Republicans Just Passed a Bill That Could Strip Health Coverage from Hundreds of Thousands of Trans Americans

House Republicans passed a sweeping bill Thursday that could drastically change healthcare for transgender Americans, banning Medicaid from covering gender-affirming treatments for individuals of all ages. What began as a targeted provision for minors ballooned into a full-age ban, slipped in just hours before the vote.

The shift came via a last-minute manager’s amendment to secure votes for the GOP’s broader spending package. The measure narrowly passed 215-214, facing unified Democratic opposition and pushback from two Republicans.

“The bans on coverage for trans medical care were made so much worse, really, in the eleventh hour,” said Caleb Smith, policy director at the Center for American Progress. “It’s always been about curtailing access to medical care and bodily autonomy. All they had to do was strike ‘under 18,’ and now it’s everybody.”

Rep. Dan Crenshaw, who pushed the change, defended it: “Gender transition procedures are the lobotomy of our generation,” he said.

The implications are vast. Around 276,000 transgender adults rely on Medicaid, and nearly a third of all trans adults could be affected. Experts warn that this also places essential healthcare further out of reach under the ACA by redefining coverage categories.

Legal experts and LGBTQ advocates say the measure is likely unconstitutional. “It really clearly violates equal protection,” Smith added. “If you’re a cis man needing testosterone, you’re covered. If you’re a trans man, you’re not.”

The bill now heads to the Senate, where its fate remains uncertain.