Republicans Privately Pushing Anti-Trans Funding Ban For ACA Subsidy Deal After Shutdown Compromise

The proposal, which was first detailed in the Wall Street Journal, could harm transgender people even in blue states if it becomes part of the negotiated deal.

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Transgender health care has been a sticking point in negotiations over appropriations bills since the shutdown fight began months ago. Many transgender people felt a momentary relief when a short-term CR ended the shutdown without any anti-transgender provisions, pushing the next deadline to Jan. 30. But that deal—struck between a handful of moderate Democrats and Republicans—was never a final word. It simply bought time. And now the first warning sign has emerged in the promised vote over extending ACA subsidies. The Wall Street Journal reports that one provision being pushed by some Republicans is a demand to strip transgender health care from plans receiving ACA subsidies, a move that could significantly restrict access for transgender people nationwide who rely on subsidized plans for their care.

The current fight centers on enhanced subsidies for ACA plans, which cover roughly 20 million Americans. These subsidies support both lower-income people and many middle-income families who benefited from eliminating the “cliff”—the sudden spike in premiums once a household exceeds 400 percent of the federal poverty level. Reporting during the shutdown showed that without these subsidies, premiums on some plans would soar by thousands of dollars, putting coverage out of reach and threatening insurance for millions. Preserving those subsidies was a central issue in the shutdown negotiations, yet the agreement struck by a handful of Democrats and Republicans secured only a future vote on extending them—not the extensions themselves. That decision drew criticism from some Democrats who argued the party had capitulated on a core economic priority.

Now, as the deadline for a meaningful vote on subsidies approaches, new reporting from the Wall Street Journal outlines several potential Republican sticking points. Among them are proposals to route subsidies into Health Savings Accounts, tighten fraud protections, and eliminate “zero premium” plans. But for transgender people, one proposal stands out: Some Republicans are seeking a Hyde Amendment–style provision that would bar federal dollars from covering gender-affirming care or abortion in subsidized plans. It’s a familiar threat—one that appeared throughout House appropriations bills earlier this year and hung over transgender people for the duration of the previous shutdown fight.

Such an amendment would severely restrict access to care for transgender people who rely on subsidized plans. It could also place state-regulated plans in a legal bind: several states require gender-affirming care coverage or enforce anti-discrimination protections that prohibit unequal treatment of transgender patients. Any plan caught between federal subsidy rules and state law could become a flashpoint. And for transgender people themselves, the result could be abrupt and destabilizing disruptions to care.

The negotiations come on the heels of a compromise between some Democrats and Republicans to reopen the government. That deal extended funding through Jan. 30 and, notably, included no provisions targeting transgender health care. It also advanced the VA/MilCon, Legislative Branch, and Agriculture appropriations bills for the full 2026 fiscal year without anti-transgender measures—a small but meaningful victory given the anti-LGBTQ+ riders embedded in the House versions. But the rest of the appropriations fight remains unresolved. The Labor, Health and Human Services, and Education package in particular is still packed with broad anti-transgender riders on the House side, setting up another flashpoint as negotiations resume.

While Democrats have held firm on transgender health care throughout the shutdown fight—and 213 Democrats recently signed a letter to House Speaker Mike Johnson condemning the use of anti-trans slurs on the House floor—there is lingering concern that the party could accept some level of anti-trans policy in future negotiations. That fear isn’t unfounded. The recently Senate-passed National Defense Authorization Act included multiple anti-transgender provisions and still cleared the Senate with several Democratic votes.

When asked for comment on the provisions, Representative Sarah McBride of Delaware stated, “There is nothing Republicans like more than cutting people’s health care, and that’s especially true for care for transgender people. Attacks on gender affirming care are dangerous and discriminatory. As I’ve done alongside my Democratic colleagues throughout this Congress, I’ll continue to fight back against any efforts to cut my constituents’ health care. Transgender people—like all Americans—deserve the health care they need to live and thrive.”

Those wanting to contact their representatives about ensuring any ACA subsidy deal does not contain anti-transgender provisions can do so here.