Right now, the US government is facing yet another shutdown as Donald Trump throws a temper tantrum over military spending and transgender people. The last time the government shut down was in 2018, when the legislative branch wouldn't give him the money to build his border wall. It lasted 35 days. How long will this one last?
EDIT: as of 1 October, it is no longer facing a shutdown, it is shut down.
According to Trump, the issue is the healthcare industry's support for Jewish-- er, I mean, "gender ideologies". You can understand how I got that confused, because that's what Adolf Hitler had an issue with, only he called it "Jewish ideologies". Trump's a nazi. Anyway, right. It's causing a lot of panic with trans women right now. Are we going to be able to continue taking our HRT? Or are we going to be forced into detransition unless we can pay to have our pills illicitly sent to us from the manufacturer in India? At this stage, I feel I need to remind everyone about competency, and how the current regime has not displayed any. This goes beyond simply calling Trump "stupid" and leaving it at that. This is a question of "has the regime considered all possible angles to the problem and taken all possible steps to ensure compliance?" The answer here is a resounding No.
Firstly, Trump is opposed to "gender ideologies", but nowhere has anyone ever defined what this term means. Trump certainly hasn't defined it, he pays others to think for him. The truth of the matter is, if you're gonna rail against something to the point you're willing to shut the entire corporate feudal state down for an indefinite period of time, you need to be able to specify what you're railing against. "Gender ideology" is a buzz-phrase, not a definition.
But, let's assume for the sake of argument, that the legislative branch is able to divine Trump's intent and they declare gender-affirming care defunded. Well, what does "gender-affirming care" mean? If you're going to make a blanket statement like that and expect anyone to enforce it under the law, you're going to need to tell them what to enforce and how to enforce it. Before the so-called "Culture War", the term gender-affirming care referred to any medical procedure that affirmed the gender of the recipient. Transgender hormone replacement is a gender-affirming procedure, however so are hair-plugs. So is Viagra and Cialis. So is breast augmentation. So is penile enlargement. Stamping out "gender-affirming care" in one fell swoop is going to make a lot of reasonably well-off cisgender people very angry.
So, let's say the government does its due diligence (how, I don't know, considering Elon and the Funny Bunch dismantled all the agencies that used to be in charge of this sort of thing) and bovvers itself to define "gender-affirming care" as "medical treatments or surgical procedures designed to change a person's gender from male to female or vice-versa". Right now, there's a push by the binary healthcare system to conduct sex reassignment surgery on newborns who cannot be assigned "male" or "female" at birth (viz. intersex people; to wit, people who display genital characteristics of male, female, or neither). Under this new legislation, banning gender reassignment, the government would be forced into accepting the existence of intersex people by denying the specific facility the ability to operate on intersex newborns. Compulsory sex assignment surgeries on intersex people are immoral and unnecessary anyway, but how willing do you suppose a government that shits its pants at the sight of a trans woman is going to be to tolerate an intersex person?
However, just for the sake of argument, let's assume they'll be fine with intersex people. How do they intend to ban specific people from receiving the component chemicals of transgender hormone replacement? Probably they will make some heavy-handed attempt to flatly ban all of them, or at the very least, insist that the insurance companies stop covering them. Okay, fine. So, what happens when a cisgender man who gets diagnosed with prostate cancer and can't get the bicalutamide to treat it? What happens when a cisgender woman is having trouble conceiving a child because of low hormone levels and can't get the oestradiol to treat it? What happens when a cisgender man has an enlarged prostate and can't get the finasteride to treat it? Quite honestly, for every 1 trans woman who uses oestradiol and bicalutamide as a gender-affirming procedure, there are 100 cisgender people who need the component parts for other things.
So, let's assume that this really inquisitive, really thorough government is willing to tell insurance companies to seek-and-destroy. The only way for the companies to make this happen is to request all the patient data available in all the databases in the country (that they know about) and go down the list of 500 million or so names, find the ones that say "transfeminine" in the gender blank (if such a blank exists, not all databases have one), and zap their coverage. Well, great. Who's gonna do that? AI? How well has AI traditionally done at this kind of sorting job? How many thousands of false positives do you suppose interns will have to comb through to find? Like I said, medical databases are binary when it comes to gender. You're either an M or an F. These don't tend to change. So, how are these interns, then, supposed to determine that these people are on HRT? Like I said before, all the component parts of feminising HRT are chiefly used by cisgender people. This system is not set up for quick and efficient data retrieval on anything except the coarsest possible datasets— names, ages, dates of birth, and dates of death, essentially. The reviewing board is composed of doctors, but not specialists; and this is a problem that already exists in healthcare. These review boards deny claims based upon biases and a lack of experience in the selected field. An occupational therapist is not going to know that oestradiol is used for prostate cancer any more than he knows how to treat an enlarged heart. Once again, we're cutting off the cis people to spite the transfems.
Let's take Iowa as a recent example of this. Without any prompting from Donald Trump, Iowa banned gender-affirming care for minors last year. According to my own clinician, her colleague in Iowa hasn't noted any drop in new patients as a result of this, nor has she noticed any reluctance on the part of the state's Medicaid provider in approving prescriptions for transfem or transmasc HRT. The reason for this, as far as anyone can tell, is that the state legislature failed to define in statute what "gender-affirming care" was, how to enforce this rule, whether contravening it is an arrestable offence, when to arrest them, where to take them once arrested, or even whether the oversight committee in charge had even been established and, if it hadn't when it would be. This is the level of ham-fisted bureaucracy we're dealing with. Score cheap political points by bringing down a very large axe onto something that isn't actually there. The only difference here is, Trump wants this done in the entire country.
Wants what done? Who knows? He certainly doesn't know, and no one's going to tell him what he doesn't know because he already knows it!
Basically, panic is exactly what the regime wants you to do. Authoritarian regimes rule by fear, not by statute. As long as they can keep you afraid, they can control you, and that's their endgame: having you do their dirty work for them by limiting your behaviour to what you think they won't have a problem with. In other words, given the drastic cutbacks that Elon Musk made to the federal government with his so-called "Department of Government Efficiency", the federal government no longer has a mechanism by which to enforce these sweeping changes. At the end of the day, all they can do is send in the military to strongarm people, and frankly, even the military's morale is at an all-time low.