Republicans Launch Midnight Attack on Health Care Access for Trans Americans

The Intercept

22-05-2025

After days of infighting over Trump's 'Big, Beautiful Bill,' the House GOP passed reconciliation legislation in the dead of the night — with one major giveaway to the far-right. Late Wednesday, Congressional Republicans amended the bill to prohibit the use of Medicaid funding for gender-affirming care, potentially ripping healthcare access away from hundreds of thousands of transgender Americans.
An earlier version of the legislation targeted Medicaid funding for gender-affirming care for minors. In a midnight-hour maneuver, Republicans removed the word 'minors' from that provision, prohibiting the use of Medicaid funding for 'gender-transition procedures' for children as well as adults.
The legislation broadly defines 'gender-transition procedures' as everything from surgery to hormone therapy. It needs only a simple majority to pass the Senate.
Experts on transgender health care said that if this provision advances, it could make an already-dire landscape for transgender care significantly worse. They described devastating consequences for the hundreds of thousands of transgender Americans who rely on Medicaid that will be further compounded by the roughly $700 billion in cuts to the health program in the GOP bill.
'Trans folks are more likely to be lower income and subsequently more likely to qualify for [Medicaid],' said Aspen Ruhlin, community manager at the Mabel Wadsworth Center in Bangor, Maine, which provides LGBTQ+ care, including gender-affirming hormone therapy, as well as abortion care and other health care services. 'This would have a devastating impact on folks, as they would lose coverage for what is normal and needed health care.'
'There's not good coverage to begin with.'
'We have seen that in states that have fought to ban gender-affirming care. They always start with minors and then … trojan horse it into banning coverage for or banning access to gender-affirming care generally,' they said.
According to a 2022 report from the Williams Institute at the UCLA School of Law, roughly 276,000 transgender adults are enrolled in Medicaid in the United States. Even without the new legislation, accessing gender-affirming care is incredibly difficult. According to the Williams Institute report, 38,000 transgender adults with Medicaid live in states that expressly deny access to gender-affirming care, and 74,000 transgender Medicaid beneficiaries live in states without laws explicitly protecting coverage.
'There's not good coverage to begin with,' said Dr. Lakshmi Sundaresan, a family medicine physician in Michigan who provides gender-affirming services but not surgery. 'We are often already fighting this uphill battle for coverage.'
Sundaresan argued that GOP lawmakers are trying to pretend as if gender-affirming care is a financial burden on the United States, even as they cut basic services for the overwhelming majority of Americans to grant generous tax cuts for the wealthy.
'The impacts of those large scale cuts are going to be felt by the lay public, because they're going to lose coverage, or people are going to basically become bankrupt over time if they have prolonged hospitalizations,' she said.
Ruhlin said it's unclear exactly how the bill would be applied in Maine or in other states with similar laws. In 2023, the state legislature passed a law requiring the state's Medicaid program, MaineCare, to cover gender-affirming care. Ruhlin said it's possible Maine would still be allowed to use state Medicaid dollars to provide gender-affirming care, but it's not a foregone conclusion. It also likely means this provision will be subject to lawsuits.
For Ruhlin, the harm caused by these types of restrictions goes deeper than the financial burden it would place on access to gender-affirming care; it's also about the message it sends.
'Even trans folks who don't have the same needs or goals around gender access would still be negatively impacted by this because it's the social impact of reinforcing transphobia in our society,' they said.