While headlines were giving the Catholic church hierarchy plaudits for symbolic gestures in support of immigrants and a papal lunch with trans people, American bishops passed a major ban on trans healthcare throughout the church’s sprawling hospital systems. This reveals the truth of an institution deeply hostile to our existence, one that trans communities must fight to survive

On Nov. 12, the U.S. Conference of Catholic Bishops voted overwhelmingly to ban life-saving trans healthcare in its many church-run health systems across the country.

While this did draw some coverage from establishment news outlets, it generally relegated it to dry language (NPR: “the step formalizes a yearslong process for the U.S. church to address transgender health care”). They gave it a good deal less ink than the same Baltimore conference's earlier resolution condemning the Trump administration's treatment of immigrants, or to the news revealed later in the week that Pope Leo XIV would have lunch with four hand-picked trans people.

Most news outlets didn't even record the vote margin, which this reporter had to root around in various diocesan announcements to find: 206 in favor, eight abstained, seven against. The Catholic hierarchy's factions may have their disagreements, but denying healthcare to trans people isn't one of them.

This has a much larger impact than either of the symbolic steps that drew far more attention. The hospital networks run by the church are sprawling and immense. In some areas of the country they're the only major healthcare system.

Robert Barron, the bishop of Winona-Rochester, credited the ostensibly progressive Pope Francis for the move, remembering a three-hour meeting with the late pontiff.

“He specifically said to us: ‘I want you to fight gender ideology, which is repugnant to the Bible and our tradition,’” Barron told the assembled bishops.

A clearer, “we hate trans people” statement is hard to imagine.

The Catholic Health Association claims that one in seven patients in the U.S. go through their hospitals. A 2020 report from Community Catalyst found that in plenty of states, their systems make up a substantial percentage of all hospitals. This is not just something that impacts Catholics, nor only red states. Almost a third of all hospital beds in Oregon are run by the church. In Washington, it's over 40 percent, as it is throughout much of the Midwest.

Nor does it just impact hospitals themselves. Healthcare systems run by the church are rapidly expanding, taking over urgent cares, specialists and doctor's offices around the country.

“From 2001 to 2025, Catholic provider growth rate was 28.5 percent,” a September report from the liberal Center for American Progress summarized. “During that same period the number of non-Catholic hospitals declined by nearly 14 percent. By 2020 four of the country's 10 largest hospital systems — by number of beds — were Catholic, and at least 1 in 6 of America's hospital beds were in Catholic hospitals.”

The recent attacks on public healthcare funding are not going to improve this situation.

A 2024 KFF Health News report highlighted the case of a Michigan woman, Kalaina Sullivan, who repeatedly found essential care denied her as one provider after another was taken over or bought out by the church's apparatus.

Sullivan’s main provider was owned by one of the Catholic church’s healthcare systems. So she had to travel to get a procedure done to ensure she couldn’t get pregnant in the future. Shortly afterwards, that practice was also bought out by the same system. As of 2024 she’d have to travel over 30 minutes to any hospital not controlled by the church’s dictates.

“I just don’t see why there’s any reason for me to have to follow the rules of their religion and have that be a part of what’s going on with my body,” Sullivan told KFF Health News.

This means that even where laws protecting trans and reproductive healthcare are on the books — Michigan voters enshrined abortion protections in 2022 — many areas are under de facto bans because the nearest providers are controlled by a religious hierarchy that forbids them anyway. The analysis from CAP — hardly a bastion of radicalism — found the situation so severe that they called for using antitrust laws to curb it.

All this makes the bishops' actions one of the biggest attacks on trans healthcare in the United States yet, not passed by politicians that at least fear some level of public outrage, but a sweeping ban enacted by a theocratic hierarchy.

It is worth remembering that trans healthcare is not optional. It literally saves lives. The increasing hostility to it is, rightly, considered a harbinger of genocide by the Lemkin Institute, which has repeatedly sounded the alarm about “a genocidal process against the transgender community that has been emerging in the United States for over a decade.”

Catholic hospitals have never exactly been friendly terrain for trans people — as we're about to detail, the church hierarchy's hatred of us runs deep — but the recent declaration by the conference of bishops replaces a more hodge-podge system with occasional breathing room with an outright and total ban at a time when our survival is under increasing attack everywhere.

“Catholic providers will continue to welcome those who seek medical care from us and identify as transgender,” a statement from the Catholic Health Association declared after the ban's passage. “We will continue to treat these individuals with dignity and respect.”

This is, to be clear, nonsense. It is the same language used to excuse “separate but equal” and other horrific bigotry as something they're not.

In reality the ban means that trans people are even less likely to get treated in the church's healthcare systems for anything. Bans on trans healthcare never end just at care specific to us. Broken bone? Surgery complications? Infection? Historically, bigoted medical institutions are happy to let us perish.

