In a sweeping and controversial change quietly enacted by the Trump administration, Department of Veterans Affairs (VA) doctors and medical staff are now permitted to refuse treatment to veterans based on their political affiliation or marital status, according to documents obtained by The Guardian.

The shift follows a January 2025 executive order from President Trump titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”—an order initially aimed at eliminating gender-affirming care across federal agencies. But buried in its wake are policy changes that open the door to ideological discrimination in one of the largest hospital systems in the country.

Under the new VA rules, which have already gone into effect at several medical centers, healthcare providers are no longer explicitly prohibited from refusing to treat patients based on political beliefs or whether they are married. Previously, VA bylaws guaranteed that no patient would face discrimination based on “politics,” “marital status,” or “national origin.” Those protections are now gone.

And the change is not limited to patient care. The rules also allow VA hospitals to refuse employment to physicians and other healthcare workers based on their political affiliation, marital status, or participation in labor unions.

“It seems on its face an effort to exert political control over VA medical staff,” said Dr. Arthur Caplan, founding head of medical ethics at NYU’s Grossman School of Medicine.

Caplan warns the changes could lead to scenarios where doctors interrogate veterans about whether they voted for Joe Biden, support LGBTQ+ rights, or wear anti-Trump buttons—and then deny them care.

A New Test for Patriotism?

While the Department of Veterans Affairs maintains that “all eligible veterans will always be welcome at VA,” press secretary Peter Kasperowicz acknowledged the rules were revised to comply with Trump’s executive order and said the changes are simply “a formality.”

But former top VA health official Dr. Kenneth Kizer calls the implications far-reaching and dangerous.

“This opens the door to doctors refusing care for rape survivors, pot smokers, or anyone whose beliefs they disagree with,” said Kizer, who served during the Clinton administration.

The VA system, which serves 9 million veterans annually and employs more than 26,000 doctors, is the largest integrated health system in the country. It operates more than 170 hospitals and 1,000 clinics, many in rural or underserved areas where private care isn’t an option.

That’s why the new policy is particularly chilling for advocates like Tia Christopher, a Navy veteran and survivor of military sexual trauma. “Some may have to travel over a hundred miles just to find a doctor who will treat them,” she said. “It could have a huge ripple effect.”

No Consultation. No Vote. No Warning.

Even more disturbing for medical professionals is how the rule changes were implemented—without consulting doctors or local hospital leadership, in violation of standards set by the Joint Commission, which accredits hospitals nationwide.

The American Medical Association issued a formal rebuke during its convention this week in Chicago, passing a resolution urging the VA and all hospitals to honor medical staff self-governance and reject changes that aren’t approved by healthcare workers themselves.

VA spokesperson Kasperowicz insisted the agency worked with the Joint Commission to ensure compliance, but declined to specify which federal laws mandated the changes or how they align with medical ethics.

“This is not how you run a medical system,” said Caplan. “These rules are unethical, and they’re politically motivated.”

The Bigger Picture

This is only the latest in what many experts call an ongoing politicization of science and medicine under Trump’s second term.

Earlier this month, the Department of Health and Human Services, now led by anti-vaccine activist Robert F. Kennedy Jr., fired every member of a key vaccine advisory panel. At the Centers for Disease Control and the National Institutes of Health, research restrictions and censorship of public health messaging have become increasingly common.

Within the VA itself, agency researchers have been forbidden from publishing studies in scientific journals without approval from political appointees—effectively muzzling independent science.

Taken together, these moves represent a radical reshaping of America’s public health institutions, where ideology increasingly outweighs evidence.

“We tell doctors: leave politics at the door,” Caplan said. “Now the government is telling them to bring it into the exam room.”