House Republicans’ reconciliation bill gave the conservative movement a victory they have been fighting for for years: a nationwide ban on federal funds from being used to cover gender-affirming care for transgender people of any age.
“This has been our top priority from the beginning of this year, and we had been preparing for this ever since election night in 2024,” Terry Schilling, president of the conservative American Principles Project, told NOTUS.
While much of the fight over gender-affirming-care access has been happening at the state level — and focused almost entirely on minors — the provision in the reconciliation bill marks the first time a federal restriction on gender-affirming care for adults has passed a full chamber of Congress. But in the future, Republican lawmakers and their allies hope the ban will be a standard part of spending bills moving forward.
“It’s the new Hyde Amendment,” Rep. Dan Crenshaw told NOTUS, referring to a similar restriction on using federal funds for abortions.
Crenshaw led the push for the Medicaid ban to be added to the reconciliation bill. The Texas congressman called it the “Crenshaw Amendment.” In addition to barring Medicaid and CHIP from paying for gender-affirming care, it also bars states from considering “gender transition procedures” as an “essential health benefit” under the Affordable Care Act.
“I have a lot of things I’d like to be remembered for, but this is certainly one of them. I’m really proud to put my name on it,” he said.
Crenshaw initially wanted the language to be based on a bill he reintroduced earlier this Congress that would bar children’s hospitals from receiving graduate medical-education funding if they offered gender-affirming care to minors. Such a provision likely would be stripped out in the Senate under the “Byrd rule,” he said, so a Medicaid ban was the next best thing.
“Smart policymakers take small steps. You try to take too big of a step and you end up losing,” Crenshaw said. He added that he hopes this reconciliation measure would open the door to future legislation like his hospital bill or even a “full-on federal ban” on gender-affirming care for trans minors.
If Crenshaw’s provision becomes law, it could impact access for at least 185,000 transgender people who have Medicaid as their primary insurance, according to a report from the Williams Institute. Already, over half of U.S. states have policies to restrict such care for people under 18, and 13 states have measures explicitly blocking Medicaid from covering gender-affirming medical procedures, according to the Movement Advancement Project.
“People will find ways to pay for it themselves, which is the way it should be. It’s not something the government should be doing,” said Walt Heyer, a senior fellow at the Family Research Council.
Heyer lived as a trans woman for eight years and is known within conservative circles for having “detransitioned.” He told NOTUS he rejected the “detransitioner” label because, he said, “there is no such thing as a transgender.”
“If there are fewer people that have access to this, you can easily equate that to fewer people are going to have regrettable outcomes,” Heyer continued.
Anti-trans messaging became a key part of GOP messaging during the 2024 election, and it was one that Democrats had a hard time responding to. The passage of the House reconciliation bill that targets gender-affirming care marks an official turn from campaign messaging and executive actions — President Donald Trump issued an executive order to withhold federal grants from certain medical institutions that provide trans health care — into actual lawmaking.
Leading medical organizations like the American Medical Association, the American Academy of Pediatrics and the Endocrine Society all support gender-affirming care and say it “saves lives.” Peer-reviewed studies have shown that a minority of people who transition regret doing so. Conservative groups, and Heyer as well, say those studies are not conducted properly.
The reconciliation bill initially only had a funding ban for trans minors. However, the prohibition expanded to include adults just hours before House Republicans passed the legislation.
Trans rights advocates and health care providers immediately denounced the measure.
“Arbitrarily cutting Medicaid coverage for some of the most vulnerable and marginalized people in our community is un-American and puts lives at risk,” Plume Health, a leading gender-affirming care provider for trans adults, said in a statement.
Jamila Perritt, president and CEO of Physicians for Reproductive Health, an organization whose members offer care for trans patients, said in a statement that the “ramifications will be tragic.”
Conservative groups say they hope the ban will soon extend to all types of federal funding.
Schilling said there is a “fight coming up” in the next appropriation bills to ensure a restriction on federal funds for transgender people of all ages extends to Tricare (the health insurance program for military service members), the Federal Employee Health Benefits program and Immigration and Customs Enforcement, which has protocols in place to offer gender-affirming care to detained migrants.
An estimate from the Congressional Budget Office found that the provision explicitly targeting care for trans minors would decrease the budget deficit by $700 million over the next 10 years. Crenshaw’s office estimated that by including adults the number could increase to over $1 billion.
The reconciliation fight now heads to the Senate, where the bill is expected to face major changes. However, it’s unclear whether the Crenshaw Amendment will face strong opposition from Democrats moving forward. Previous legislation containing bans on some federal funds paying for gender-affirming care for minors have passed both chambers with bipartisan support.
Even during the 26-hour long House Energy and Commerce Committee reconciliation markup hearing, though Democrats filed over 350 amendments to the bill, not one directly challenged the portion barring Medicaid from being used on gender-affirming care for trans youth.
Democrats, Crenshaw said, are “trying to figure out what happened in the last election.” He added that they didn’t fight the amendment because “you’re losing voters when you’re talking about transitioning kids.”
“I’m optimistic that this isn’t one of those things that’s getting stripped out,” Crenshaw continued. “We’re going to argue with the Senate over a bunch of things, and I can’t even foresee what, but this isn’t one of them.”
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Oriana González is a reporter at NOTUS.