Rules & Legislation Committee
February 26, 2026

Dear Members of the Public and Fellow City Councilmembers, Gender-affirming care is medically-necessary care that comes in the form of services like counseling, medications (such as puberty blockers and hormone therapy), surgery to change outward appearance, and other medically supervised treatments that support and affirm an individual’s gender identity when it conflicts with the gender they were assigned at birth. Studies consistently show that when transgender people have access to affirming healthcare, their mental health improves, and rates of depression and suicide risk decrease significantly. Gender-affirming care is life-saving care. New proposed rules from the Trump administration threaten access to gender-affirming care for youth across the country and in Oakland. On January 28, 2025, Trump issued Executive Order 14187, directing federal agencies to eliminate federal funding and support for gender-affirming care for people under age 19, including puberty blockers, hormone therapy, and gender-affirming surgery. Then, on December 18, 2025, the Centers for Medicare and Medicaid Services announced two proposed rules aimed at making this directive a reality. The first rule would restrict access to gender-affirming care for youth by prohibiting hospitals which provide this care from participating in Medicare or Medicaid. The second rule would prohibit federal reimbursement for youth gender-affirming care provided under Medicaid and the Children’s Health Insurance Program (CHIP). Seeing as virtually every hospital in the country relies on Medicare and Medicaid funding, these proposed rules would severely limit access to medically-necessary care if finalized. The City of Oakland is home to major healthcare providers—Sutter, Kaiser, and UCSF. Sutter moved to stop providing gender-affirming care at the end of last year but reversed its decision. As of August 2025, Kaiser Oakland no longer provides access to gender-affirming surgeries for patients under 19 years old. Our healthcare providers must not crumble under Trump administration pressure. California has taken steps to protect the rights of transgender youth. California Attorney General Bonta is party to multiple lawsuits opposing the federal government’s efforts to limit gender-affirming care and recently issued guidance confirming that “gender-affirming healthcare services, and gender affirming mental healthcare services are rights secured by the Constitution and laws of California.” Youth and adults deserve access to healthcare that respects who they are. By safeguarding gender-affirming care in Oakland, we are not only protecting medical access—we are reaffirming the kind of community we want to be: one that values empathy, inclusion, and the wellbeing of all its residents. Sincerely, Zac Unger, District One Councilmember
CITY OF OAKLAND Zac Unger COUNCILMEMBER – DISTRICT ONE CITY HALL • ONE FRANK OGAWA PLAZA • 2ND FLOOR • OAKLAND, CA 94612 (510) 238-7001 • [email protected]