In the final weeks of the 2024 election, the refrain “Kamala is for They/Them, Trump is for You” blared from TVs in the battleground states during NFL and college-football games. Seeking to capitalize on voters’ frustrations after several years of inflation, the campaign ad warned that a Harris presidency would mean government-funded transition surgeries for children and migrants amid soaring food and housing costs for Americans.

This wasn’t the first time that the MAGA movement concocted a blend of populist resentment and anti-trans sentiment. That summer, Trump posted a video on social media in which he pledged to “investigate Big Pharma and the big hospital networks to determine whether they have deliberately covered up horrific long-term side effects of sex transitions in order to get rich at the expense of vulnerable patients.”

Since retaking office, the president has made good on that promise. The Department of Justice has issued subpoenas to doctors and clinics providing gender-identity care to children, while the Trump administration has moved to implement an executive order directing the Department of Health and Human Services and the Department of Justice to investigate and restrict such care. More recently, the federal health bureaucracy issued a report, “Wolves in White Coats: How Doctors and Hospitals Pushed and Profited From the Fraud of ‘Gender Medicine,’” alleging potentially fraudulent insurance-coding practices in gender-affirming care for minors. If the Trump regime and its allies cannot credibly run on a record of economic success, at the very least they might direct voters’ attention to someone else who, they claim, has been picking taxpayers’ pockets.

For a document that is ostensibly about healthcare, the provenance of its authors—mainly conservative women’s groups and Christian policy shops—is striking. Its most decorated author, May Mailman, is a veteran of the first Trump administration’s immigration team who returned to the White House to orchestrate the 2025 executive order “Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.” Its few medical experts are Quentin Van Meter, the former president of the fringe American College of Pediatricians, which broke away from the prestigious American Academy of Pediatrics over the latter’s support of adoption rights for gay and lesbian parents, and Eithan Haim, who previously collaborated with the conservative activist Christopher Rufo to expose Texas Children’s Hospital’s defiance of the state’s criminalization of trans healthcare.

The report itself presents what one could call a trans-exceptionalist view of the US healthcare system’s flaws. That is, it portrays the real deficiencies of a highly privatized approach to care as a problem of “ideological capture” and radical transgender activism rather than one of marketized medicine. It attempts to shock readers with sensationalized language about the “unique and lifelong revenue streams” that “sex-rejecting procedures” afford providers. Those relatively low-paid and prestige-hungry pediatricians, the report’s authors claim, stumbled upon a “strategic area of growth” in gender-affirming care, one that greedy “elite” hospital administrators were more than happy to encourage.

There is truth but far more fiction in this account of trans medicine. While medical transition does indeed require the persistent use of hormonal medications, these are often available as cheap generics. Yet the report explicitly alleges that pediatric gender-medicine programs generated substantial revenue and created groups of “captive patients” requiring long-term care. There is limited evidence, in the report or elsewhere, that leaders of hospitals consider gender-identity clinics, with their tiny patient populations, to be an especially lucrative “growth area.”

At its worst, “Wolves in White Coats” takes real problems in healthcare billing and attributes them to providers of trans care. The authors make a scandal of how some providers used creative diagnostic codes to convince insurers to pay for medically necessary treatment. For instance, the report alleges that a physician might diagnose a patient with an “unspecified endocrine disorder” rather than gender dysphoria, or file claims for adolescents with a diagnosis of “precocious puberty.” In the eyes of the Trump administration, however, these acts of clever compassion are nothing more than fraud.

The report also cites recent high-profile instances of actual systematic fraud in the Medicare Advantage system. These cases have nothing to do with trans medicine, but they have everything to do with the Trump administration’s support for this privatized form of Medicare—one that creates an incentive for this exact kind of con. By paying “risk-adjusted” higher rates to insurers based on the health of enrollees, Medicare Advantage basically invites its partners in the insurance industry to manipulate patient records. Unlike these insurers, however, trans-healthcare providers are not taking liberties with diagnostic codes to make anyone rich; they’re simply trying to get their patients much-needed care in a system that often withholds everything from hormones to cancer drugs.

