As part of the sweeping cuts to Medicaid for millions of poor Americans, Republicans in the House have included a new attack on the rights of transgender people with potentially devastating consequences. For years, a major policy goal of the far right has been ending gender-affirming care for trans people, starting with children.
In the language of the budget reconciliation bill — or the “One Big Beautiful Bill Act” as it’s officially named — passed by the U.S. House of Representatives in May, Republicans had initially included a passage “prohibiting federal Medicaid and CHIP [Children’s Health Insurance Program] funding for gender transition procedures for minors.” However, shortly before the House voted to pass the bill, an amendment struck the words “for minors” from this passage, extending the ban to trans adults on Medicaid as well.
The original language was bad enough: denying affirming support for trans youth corresponds to worsening mental health. According to the Trevor Project, 46% of trans youth in the U.S. attempted suicide in 2023. By extending the ban to adults, this bill has become a major attack on the rights of all trans people and could set a dangerous precedent for future attacks.
According to the Williams Institute at UCLA, 276,000 trans adults use Medicaid nationwide; there is no available data on the number of trans youth who use the health insurance program. Data about the true size of the transgender population in the U.S. varies, but the Williams Institute’s data points to there being about 1.3 million trans adults, meaning more than one-in-five trans people will have their access to essential procedures, such as hormone replacement therapy and gender-affirming surgery, taken away from them or made too expensive to pursue.
For several years, Republicans have made trans youth the tip of the spear of their attack on LGBTQ rights. After passing several bans for trans youth last year, Republican lawmakers in Ohio admitted that banning it for adults was the “endgame.”
However, the anti-trans attacks in the budget bill go further. It also alters the 2010 Affordable Care Act — also known as “Obamacare” — to prohibit states from deeming “gender transition procedures” as an “essential health benefit.” This would make it possible for insurance companies to refuse to cover part or all of those procedures for trans people using insurance purchased through ACA exchanges. This would force trans people to pay out-of-pocket or, more likely, to D-I-Y hormone therapy and crowdfund the money — something many trans people are already forced to do under the present profit-driven system, as even routine bloodwork can cost hundreds of dollars, while surgeries can cost tens of thousands.
For trans people who have medically and socially transitioned to live as their true gender and not the one assigned to them at birth, the consequences of losing access can be devastating. Losing access to hormone supplements once you’ve been on them for years, or after receiving gender-affirming surgery, is a serious health problem, as the body has become unable to make its own in adequate quantities. This can lead to brittle bones, organ deterioration, depression and other health issues. “Detransitioning,” or going back to living as your gender assigned at birth, is something few trans people do, but of those who do, a large majority say it is due to the immense socioeconomic difficulties faced by trans people in U.S. society, not because of regret. It is a major psychological shock.
The goal of the far right with these attacks is clear: they want to demonize trans people as the enemies of women, children and the entire working class. They hope to make us fight each other instead of fighting together against the billionaires’ agenda to destroy decades of rights we have won through struggle.
If we want to win, we must reject this divide-and-rule strategy. Fight the billionaire class, not trans people!
Feature image by Matt Hrkac from Melbourne, Australia – Transgender Day of Visibility 2023 – Naarm (Melbourne). Credit: Wikimedia Commons (CC BY 2.0)
