Read up on 1557 changes and title ix changes, which include language that specifically permits institutions to say, "we do not discriminate based on criteria X, y, z" when they discriminate against trans people.

It also affirmed that they felt they could supersede state law to protect caregivers (doctors, etc) who provide care against the law in their state (gender affirming care). They declined to exercise that authority and explicitly said they would not.

They also said they would consider provider discrimination only on a case by case basis (which they are not funded to do, and leaves poorer people more likely to suffer discrimination).

They added language stating "nothing in this rule imposes a requirement that covered entities provide gender affirming care".

They specifically struck the following language: "a providers belief that gender transition or other gender affirming care can never be beneficial for such individuals is not sufficient basis for a judgement that a health service is not clinically appropriate." Basically giving doctors the explicit right to say "I don't believe in gender affirming care and will not provide it".