The attack on transgender kids isn’t just cruel. It’s an omen.

In his first six months in office, President Donald Trump has launched a relentless campaign of fear and intimidation aimed at dismantling the network that provides health care to transgender adolescents.

It’s working.

Hospitals — worried that their federal funding for Medicaid and Medicare may be jeopardized — are rapidly withdrawing support from this small, vulnerable group of young people. With each passing month of Trump’s presidency, families find the future of care for their transgender children increasingly uncertain.

This is not only cruel — it’s also a chilling sign of how easily this administration can target any form of health care it opposes.

Subpoenas mounting

In recent weeks, the tone of the administration’s attacks has become darker. A daylong event this month organized by the Federal Trade Commission, titled “The Dangers of ‘Gender-Affirming Care’ for Minors,” was clearly intended to send a message to the medical community that supports these kids and their families. At the workshop, Chad Mizelle, chief of staff to U.S. Attorney General Pam Bondi, highlighted the “civil and criminal tools” at the FTC’s disposal to “root out fraud.”

Mizelle revealed that his office has issued nearly 20 subpoenas to clinics that offer gender-affirming care. He didn’t provide details about who was under investigation, but he said the scope spanned health care fraud related to Medicaid billing and false statements and manufacturers of certain drugs. The New York Times later reported that those subpoenas sought confidential patient information from doctors and hospitals.

The FTC was an unusual and arguably inappropriate venue for the event, and panelists appeared intent on rationalizing the agency’s creep into regulating this sensitive area of medicine. They asserted that doctors have been deceiving parents about the benefits of gender-affirming care — a claim that seemed more political than based on any real evidence. The event highlighted the lengths the Trump administration is willing to go to restrict access to this care. This approach mirrors efforts to target other politically charged areas of medicine, such as medication abortion, through a variety of regulatory and legal avenues.

Hospitals buckling

Between the legal threats and the specter of losing federal funding, hospitals around the country are backing away from treating new and, increasingly, existing patients — regardless of the laws in their states. Families’ options are quickly narrowing.

Last week, Kaiser Permanente, which operates medical facilities across eight states, announced it is pausing gender-affirming surgeries for individuals under the age of 19, joining a growing list of providers discontinuing such care. Other hospitals have gone even further, ending access to puberty blockers and hormones.

Yale Medicine, Children’s National in DC and the University of Pittsburgh Medical Center are among those that no longer offer these treatments to patients under the age of 19.

Some programs are disappearing altogether. Also last week, the Center for Transyouth Health and Development at Children’s Hospital of Los Angeles — one of the oldest and largest programs of its kind in the U.S. — closed, leaving nearly 3,000 patients in the lurch. UChicago Medicine also abruptly ended all gender-affirming pediatric services, and Connecticut Children’s Medical Center announced it would wind down its program for gender-diverse youth.

Parents living in blue states no longer feel secure in their ability to access care for their children. So far, obtaining services hasn’t been an issue for Sara and Christian Madera’s 10-year-old transgender son. He recently received an implant that will deliver puberty blockers for the next year. Although that gives the New Jersey family some temporary comfort, “it is really nerve-wracking to think of what’s beyond that,” Sara says.

Families like the Maderas are also terrified that the rhetoric doesn’t stop at restricting health care access — that their parental rights could eventually be at risk. An increasing number of them are considering moving abroad. Other countries are also grappling with how best to approach health care for transgender adolescents, but Christian says their conversations at least feel more nuanced and productive. “People are still listening to doctors,” he adds.

Anyone not directly touched by this issue might be tempted to ignore the plight of these families and the government’s targeting of transgender youth. And yet everyone should be paying attention. The cruelty on display should be reason enough to care — but if you need another: The same playbook that uses the guise of “protecting” the public to dismantle health care for transgender kids could be applied in other areas of medicine.

That erosion of medical freedom — a principle the administration follows selectively — is already underway for transgender adults.

Puerto Rico, for instance, recently passed a severe law threatening medical providers with up to 15 years in prison and a $50,000 fine for providing gender-affirming care for anyone under 21. Many transgender adults now worry that states on the mainland may blur the definition of adulthood — or seek to ban care entirely.

What’s next?

We should also ask what comes next. Will it be withholding access to PrEP, the medication that can prevent HIV? ADHD treatments? Antidepressants? Medication abortion? HPV vaccines? Childhood vaccines in general?

That’s not a random list. Conservative groups have scrutinized all these medical interventions. Now that scrutiny is coming from within health agency leadership as well. Take, for example, a recent Food and Drug Administration panel on the use of antidepressants during pregnancy, which alarmed experts by amplifying the risks of these medications while downplaying the dangers of untreated mental health conditions during pregnancy.

The concern is that these ad hoc panels could be used to justify policy changes that restrict or eliminate patients’ access to essential medications, superseding the rigorous, evidence-based processes in place to determine standards of care — all under the guise of “protecting” pregnant women and their children.

And of course, Health and Human Services Secretary Robert F. Kennedy, Jr., is making sweeping changes that could institutionalize this approach. He has already replaced every member of the CDC’s external advisory panel for vaccines with his own selected “experts” and is expected to oust the entire U.S. Preventive Services Task Force — an independent body that determines which services, like mammograms, insurers are required to cover.

This strategy — using flawed science, fear and political intimidation — is an immediate threat to the health of transgender people, not to mention their fundamental right to exist in society.

But make no mistake, this approach is unlikely to stop there. In one way or another, it will erode everyone’s access to care — and we all will be worse off for it.