Corrected 3:46 p.m. | House Republicans attempting to tie the reauthorization of a critical pediatrician training program to efforts to limit gender-affirming care for transgender children acknowledge those efforts will collapse. Now lawmakers are looking to fund the program as-is through the appropriations process. 

Federal authorization for the Children’s Hospitals Graduate Medical Education Program, which trains more than half of pediatric specialists and almost half of general pediatricians nationwide, lapsed on Sept. 30. 

Earlier this year, the Republican-led House Energy and Commerce Committee approved a reauthorization bill that bars any federal funds from going to hospitals that provide gender-affirming care. That provision was a nonstarter for Democrats, who wanted to see a clean reauthorization of the physician training program.

Both sides have refused to budge, and without congressional investment, hospitals might be forced to make cuts to fund their next classes of fellows and residents.

But in a last-minute bid to prevent more pediatrician shortages, some lawmakers hope to appropriate dollars for the Children’s Hospitals Graduate Medical Education program through the fiscal 2024 Labor-Health and Human Services-Education funding bill.

There are no actual consequences to not reauthorizing the program and just appropriating funding, a Senate Democratic aide said, unless lawmakers want to make changes to the program. Funding the training program through the appropriations process would sidestep GOP attempts to tie the training program to an anti-trans policy. 

The Labor-HHS-Education funding deadline this year is Feb. 2, thanks to an unusual two-pronged approach the Hill is taking to appropriations this year. So far the House has passed seven of its 12 appropriations bills, but the health funding bill is not on that list. 

The proposed House Labor-HHS funding bill includes $400 million for the program, a $15 million boost above the 2023 enacted level — but it includes the gender-affirming care restrictions. The Senate bill proposes $385 million — flat funding — without restrictions.  

“The focus right now is ensuring the appropriations is as robust as possible to make sure the funding continues,” a Children’s Hospital Association spokesperson said. The group is hopeful the gender-affirming care provisions will be stripped out in conference.

Rep. Kim Schrier, D-Wash., a pediatrician who led Democrats’ attempt to get a clean reauthorization of the program through the House, said she’s hopeful this plan will get funds to children’s hospitals in the next year, though she’s disappointed the usually bipartisan program has devolved to this.

“Congress cannot afford to cut funding at a time when the US desperately needs to be training the next generation of pediatricians and pediatric subspecialists,” Schrier said in a statement.

The standoff comes as pediatric hospitals face workforce shortages among physicians and nurses and many children’s hospitals have been forced to rely on temporary staffing agencies to fill workforce gaps, according to the Children’s Hospital Association. 

It’s become more difficult to fill pediatric residency positions in recent years, and several pediatric specialties are seeing 20 to 40 percent fewer applicants, according to the American Academy of Pediatrics.

The Children’s Hospitals Graduate Medical Education program is, at its core, a workforce program and has historically been a bipartisan, feel-good issue. In 2018 Texas Republican Michael C. Burgess co-led the reauthorization.

But House Republicans are making gender-affirming care a hallmark social issue of this Congress. So far they’ve added riders to seven of 12 government funding bills to limit access to hormone therapy, surgery and other, similar care. 

Most of the bills have little chance of passing the Democrat-controlled Senate, but that’s not the point for conservatives, who want to amplify the issue ahead of the 2024 election.

“This is the issue of our time. This is the hill we’re going to die on,” Rep. Daniel Crenshaw, R-Texas, who led the legislative push in committee to tie pediatric physician training to gender-affirming care bans, said of gender-affirming care during a summer legislative hearing on his bill.

But asked this week whether he’d hold up the appropriations process over the policy rider, Crenshaw, who is still advocating for his legislation with riders blocking gender-affirming care, acknowledged the House needs “to get a bill to the floor.”

“I’m weighing my options as the funding process moves,” he said.

This story has been corrected to reflect the correct date the Labor-HHS-Education spending bill expires.