Republicans Sneak Anti-Trans Health Care Provision Into Defense Bill

House Democrats have a chance on Tuesday to block a provision targeting health care for transgender youth on military health insurance from the annual defense spending bill. The proposal, which was tacked onto the National Defense Authorization Act, or NDAA, at the eleventh hour, would codify explicitly anti-LGBTQ+ policy into federal law for the first time in decades.

The controversial language, which was pushed by Republican leadership and adopted into a bipartisan compromise bill, would prohibit “medical interventions for the treatment of gender dysphoria that could result in sterilization,” effectively prohibiting access to gender-affirming care for minors with active-duty family members in the military.

A procedural vote on Tuesday afternoon will determine whether the NDAA will come to the House floor for a vote with the provision in place or whether lawmakers will be forced to renegotiate and potentially remove the anti-transgender language from the bill.

House Speaker Mike Johnson, R-La., left no ambiguity about the legislation’s intent, saying it would work by “permanently banning transgender medical treatment for minors” on military insurance.

Civil liberties groups expect the Tuesday vote to be tight and are urging House Democrats to vote “no” on moving the current version of the bill forward. As with previous votes, Republicans will likely need some Democratic support to advance the bill. Advocates are raising the alarm about the bill’s potential deadly consequences for trans youth on military insurance and warning that its passage would represent a serious rollback in rights for LGBTQ+ people in the United States. 

“Not only would this be devastating for the lives, health and well being of these children and military families, this would be the first time in almost three decades that we have seen the adoption of explicit anti-LGBTQ policy in federal statute,” said Ian Thompson, senior legislative advocate at the American Civil Liberties Union.

Thompson noted that the Defense of Marriage Act, which prohibited same-sex marriages and was signed by President Bill Clinton in 1996, was the most recent example of explicitly anti-LGBTQ+ policies being codified into federal law. “So that is incredibly significant,” he said. “And we have been really trying to elevate that point with key allies on Capitol Hill and in the administration, to really just kind of hammer home the gravity of this attack on human rights and the freedom of transgender people.”

While it’s unclear how many transgender youth get their health care through the military’s insurer, TRICARE, a 2022 analysis published in the American Journal of Public Health found that roughly 2,500 minors sought care for experiencing gender dysphoria that year through the insurance program. 

Rep. Delia Ramirez, D-Ill., chastised her Republican colleagues for “targeting trans people” instead of doing the work of legislating. “It is not only an unprecedented discriminatory rider, but it will cause real, irreversible harm,” said Ramirez in a statement to The Intercept. “Young trans people deserve the care they need to flourish. And we all deserve to have the opportunity to debate and shape significant pieces of legislation that impact our communities.”

Ranking Member of the House Armed Services Committee, Rep. Adam Smith, D-Wash., called on Republicans to remove the anti-trans provision on Sunday. “Blanketly denying health care to people who clearly need it, just because of a biased notion against transgender people, is wrong,” said Smith in a statement. “Speaker Johnson is pandering to the most extreme elements of his party to ensure that he retains his speakership. In doing so, he has upended what had been a bipartisan process.” 

Groups opposed to the provision are also hoping that the Biden administration will weigh in to support trans youth. The Human Rights Campaign pointed out over the weekend that President Joe Biden “has promised repeatedly to veto any legislation that would enshrine discrimination against transgender people into law.”

Thompson of the ACLU noted that while the White House generally releases a statement of administrative policy on important legislation like the NDAA, which is considered a “must pass” bill, it has not yet done so. The White House previously was under fire from trans rights groups after stating that it opposed gender-affirming surgeries for transgender youth. The administration later changed its position, saying it opposed limits on health care for transgender individuals.

Even if the current version of the NDAA advances, Thompson said that the fight will not be over. “Our hope is that the rule will fail and they will only be able to move forward a version of this legislation that does not include this health care ban as a part of it,” he said. “But should the rule be adopted and they actually have to take a vote on the underlying bill itself — it is, once again, our hope that pro-equality members of Congress will oppose the defense bill because of the inclusion of this health care ban.”

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