A federal judge in Oregon issued a written opinion rebuking Health and Human Services Secretary Robert F. Kennedy Jr. for attempting to strip Medicare and Medicaid funding from hospitals that provide gender-affirming care to minors, ruling that Kennedy exceeded his legal authority and bypassed the regulatory process required to make such a change.

U.S. District Judge Mustafa T. Kasubhai filed the formal opinion on April 18 in Oregon v. Kennedy, case No. 6:25-cv-02409-MTK. The order grants summary judgment to a coalition of states that sued the Trump administration over the funding move, as Bloomberg Law reported.

The opinion puts into writing what Kasubhai first announced from the bench in March: that Kennedy's declaration to slash federal funding ran afoul of his authority. The judge said the move required a more formal regulatory process, one the nation's top health official never undertook.

The judge's sharpest words

Kasubhai did not limit himself to procedural findings. His written opinion included pointed language aimed directly at Kennedy's conduct. Bloomberg Law quoted the judge writing:

"Unserious leaders are unsafe."

The judge went further, framing the case as a lesson about the boundaries of executive power:

"This case illustrates that when a leader acts without authority and in the absence of the rule of law, he acts with cruelty."

That kind of language from a federal bench is unusual. Judges typically confine themselves to statutory analysis and procedural findings. Kasubhai's opinion reads more like a public rebuke, the kind that invites political reaction on both sides.

For conservatives who support protecting children from irreversible medical procedures, the substance of Kennedy's goal is easy to defend. But the legal question is different from the policy question. If the judge is right that Kennedy skipped the required rulemaking steps, the administration handed its opponents an easy win, and a quotable one at that.

A pattern across federal courts

The Oregon ruling is not an isolated clash between the Trump administration's health agenda and the federal judiciary. In a separate case in Rhode Island, U.S. District Judge Mary McElroy granted a preliminary injunction blocking the administration and Kennedy from terminating $11 billion in public health grants, according to Just The News. The lawsuit was brought by the District of Columbia and 23 states, including California.

Judge McElroy wrote that the federal government "clearly usurped Congress's authority to spend and allocate funds" when it terminated the grants. She added that if Congress had intended to give HHS the power to withhold those dollars, "it would have done so."

The Rhode Island injunction extended an earlier temporary restraining order and paused the Trump administration's March 24 termination of the grants. Together, the Oregon and Rhode Island rulings suggest a growing judicial consensus: whatever policy goals the administration pursues through HHS, the courts expect the agency to follow the procedural rules Congress laid down.

That is a problem the administration can fix, but only if it takes the rulemaking process seriously. Issuing declarations and expecting courts to defer has not worked.

The broader fight over children's gender medicine

The legal setback in Oregon arrives against a backdrop of real movement on the ground. Children's Minnesota paused puberty-blocking drugs for minors after an HHS investigation referral, a sign that federal pressure can change institutional behavior without a court order.

Kennedy's HHS has also drawn attention for other regulatory and investigative actions. Rep. Elise Stefanik called on the secretary to investigate a New York City health department working group funded by taxpayers, showing the range of controversies now landing on Kennedy's desk.

Meanwhile, the Trump administration's broader pressure campaign has produced tangible results elsewhere. NYU Langone shut down its transgender youth program after sustained federal scrutiny, a development that supporters of the policy celebrated as proof that executive action can reshape medical practice.

But the Oregon and Rhode Island rulings show the limits of that approach when it bypasses formal channels. Courts are not objecting to the administration's policy preferences. They are objecting to the method.

Process matters, especially for the right

Conservatives have spent decades arguing that the administrative state must follow its own rules. The demand for proper notice-and-comment rulemaking, for adherence to statutory authority, for respect of Congress's spending power, these are foundational conservative legal principles.

When a federal judge says HHS skipped the required regulatory process, that is not a left-wing talking point. It is exactly the kind of procedural discipline conservatives have championed in fights against EPA overreach, OSHA mandates, and student-loan forgiveness schemes.

The same standard must apply when the policy goal is one conservatives favor. If Kennedy wants to cut funding tied to gender-affirming procedures for minors, the law gives him a path. He has to walk it. Issuing a bare declaration and daring courts to stop him is the kind of executive shortcut the right has rightly criticized for years.

Judges across the country have shown a willingness to block Trump administration health initiatives on procedural grounds. A Biden-appointed judge previously halted a Trump vaccine policy, drawing criticism and two Supreme Court reversals, a reminder that not every lower-court ruling will survive appeal.

That possibility exists here too. The administration could appeal Kasubhai's ruling or pursue the same policy through proper rulemaking. Either path would put the substance of the debate, whether taxpayer dollars should fund gender procedures for children, back at the center, where it belongs.

What remains unanswered

The Bloomberg Law report leaves several questions open. The specific text of Kennedy's declaration has not been detailed beyond the judge's characterization. The full list of states in the coalition that sued has not been published in the available reporting. And no hospitals affected by the funding threat have been named.

The administration has not yet responded publicly to the written opinion, and it remains unclear whether HHS will appeal or pursue a formal rulemaking process to achieve the same policy outcome. The leadership shakeup at federal health agencies continues; the president recently tapped former deputy surgeon general Erica Schwartz to lead the CDC, signaling that personnel changes are still underway.

For now, the Oregon ruling stands. Medicare and Medicaid funding for hospitals providing gender-affirming care to minors remains intact, not because the courts endorsed the practice, but because the administration failed to follow the rules it needed to follow.

Good policy pursued through bad process is still bad government. If Kennedy wants to win this fight, he needs to do the paperwork.