Health

Inside the Department of Veterans Affairs — the nation’s most extensive health care system — a quiet rebellion seems to be growing.

Dozens of VA clinicians are breaking their silence, accusing the Trumpadministration of abandoning the very veterans they swore to serve. In a searing letter asking VA staff to sign on to an editorial circulating this week — and obtained by The Advocate — they describe a workplace transformed by fear, censorship, and cruelty. When The Advocate became aware of the document Friday afternoon, more than 50 clinicians whose details are being kept confidential out of fear of retaliation had signed it, according to a person with knowledge of its contents.

“Our leadership is failing Veterans,” they write.

This growing outrage follows a dramatic policy reversal last month. On March 17, VA Secretary Doug Collins — appointed by President Donald Trump — ordered the agency to end new prescriptions for hormone therapy and referrals for gender-affirming care for transgender veterans. The announcement was part of a broader rollback of LGBTQ+ protections across the federal government since day one of the second Trump administration that has systematically targeted trans and nonbinary people’s existence. The Advocate was the first to report on the rollback of policies around the dignified treatment of transgender vets.

Clinicians say the policy does not just cut off lifesaving health care — it signals to transgender veterans that they are no longer safe or welcome in a system designed to care for them.

Since the March directive, VA staff say they’ve been ordered to remove Pride flags and other LGBTQ-inclusive signage from hospitals, delete pronouns from staff bios, and report colleagues for using words like “transgender” or “LGBTQ+” in official communications.

It didn’t happen overnight. “It happened in small steps, as oppression often does,” the letter says.

But now the impact is unmistakable. Veterans — especially transgender veterans — are afraid to come back. Inside VA facilities, fear is spreading like wildfire. “People across facilities have been signing with the promise for anonymity,” a VA provider told The Advocate. The provider — speaking on condition of anonymity out of fear of retaliation — said some staff want to sign the letter but worry they could be fired if their names get out.

Their fear is not misplaced. Staff have been told to report on each other, the provider said.

In response to The Advocate’s request for comment, VA Press Secretary Peter Kasperowicz defended the rollback, calling it a “commonsense reform” that he said should have happened long ago.

“VA is phasing out treatment for gender dysphoria and directing all savings to helping paralyzed Veterans and amputees,” Kasperowicz said in a statement to The Advocate. 

He added, “VA has received almost no criticism in response to this decision — proof that the vast majority of Veterans and Americans support it.”

But advocates and VA providers say that claim doesn’t hold up. Lindsay Church, a transgender Navy veteran and executive director of Minority Veterans of America, called Kasperowicz’s justification dishonest.

“VA has so far failed to produce any information about how much the department even spends on the treatment of gender dysphoria and therefore cannot redirect funding in this manner,” Church told The Advocate. “Furthermore, the provision of gender-affirming care transcends administrations, dating back to the first Trump administration. VA leadership is trying to deflect from their work gutting the department and the care veterans receive by targeting vulnerable veterans. Providers have voiced very real objection to the decision to rescind gender-affirming care — and to deny this is a lie.”

Clinicians say the damage has already been done inside the system. “Veterans — especially those who are transgender — now live in fear,” the letter reads. And staff do too.

For transgender veterans, the rollback of gender-affirming care feels like erasure — a political decision with life-or-death consequences. “How safe do I feel? Less than welcome,” retired Army Staff Sgt. Alleria Stanley recently toldThe Advocate. Stanley — a 20-year combat veteran who retired with full benefits after transitioning on active duty — said the message from the VA is clear.

“They just told transgender veterans, ‘You are not worthy,’” she said after the March announcement.

U.S. Rep. Mark Takano of California, ranking member of the House Committee on Veterans’ Affairs, praised the VA clinicians behind the letter and condemned the climate of fear emerging within the agency. 

“I wholeheartedly support the views in this letter and deeply admire the courage of the VA clinicians who are putting the health care of veterans first by signing this letter,” Takano told The Advocate. “It’s not easy to step forward in the culture of fear of retaliation Secretary Collins is concocting across VA. Sharing truths, even uncomfortable truths, is an essential step in combating misinformation.”

