1. United States
2. Mich.
3. Letter

I am writing to urge you to take immediate action against the Department of Health and Human Services investigation announced this week by Office for Civil Rights director Paula M. Stannard. This investigation, framed as protecting religious freedom for behavioral health providers, is actually designed to restrict access to medically necessary care for transgender people. The investigation examines whether state licensing rules requiring behavioral health providers to participate in or refer patients for gender-affirming care violate federal protections for religious objections. HHS language groups what they call "sex-rejecting procedures" with female genital mutilation, conflating evidence-based transgender medical care with criminal acts. This is the fifth conscience rights investigation announced during Trump's second term, part of what former HHS deputy assistant secretary for health policy Adrian Shanker describes as a sustained campaign to use federal civil rights enforcement as a political instrument to suppress access to gender-affirming medicine. The consequences for transgender people are severe and immediate. Behavioral health professionals serve as the gateway to care for gender dysphoria, depression, and anxiety, conditions that disproportionately affect trans youth and adults. Public announcements of federal enforcement actions create fear across the medical system, resulting in what Shanker calls "compliance in advance," where hospitals and clinics quietly scale back or abandon services before any formal penalties are imposed. This investigation functions as enforcement action rather than rule change, creating legal uncertainty that will cause providers to deny care. States strengthened referral requirements after patients were turned away from essential care. Treating these patient protections as unlawful coercion of religious providers prioritizes provider beliefs over patient health and safety. I urge you to publicly oppose this investigation, demand HHS identify which state is under investigation and what triggered the probe, and introduce or support legislation that protects access to gender-affirming care. Transgender people deserve the same access to medically necessary health care as all Americans.