The tax bill passed by the House on Thursday would bar Medicaid coverage of all transgender care and prohibit plans offered under the Affordable Care Act’s exchanges from covering such care as an essential health benefit, potentially jeopardizing access to care for hundreds of thousands of trans adults and an unknown number of minors.
The bill initially prohibited Medicaid from covering “gender transition procedures” for minors, including puberty blockers, hormone therapy and surgery. However, House Republican leadership introduced an amendment to the bill late Wednesday that struck the word “minors” and the words “under 18 years of age” from that section, The Independent first reported.
The amendment passed the GOP-led House Rules Committee on Wednesday night before the full House passed it Thursday morning.
Another portion of the bill prohibits transition-related medical care as an essential health benefit under health care plans offered through the Affordable Care Act’s marketplace. Essential health benefits packages vary by state but are required by federal law to cover 10 categories of benefits. Nearly half of states have prohibited health insurance providers from explicitly refusing to cover transition-related care.
The tax bill’s prohibitions could have a significant effect on hundreds of thousands of trans adults in the U.S. A report published this month by the Williams Institute at UCLA School of Law found that about 180,000 trans adults use Medicaid as their primary insurance. Another study, published in 2023, found that nearly 1 in 4 (24.6%) trans adults are on Medicaid, or about 312,000, based on one estimate that there are 1.3 million trans adults in the U.S.
It’s unclear how many trans adults are enrolled in insurance through the health care marketplace. The Department of Health and Human Services reported that nearly 24 million people had enrolled in marketplace coverage by January. There are an additional 300,000 youth ages 13-17 who identify as transgender, and it’s unclear how many of them are on Medicaid or marketplace insurance plans.
President Donald Trump has made curtailing access to care for trans people a priority of his administration. In the first few weeks of his presidency, he has signed several executive orders targeting trans people, including proclaiming that the government will recognize only two unchangeable sexes; prohibiting trans women and girls from playing on female sports teams; barring transgender people from serving openly in the military; and restricting access to gender-affirming care nationwide for trans people younger than 19.
Trump and Republicans oppose access to transition-related care for minors, arguing that they are too young to make informed decisions about receiving such treatments and that the long-term effects of some of the treatments have not been well studied. LGBTQ advocates and medical professionals who treat trans people say those arguments aren’t accurate and spread misinformation, and most major medical associations such as the American Medical Association, the American Academy of Pediatrics and the American Psychological Association, support access to such care.
Speaker Mike Johnson, who helped negotiate the amendment among Republicans, did not immediately respond to a request for comment. The White House also didn’t immediately respond to a request for comment regarding whether it supports the amendment.
LGBTQ advocates began forcefully speaking out against the tax bill Thursday. Jennifer Pizer, chief legal officer at Lambda Legal, an LGBTQ advocacy organization, said it’s unclear how the administration plans to argue against transition care for adults, who can make their own medical decisions and for whom transition care is well studied and supported.
“It makes the animus, the hostility against this group of people, unmistakable,” Pizer said. “Under any standard of constitutional review, laws based on animus or hostility to a group are not legitimate.”
If the bill becomes law as is, Pizer said it would likely face a legal challenge for potentially violating the Constitution’s equal protection clause, which requires that laws treat people equally. She also noted that, after a suit by Lambda Legal and other LGBTQ advocacy groups, a federal judge blocked Trump’s executive order that would have cut off all federal funding to medical schools and hospitals that provide transition care to minors.
The bill would also directly conflict with laws in half of states that prohibit insurers from excluding coverage for gender-affirming care. In those cases, Pizer said the states could use their own funding to continue covering the care under state Medicaid plans. However, “that’s not a happy answer for people who live in other parts of the country, where states themselves are hostile to transgender people and this medical care.”
“This aggressive effort to reimpose exclusions, it’s about hostility to a group and it’s a political movement,” she said. “It’s not coming from medical experts or providers who engage with actual patients. This is about politics and not about anything that’s justified in terms of our medical programs.”