Although Republican elites have benefited politically from the myth that a marauding gender-identity industry has been preying on unsuspecting children and their parents, they did not invent this conspiracy theory. One of the first influential articulations of the idea came in 2018, from the little-known blogger Jennifer Bilek, writing in The Federalist. Bilek described a cabal of gay, trans, and Jewish billionaires, along with major pharmaceutical companies and Silicon Valley types, who had constructed a medical-industrial complex rivaling the military’s own sprawling network of government-subsidized firms. Over the next few years, this idea gained traction among gender-critical feminists and Christian fundamentalists before a slightly tamer version was adopted by think tanks like the Heritage Foundation and the Manhattan Institute.

In the summer of 2022, as inflation hit a 40-year high and the Democrats’ ambitious Build Back Better economic plan lay dead in the Senate, an influential conservative group put the gender-identity-industry trope to work. That August, the American Principles Project unveiled its “Top 25 Threats to the American Family” report, led by Senators Marco Rubio and Josh Hawley and featuring contributions from JD Vance and others who became leaders in the second Trump administration.

Straying from the GOP’s typical pro-business rhetoric, the American Principles Project took on Google, Amazon, and BlackRock as well as “special-interest groups” like the Chamber of Commerce and Big Pharma. Special ire was reserved for AbbVie, the manufacturer of puberty-suppressing medications, which was compared to the corrupt Tammany Hall political machine. “Woke” Silicon Valley moguls were also blamed for their role in broadcasting social-media content that allegedly spread gender dysphoria like a social contagion.

This message ultimately resonated with many Americans, drawing as it did from a growing suspicion of Big Pharma and Big Tech in the post-pandemic era. Vaccine skeptics like Steve Bannon hosted Bilek to complain about the “transhumanist” machinations of trans-healthcare providers, while Make America Healthy Again leader Robert F. Kennedy Jr. and podcasters like Joe Rogan demonized gender clinicians and public-health officials alike. Just in time for Trump’s adoption of the conspiracy theory, the American Principles Project published its “Gender Industrial Complex” report in 2024, documenting a purported $4.4 billion market in hormones and surgeries—which might sound scandalous without the context that US healthcare spending runs in the trillions.

This election season, Republicans are hoping that the anti-trans sentiment that propelled Trump back into office still has momentum. In Texas, the president’s handpicked candidate Ken Paxton has made such attacks central to his Senate race against Democratic nominee James Talarico. Resorting to schoolyard-bullying tactics, Paxton has referred to his opponent as “low-T Talarico” and “Six-Gender Jimmy”—barbs that conflate Talarico’s support for trans rights with a supposed masculinity deficit.

Even more brazenly, the American Principles Project has been running a pro-Paxton ad that loops Talarico into the gender-identity-industry conspiracy. Borrowing from President Lyndon B. Johnson’s famous 1964 “Daisy” campaign ad, which cautioned against Republican nominee Barry Goldwater’s trigger-happy attitude toward the country’s nuclear arsenal, the video depicts an innocent young white girl who—according to an AI-generated LBJ voice-over—is at risk of a “trans industry [that] preys on confused children.”

These fears have also moved into intra-GOP battles over the party’s future. This was most visible in Kentucky, where the isolationist US Representative Thomas Massie fought against the Trump-endorsed Ed Gallrein in what became the most expensive House primary race in history. In one ad, a pro-Massie PAC broadcast that Gallrein was funded by the billionaire hedge-fund manager Paul Singer, a Republican known for his iconoclastic support of LGBTQ causes as well as his donations to the Israel lobby. The ad foregrounds Singer’s visage as a rainbow Star of David rises behind him while the voice-over denounces Singer as a “far-left trans-activist billionaire.” Elsewhere, Groyper-aligned candidates and their media champions like Tucker Carlson are harnessing due outrage against Israel, Silicon Valley, and the affordability crisis to push these and other scapegoating narratives into the political mainstream.

And yet those conservatives who are most eager to denounce Big Pharma and specific features of our privatized healthcare system are also the least likely to do anything about them. Instead, they’ve cut Medicaid and refused to extend the Affordable Care Act’s tax credits. And lest liberals remain off the hook, their failure to reckon with inequality and their complicity with the forces that keep both the healthcare industry and the country’s megadonor-driven politics intact are also to blame. After all, “Kamala is for They/Them, Trump is for You” worked because the Democratic Party’s botched economic agenda fueled the idea that trans rights are incompatible with the public good. Until something is done about the ugly truths of private power, there will be plenty of those who are drawn to these conspiratorial untruths.