The New House Appropriations Bill Doesn’t Just Target Trans Care, But All LGBTQ+ Americans

Breaking down the potential implications of the worst legislative attack LGBTQ+ Americans have faced in years.

Last week, the Republican-controlled House Appropriations Committee unveiled its draft of the appropriations bill for the Departments of Labor, Education, and Health and Human Services. And like with previous spending bills, conservatives are once again attempting to use it to sneak extreme anti-trans provisions into law. Hidden in this bill are provisions to block federal funding (including for Medicaid and Medicare) from going towards gender-affirming care, stop funding from going towards protecting Americans from discrimination on the basis of gender identity or sexual orientation, and codify Trump’s trans sports ban into law.

It’s important to note that the Senate’s version of the bill, which fully passed its committee over a month ago, does not include any of these extreme provisions. And unlike a reconciliation bill, an appropriations bill needs 60 votes to overcome a filibuster. Because it's a better compromise, the Senate’s version should, at least in theory, stand more of a chance at passing, but that's not to say the House version of the bill isn’t a threat. And being the most significant transphobic legislative attack so far since Trump took office, it’s hard to quantify exactly just how much damage this passing would do.

As of right now, there are a lot of different things being reported, so I’d like to take some time to examine exactly what this bill would and wouldn’t do.

Another Attack Against Gender-Affirming Care

The most potent part of the bill against trans care lies in Section 244. More specifically, this section states that “None of the funds made available by this Act may be used for any social, psychological, behavioral, or medical intervention performed for the purposes of intentionally changing the body of an individual to no longer correspond to the individual’s biological sex.” In other words, it aims to build on the provision removed from the ‘Big, Beautiful Bill’ in order to strip gender-affirming care coverage from transgender Americans on Medicaid and Medicare. But unlike the Big Beautiful Bill’s provision, this one is much more vague.

Because of how it’s written, it doesn’t seem to apply to just hormones and surgeries for trans people but to therapy that affirms their gender identities as well. And because of its categorical ban on any procedures that alter one’s ‘biological sex,’ it could even be construed to block funds from going to life-saving cancer treatments should they involve ‘changing the body of an individual to no longer correspond to the individual’s biological sex.’ If this passes, it would mean that states that mandate Medicaid coverage for gender-affirming care would have to pay for it themselves. Here’s a map of Medicaid coverage of gender-affirming procedures, by state:

For sources, tables, and maps for other issues, head to Transitics’ CATPALM page.

I imagine that without federal dollars to offset the cost of providing gender-affirming care (which is pretty minimal in all fairness), some states where support is already low—like North Dakota, Georgia, and Utah—may just opt to cut gender-affirming care entirely. For blue states, this would mean further strain on their budgets, which could sow some public opposition.

Already, attacks against transgender care at the federal level have been wide-reaching. In June, the HHS finalised a new rule that removed gender-affirming care as an Essential Health Benefit, which means that insurance plans (such as marketplace plans) regulated directly by the Affordable Care Act can no longer cover gender-affirming care unless they’re made to by state law. Then, last month, gender-affirming care was excluded from Federal Employee Health Benefits. Additionally, Trump’s executive order targeting gender-affirming care for minors, which is only meant to block funding from going to the outlined procedures, has been routinely used to harass those that continue to provide it to the point where they are made to choose between staying open or helping trans kids.

But It’s Not Just Trans Healthcare This Time

It’s not even just healthcare. This bill also applies to Labor and Education, which means that LGBTQ+ discrimination protections in employment and education would also be targeted. Flanking the gender-affirming care part are sections 243 and 245. The first provision mandates that no funds ‘may be used to implement, administer, or enforce’ Biden’s Executive Order 13988, an order that codified the LGBTQ+ discrimination protections afforded by the 2020 Supreme Court ruling in Bostock v. Clayton County into federal policy and action. But with nobody around to enforce those protections, LGBTQ+ Americans who don’t have state-level protections will have to resort to lawsuits, which are both time-consuming and costly.

Then, section 245 specifies that no federal funds can be used to enforce Biden-era HHS rule ‘Nondiscrimination in Health Programs and Activities,’ which would mean that the federal government would have the authority to essentially turn the other way should healthcare companies start discriminating against LGBTQ+ individuals when it comes to treatment and coverage. And furthermore, section 311 would codify Trump’s trans sports ban into law by banning federal grants from going to institutions that allow trans athletes to participate (in any capacity) on the teams that align with their gender identities.

But there’s also something it’s not: it doesn’t give the Trump administration any more leeway to harass providers that continue to perform gender-affirming procedures. And regardless, it’s not like they’ve needed legislative authority to attempt doing that. Even without an appropriations bill, Trump has used his own executive orders to define the care that can land providers in hot water. A bill that bans federal dollars from going towards gender-affirming care doesn’t preclude doctors and hospitals from providing it, but it does revoke some of the funding they may have otherwise received.

That’s not to say it isn’t terrible—it is. If this bill passes, it would place all LGBTQ+ Americans at risk of discrimination in employment and healthcare. This bill would not just allow companies to discriminate against us; it actively encourages them to. However, the good news is that the Senate’s version of the appropriations bill contains none of these things. And like I said above, because this bill—by virtue of not being a reconciliation bill—requires 60 votes to pass, it’s fairly likely that the House’s bill won’t even see a vote in the Senate.

But make no mistake: this bill doesn’t need to pass for it to do damage. Even if it doesn’t pass this time, it sets the new standard for what Republicans will advocate for in future spending bills. And if they’re not stopped, it won’t just be trans healthcare and LGBTQ+ discrimination protections they’ll try to come for next time.