This is compounded by the fact that as an overwhelmingly working class demographic often facing overlapping oppressions (generational poverty, racism, xenophobia), trans people are in particular need of all forms of medical care. We face more stress and deprivation, including malnutrition. We're far more likely to be attacked or injured. Due to all this, including widespread poverty, illnesses often hit us harder too. A major correlating factor in trans people ending up in prison is lack of access to medical care.

A scenario I'm personally aware of illustrates this point: a trans woman shows up to an ER, bleeding from a recent surgery. Even at hospitals without outright trans healthcare bans she could easily face rejection or deadly hesitation from medical staff. What about at ones whose owners outright ban trans healthcare? If it's for complications from recent bottom surgery will they just let her die? Throughout history, too often the answer is “yes.”

We also have recent examples of Catholic hospitals in particular doing this to patients desperately in need of reproductive care.

“We had many instances where people would have to get in their car to drive to us while they were bleeding, or patients who had their water bags broken for up to five days, or even a week,” Jennifer Chin, an OB-GYN in Seattle who's treated many patients turned away from Catholic hospitals, told KFF Health News in 2024.

“Dignity and respect” indeed.

Given that, a lot more skepticism is in order. Especially when it comes to propaganda around the blood-soaked institution that is the Catholic Church.

Individual Catholics across the globe have a wide range of beliefs, from leftist liberation theology to outright fascism. Indeed, American Catholics as a population tend to be more broadly supportive of queer and trans rights than the institution itself. A 2023-24 Pew Research study found Catholic respondents split, with 36 percent broadly supporting trans rights and 35 against. By comparison, among evangelicals the divide was 18-64.

The church hierarchy, however, is a very different story. It has been, and remains, a relentlessly reactionary force.

For the sake of brevity we'll just focus on the last century or so. As an institution the Catholic Church actively collaborated with multiple fascist regimes, including those of Mussolini, Hitler and Franco. It set itself dead against rights for women and practically any marginalized group one cares to mention.

While much of the attention on the far-right push to overturn abortion rights focused on louder (and also thoroughly evil) evangelical Protestant organizations, the Catholic Church was the creator of the notorious “crisis pregnancy centers” that spew anti-abortion pseudoscience and intimidate pregnant people seeking basic care. The church hierarchy also helped bankroll efforts to roll back bodily autonomy around the globe, including overturning Roe.

The largest anti-abortion group in the United States, the National Right to Life Committee, was started and financially backed by the Catholic hierarchy, at another one of those bishops' conferences. After Roe became law in the '70s, the bishops pushed for a constitutional amendment banning abortion permanently. This continues to the present day, as the bishops' conference pushed a major 2023 lawsuit to ignore laws requiring employers to medically accommodate workers who'd recently had an abortion. All of this is without even discussing the church using its control to ensure pregnant people suffer or even die in brutal conditions

Then there were the widespread systems of “residential schools” and “Magdalene laundries,” which were concentration camps under other names. Often, for indigenous children and non-conforming (including queer) women, these were also death camps. They only shut down in the '90s. Bodies, especially of children, are still being found. They remain a bleak reminder of what happens when the Catholic hierarchy has free political reign.

That's before we get into the endemic levels of horrific child abuse perpetrated by priests and others in the church hierarchy, covered up for decades at all levels of the institution in places around the world. The current pope is not an exception.

Of course, this has long meant an absolute and brutal opposition to trans rights and healthcare. The church hierarchy's influence with the Reagan administration was a factor in the 1981 ban on Medicare covering trans care, which led to wider bans throughout U.S. healthcare systems and was only lifted in 2014. As the AIDS genocides escalated, the same bishops and cardinals staunchly opposed basic measures like condoms and informing the public about safe sexual practices.

As the saying goes, the point of a system is what it does.

Given that, it's not shocking that in 1989 ACT UP launched a major action called Stop the Church “to protest the AIDSphobic, homophobic, misogynistic and anti-abortion policies of the Catholic Church,” according to ACT UP’s Oral History Project. Teaming up with WHAM!, a women's health action group, thousands disrupted a mass by Cardinal John O'Connor, who'd spearheaded the hierarchy's opposition to stopping the AIDS genocides, storming into St. Patrick's Cathedral in New York City. Over 100 people were arrested.

While the action drew widespread condemnation from the political and media establishment, veterans of the group recalled that it had a real impact.

“I think the shock of going inside and confronting the cardinal really worked,” ACT UP member Jim Hubbard recalled in a 2012 Radio Free Europe article. “It helped bring ACT UP to mainstream attention. It brought the crisis to a point where the government and the mainstream media really had to start dealing with it.”

But you may have heard this was all in the past, that since Pope Francis took the highest spot in the Catholic hierarchy in 2013, there were at least some real moves in another, less utterly horrific direction.

This isn't true. The shift during Francis' papacy was overwhelmingly one of public relations rather than actual changes to how the institution used its power.