Takano, who is also the chair of the Congressional Equality Caucus, added, “I stand with our LGBTQ+ veteran community, especially those facing transphobia, and will continue to fight for quality care for all veterans.”

Clinicians say they’ve seen the lifesaving power of gender-affirming care — veterans pulled back from the brink of suicide after starting hormone therapy, suffering lifted after years in darkness. Dr. Mary Brinkmeyer, a psychologist who resigned from her position as an LGBTQ+ care coordinator at the VA hospital in Hampton, Virginia, out of protest in February, is one of those who have seen the benefits of care and who fear for those who are denied it after having earned the care they need.

These new directives, the letter says, “break this promise.” Veterans made sacrifices “in body and soul” for their country, it continues — but the government is failing them. “Many are afraid to seek care at all, terrified they’ll be targets of humiliation or violence,” the clinicians write. Despite the climate of fear, the letter calls on VA leadership and the federal government to reverse course. “Get out of our lane,” the clinicians demand. Leave medical decisions where they belong: between patients and their providers.

“Over the years, Veterans have fought hard for the medical care they need, from care for Agent Orange to military sexual trauma,” the clinicians write. “Thanks to their efforts, the VA has made strides on treating post-traumatic stress disorder, reducing Veteran suicide, managing toxic exposures, and providing reproductive and gender-affirming care. We must uphold these advancements for allVeterans.”

The letter ends not in despair — but in defiance.

Clinicians vow to continue honoring their oath to care for all veterans — regardless of who they are, how they served, or how they identify. “We will not forsake the oath we took to provide care regardless of religion, nationality, race, age, gender, sexual orientation, disabilities, party politics, or social standing,” they promise.

“To our Veterans: please know that we vehemently oppose these orders and that even in this darkness, there is resistance,” they write.

“We will continue to treat you with the respect and dignity you were promised when you sacrificed in service of our country,” the letter says. And they leave no doubt about their message to transgender veterans facing discrimination and fear inside the VA.

“Here, in our clinics and hospitals, you are welcome, and you are not alone,” they pledge.

TheU.S. Supreme Court has agreed to hear a pivotal case that could significantly impact access to preventivehealth care under the Affordable Care Act, including life-saving HIV prevention drugs like pre-exposure prophylaxis or PrEP. The court granted the petition on Friday. The case, which the federal government petitioned for the court’s intervention, is set to be argued this spring, with a decision expected before the Court’s term ends in June.

The Advocate was the first to report on the existence of this case back in 2022 when it was revealed that conservative attorney Jonathan Mitchell was representing Braidwood Management, Inc., aTexas-based business, and other plaintiffs in challenging the ACA’s requirement that insurers cover preventive services like PrEP without cost-sharing. The plaintiffs, claiming that coverage of PrEP violates their religious beliefs, argue that it promotes “homosexual behavior.”

Initially, U.S. District Judge Reed O’Connor sided with the plaintiffs, ruling that the ACA mandate violated their religious rights. However, the Department of Justice swiftly appealed, and the Fifth Circuit Court upheld the district court’s decision butlimited the scope of its effect. The decision meant that while the plaintiffs are exempted, the broader mandate requiring insurance providers to cover preventive services, including PrEP, remains in effect nationwide.

The case is now headed to the Supreme Court, where it will be argued that the ACA’s coverage requirements, which have been instrumental in reducing HIV transmission and improving public health, should be upheld.

At the heart of the case is the structure of the U.S. Preventive Services Task Force, which issues recommendations for preventive services like PrEP. The Fifth Circuit Court of Appeals ruled that the Task Force’s structure violated the Appointments Clause of the U.S. Constitution.

The government maintains that the Task Force operates within constitutional bounds, with members serving as “inferior officers” under the secretary’s supervision, that this structure is consistent with constitutional requirements, and that it is vital to ensure that essential preventive services are covered under the ACA.

The case also raises the specter of rolling back coverage for a range of other critical preventive services, including cancer screenings, diabetes prevention, and vaccinations—services that have long been proven to save lives and reduce health care costs. If the court upholds the Fifth Circuit’s ruling, the federal mandate requiring insurers to cover Task Force recommendations could be significantly weakened, disrupting the health care protections millions of Americans currently rely on.