Democrats Must Reject The Premise Of Trans Healthcare Bans In Republican Healthcare Offer

Republicans' new healthcare bill would bar transgender healthcare as an essential health benefit, bar trans medicaid coverage, and would bar HSAs from considering trans healthcare medically necessary.

Bill Cassidy // Wikimedia Commons

Late last night, Senate Republicans unveiled their proposal to address spiking health-care premiums ahead of the expiration of key ACA subsidies—the same subsidies at the center of the recent government shutdown. As part of the agreement to reopen the government, Democrats secured a forthcoming vote on extending those subsidies, a vote almost certain to fail in the coming days. Eager to avoid the appearance of inaction, Republicans released their own plan, framing it as the basis for future negotiations. Importantly for transgender people, as first reported by the Wall Street Journal two weeks ago and confirmed by EITM at around the same time, the plan they were working on and finally released includes sweeping new restrictions on gender-affirming care for transgender people of any age. Now, as Democrats work to address the coming healthcare premium spikes, they must reject the premise that transgender healthcare can be sacrificed to achieve their goals.

The new health-care proposal, authored by Senators Mike Crapo and Bill Cassidy, leans heavily on Health Savings Accounts as the supposed backstop for premium spikes across the country. Crucially, their bill would bar HSAs from treating gender-affirming care as medically necessary, meaning many transgender people could be forced to shoulder far higher out-of-pocket costs for even basic care. The proposal goes further still: ACA plans would no longer be allowed to classify gender-affirming care as an essential health benefit—a technical but sweeping change that could undermine coverage across the exchanges and introduce wide, unpredictable gaps in access to transition-related treatment. Lastly, the proposal would ban medicaid from covering transgender healthcare, leaving transgender people struggling to make ends meet unable to access their care.

After the plan was released, it quickly appeared to gain Senate Majority Leader John Thune’s blessing as the Senate GOP’s preferred response to the looming spike in ACA premiums—costs that, for some families, could rise by thousands of dollars a month. To be clear, multiple sources familiar with the process tell EITM that this proposal has virtually no path to passage. But its significance lies elsewhere: by openly declaring restrictions on gender-affirming care as part of their negotiating stance, Republicans are laying down a marker for future talks as pressure mounts and families begin feeling the consequences of soaring premiums. Democrats must resist efforts to make transgender healthcare a bargaining chip in these or any upcoming negotiations.

This effort is only the latest in a long string of Republican attempts to target transgender healthcare through federal legislation. Democrats have blocked many of these measures, but the proposals keep resurfacing. Earlier this year, Republicans pushed to bar Medicaid from covering transgender care in the so-called “big beautiful bill,” a provision that ultimately failed. During the shutdown fight, multiple GOP funding bills carried anti-trans riders, though none made it into the negotiated continuing resolution or the smaller minibus bills that followed. More recently, similar provisions were stripped from the NDAA—including language that would have barred Tricare from covering gender-affirming surgeries, as well as an earlier youth-care ban that had appeared in a previous NDAA. Now, the same fight is erupting again in the middle of the ACA subsidy crisis. Clearly, this is a priority Republicans are unwilling to abandon.

Healthcare coverage is essential for transgender people. While many transition-related medications are generic and not especially costly, required lab work can quickly put care out of reach for anyone on a tight budget. For transgender people who need surgery, the financial barriers are even steeper—procedures can run into the tens of thousands of dollars, making them entirely inaccessible without insurance. Even basic medications can be difficult to afford for those on Medicaid. And the stakes of losing coverage are far greater than financial strain: when transgender people are cut off from care, rates of suicidality rise, as do mental-health crises linked to untreated depression and anxiety. For these reasons, gender-affirming care has long been recognized as medically necessary for those who need it. Stripping an entire class of people of such care is unconscionable.

Democrats continue to be told by conservative forces within the party that transgender people can and must be sacrificed to achieve other policy goals and secure political victories. They must not listen. Transgender people, our families, other LGBTQ+ people, and our allies make up a significant share of the Democratic base. Many of us work or volunteer on campaigns, organize within the party, and are among its most loyal voters—a reflection of how profoundly public policy shapes our lives. Throwing our rights under the bus would be a direct insult to the very communities that have fought hardest for the progressive goals Democrats claim to champion.

More importantly, the recent election shows such sacrifices aren’t even necessary. Voters appear exhausted by the GOP’s anti-trans and anti-LGBTQ+ extremism. In races where Republicans poured massive sums into anti-trans messaging, not only did governor-elect Abigail Spanberger in Virginia and governor-elect Mikie Sherrill in New Jersey win decisively, Democrats performed strongly up and down the ballot. Moms-for-Liberty-style candidates—who centered their campaigns on anti-trans rhetoric—were wiped out. The notion that this kind of fearmongering “works” is disappearing; if anything, its excesses are becoming a liability. Democrats can rightly point out that Republicans care so little about rising healthcare costs that they prefer to spend their energy targeting transgender people rather than proposing real solutions that would lower costs for everyone.

To congressional Democrats’ credit, recent fights have shown that they are willing to push back, even if behind the scenes, against these anti-transgender proposals in congress. We saw a massive stand against a national transgender sports ban in the House. We have seen the loss of a similar provision to this latest healthcare policy in the fight over Trump’s “big beautiful bill.” We have seen the latest continuing resolution and smaller “minibus bills” devoid of such attacks on transgender people. We even saw the healthcare ban stripped from the negotiated NDAA after similar policies passed in the House and Senate. But last night’s bill proposal shows that this fight is not over, Republicans intend to keep pushing for these policies, and Democrats must not budge from fighting for the rights of all people they champion.

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