This was especially true with everything involving bodily autonomy. Indeed, Francis was particularly harsh about his stances against trans people, comparing us to nuclear weaponry. While our endlessly inventive communities quickly repurposed these because they make us sound cool as hell, they're also a clear reminder that one of the most powerful institutions on the planet seeks our annihilation.

In a notable contrast with ACT UP's courageous history of confrontation, in 2013 The Advocate named Francis its person of the year, based mostly on vibes and vague statements. If this was meant to encourage more pro-trans and queer actions from the papacy, it was an utter failure.

In a pattern that will become familiar, such steps as his papacy took towards more tolerance were highly symbolic or only impacted Catholics in specific ritual circumstances, while the broader moves — and plenty of his remarks to others in the hierarchy — were all staunchly against trans rights.

In 2015, Francis' remarks equating us to radioactive destruction also embraced the far-right's “gender ideology” framing, something the U.S. bishops continued when announcing their recent ban. In 2016, he told a conference of clergy and nuns that teaching about the very existence of trans people was part of a “global war” against marriage. In 2021, the church hierarchy tried to stop an Italian law criminalizing anti-LGBTQ violence and hate speech under the rationale it could, heaven forefend, be used against them. The same year the U.S. bishops lobbied to stop the formation of a national suicide hotline because it involved basic LGBTQ support resources.

In 2023, the U.S. bishops' conference urged Catholic hospitals not to administer trans healthcare. A 2024 papal declaration on Catholic doctrine condemned our healthcare as a violation of “human dignity.”

No, I am not making that up.

While the formal ban didn't happen during Francis' reign, his papacy laid extensive groundwork for it, as the bishops themselves openly said when they passed it.

An incident towards the end of Francis' papacy also peeled back the facade and showed a truer, and uglier, example of his views than magnanimous public statements. In a May 2024 private discussion with bishops about whether to admit gay men into seminaries, he used the Italian slur to dismiss the idea.

As journalist Paul Vallely, who's written extensively about the church, summed up Francis' approach in a prescient 2015 NPR interview, he was “keeping the words and changing the tune.”

This p.r. shift — and that is, overwhelmingly, all it is — has not changed with the newest pope. While Leo hasn't made any major statements about queer or trans rights yet, his previous record and current actions since he ascended to the papacy don't show any break with Francis' history.

During his time as a bishop in the Peruvian city of Chiclayo, Leo opposed any recognition of trans rights and gender non-conformity within the education system, telling the conservative newspaper Diario Correo in 2016, “the promotion of gender ideology is confusing, because it seeks to create genders that don't exist.”

In a September interview with the Catholic magazine Crux, Leo stressed that “the doctrine on LGBT people is not going to change” though claiming that, somehow, gay and trans Catholics would still be “welcome.” To those of us who grew up with constant invocations of “love the sinner, hate the sin” plastered over a reality of brutal violence, it's a familiar refrain.

Even that much-touted p.r. lunch with trans women had a catch: the pope, unlike even his predecessor, refused to sit at the same table.

At TNN, we like to direct our readers to concrete actions they can take, like when we helped bring public pressure against attempts to ban Medicaid from covering trans healthcare earlier this year.

But that's not really possible here, because in this case those with the power over our healthcare in a shocking amount of the country's hospital systems aren't even elected officials that might be intimidated by a public backlash, they're appointed religious authorities within what remains an absolute theocratic monarchy.

It is a problem that the literal life or death power over so many lies in the hands of an institution so utterly unaccountable, with such a long history of hatred and abuse.

Of course, no power is unshakeable. For a start, what people can do — both trans people and cis folks who care at all about our lives — is exercise a lot more skepticism about propaganda from an institution whose conduct so vastly belies its occasional words of tolerance.

There is a regrettable tendency, especially when circumstances are as dire as they are now, to look for any sign of hope in status quo institutions. That maybe this apology, or that gesture, may portend something less oppressive. The stark evidence is that it does not.

They should put hard pressure on media to adopt a similarly skeptical stance. We'd be having a very different discussion if the bishops' move to ban trans healthcare — and its human cost — got the same press as their far more symbolic resolution on immigration.

This all goes double for Catholics who support trans rights. If you find the current ban appalling, then far, far more is needed than the tepid statements of disappointment we usually see from ostensibly pro-trans Catholic groups. This isn't what you believe, what you stand for? Prove it.

A shift in tactics is also necessary. Over the past three decades, especially as assimilationist “Gay Inc” groups have gained more power, activism and organizing directly targeting the role of religious authorities in attacks on our rights has diminished, so as to make things more acceptable to the status quo.

This was a mistake, and not just with a refusal to confront the Catholic hierarchy. It is far past time to take a page from ACT UP, and realize that in the fight for our liberation a little anticlericalism goes a long way.

—Edited by Mira Lazine