In earlier drafts, the so-called “Big, Beautiful Bill” included a provision that would have ended Medicaid payments for “gender transition procedures” for people of all ages, and introduced narrowly rigid definitions of “sex,” “female,” and “male” that some experts believe would have far-reaching implications, beyond access to healthcare. However, amid a flurry of revisions and amendments, the controversial ban on gender-affirming care was removed shortly before Senate Republicans voted to pass the legislation on Tuesday.
Though there are many other aspects of the bill that will severely limit millions of Americans’ access to healthcare, trans rights advocates see the removal of the ban on Medicaid coverage of gender-affirming care as a win.
“There’s a lot of other elements of the bill that are concerning, but for me and for other trans folks, it’s a huge relief to see this out of the bill,” says Delphine Luneau, deputy director of communications for the Human Rights Campaign.
On June 26, the Senate parliamentarian concluded that the ban of the use of Medicaid funds for gender affirming medical care for transgender minors and adults violated the Byrd Rule, which prohibits the inclusion of “extraneous” measures in budget reconciliation bills. This meant that the provision needed 60 votes in order to remain in the bill.
“We were pretty optimistic, honestly, that we would have the votes to strike it from the bill,” says David Stacy, vice president of government affairs for the Human Rights Campaign. But rather than prolonging Tuesday morning’s Senate session by calling for a separate vote on this section of the bill, it was removed prior to the roll call vote on the bill itself, he explains.
Next, the bill heads back to the House, where members will vote on the Senate’s version, complete with amendments. Though someone in the House could add the ban on gender-affirming care back into the bill, it would then have to go back to the Senate, where it would have to get 60 votes in order to keep it in, Stacy notes.
“Fortunately, Republicans’ efforts to make trans people and their healthcare into political scapegoats failed,” Sinead Murano-Kinney, health policy analyst for Advocates for Trans Equality said in a statement to Rolling Stone. “This failure is in no small part thanks to the wisdom of the parliamentarian and the actions of Senators who respect and will fight for their trans constituents’ well-being and access to lifesaving care.”
Still, there are other aspects of the bill that would be detrimental to transgender people and Americans in general, including cutting one year of federal funding for organizations that provide abortions, like Planned Parenthood, which received more than $800,000 in Medicaid reimbursements last year.
“The defunding of Planned Parenthood is going to be incredibly harmful, because Planned Parenthood is perhaps the largest provider of healthcare to trans people as any single provider,” Stacy says. “That’s something that’s going to have a huge impact across the country if this sticks.”
For people like Luneau, Planned Parenthood plays a crucial role in providing life-saving care. “That’s the first place that I ever received transition medical care personally,” she says. “I grew up in a very small town far upstate New York, and without Planned Parenthood, I don’t know what I would have done.”
Additionally, Stacy is concerned about cuts to Medicaid — not just for the approximately 276,000 transgender adults enrolled in it, but because it’s a major provider of HIV treatment. “It’s the largest payer for HIV care in the country,” he says. “It’s going to really have an impact on LGBTQ people across the board, since LGBTQ people — especially when people living with HIV — are disproportionately [on] Medicaid. And certainly, the LGBTQ community has a higher incidence of poverty than other folks.”
It’s estimated that at least 17 million Americans would lose their healthcare coverage should this budget bill pass in the House and be signed into law. “Everyone deserves access to medically necessary healthcare, free from the interference of greedy, extremist politicians,” Murano-Kinney said in a statement. “These cuts ensure that everyone in our country is less healthy and safe.”
