite these protections, transgender children are at risk of losing gender-affirming care if Trump follows through on his campaign promises and manages to persuade Congress to pass a ban at the federal level.
“When someone’s 18 in our culture, it’s like, well, now they can make their own decisions. I think it’s going to be much harder to legislate against (adults),” but kids are more in danger of losing gender affirming care, Taylor said.
The greater risk for adults is if the Trump administration gets Congress to cut federal funding for all transgender health care in the United States, Taylor said.
California’s budget for the 2024-25 fiscal year included $161 billion for Medi-Cal. About half of the funding was provided by the federal government while the rest was covered by state and local sources, according to the Legislative Analyst’s Office.
If Trump cuts Medicare funding, it could result in transgender adults no longer being able to afford care in SLO County, Taylor said.
As a Medi-Cal recipient, Kawamoto said she is already preparing for that scenario.
She recently took on a part-time job at Lush Cosmetics on top of her full-time position at a logistics firm in SLO.
Kawamoto now works nearly 60 hours a week, saving up every penny in an emergency fund she can tap into if her health insurance is depleted under Trump.
“So many of us, and myself included, are taking so many drastic steps to get the money to maintain our level of pharmaceuticals, testosterone, estrogen, whatever on that level, to try and get the money necessary to pay for our gender-affirming surgeries.”
She is also planning to switch to private insurance through her employer in April in case Congress cuts funds to public insurance programs.
In the next four years, Kawamoto is working toward a gender reassignment surgery, but she still has to receive more medical treatment and psychological assessments before that can occur, she said.
“Transgender people have always been here. We will always be there,” she said. “One administration cannot stop the true nature of humanity — and your true self.”
This story was originally published January 17, 2025 at 5:00 AM.
