The News
A last-minute change to the GOP’s One Big Beautiful Bill Act would ban Medicaid funding for “gender transition procedures,” after an amendment expanded language affecting minors to include adults.
That was a coup for social conservative groups like the American Principles Project, which urged House Republicans to make the change, sharing a poll that found 66% support for it. But it has not been a major focus of Democratic opposition during the recess, as they made a broader case against changes like work requirements that would remove people from state-run Medicaid coverage entirely.
“Government should never insert itself between patients and providers. Insurers, whether public or private, should cover all medically necessary care, including for transgender Americans,” Rep. Sarah McBride, D-Del., the first transgender member of Congress, said in a statement to Semafor. “Just as I have done my entire life, I will continue to fight against discriminatory bans on coverage of gender affirming care, which every major medical association calls medically necessary.”
There’s no official estimate of transgender Americans who use Medicaid; studies from UCLA have pegged the number at a little more than 200,000. Coverage for gender medicine, including hormone therapy and sex reassignment surgery, was first implemented under the Obama administration, and Trump ran in 2020 on rolling it back.
And the new provisions worried even some Democrats who had been advocating for their party to find a compromise on some trans rights issues. Jonathan Cowan, president of the centrist Third Way think tank, argued for those compromises this week, but told Semafor that the coverage ban was simply cruel.
“What’s next — a federal health care registry in which you have to get the Trump Administration’s approval for any and all of your family’s medical treatments?” Cowan said. “It’s not thoughtful or nuanced but extreme and Democrats should be criticizing Republicans for trying to take away parental choice and for denying basic health care rights to trans adults.”
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David’s view
Democratic politics right now is about opposition to the OBBBA and its Medicaid cuts. The uniform Republican response is that they are not cutting Medicaid for “vulnerable” people; that they’re actually strengthening it for those people by pulling able-bodied adults off the rolls with work requirements.
The gender medicine ban, dropped into the bill at the 11th hour, does not comport with that. It’s a social conservative project, designed to roll back coverage of transgender healthcare, which they believe was foisted on the country by unethical doctors and a rapacious pharmaceutical industry.
“With the international medical consensus turning against gender ideology, and voters firmly on our side, now is the perfect time for Congress to ensure our government no longer subsidizes these controversial practices,” conservative leaders from APP, the Family Research Council, and the Family Policy Alliance, wrote to House Speaker Mike Johnson.
How are Democrats responding? Somewhat tentatively. They are not rushing out with press releases to denounce this part of the bill. As she told me before getting elected last year, McBride thinks that transgender people are better off when Democrats defend their rights as fellow citizens, not as a special interest group.
“They’re on Social Security, they’re on Medicare, and we know that Donald Trump and JD Vance would seek to gut those programs,” she said, before it was clear who would win the presidency.
The Democratic position, right now, is that the bill can still be defeated. But if Republicans do wrangle the votes in the Senate — they can lose three GOP senators and pass it — will the language be removed? Would four Republicans agree to do that? Social conservatives, who once struggled to get their party to care about this, believe that they wouldn’t. And hundreds of thousands of lives would change.
Notable
- A new Gallup poll found Republican support for same-sex marriage, and Republican acceptance of “gay or lesbian relations,” falling to the lowest levels this decade. That change isn’t due to Donald Trump, who supported legal same-sex marriage in all of his campaigns. But it has tracked with Republican campaigning against transgender rights and “gender ideology,” which the party embraced in 2021 after years of wondering about its political impact.