Don’t Panic–the Battle Over the Trans Medicaid Ban Is Far From Over. Here’s How To Fight Back.
While confusion and misinformation spreads on social media, advocates offer concrete strategies to stop the GOP’s genocidal attack on trans people’s lives through community solidarity and defiance.
Follow Mady on Bluesky here, and Mira here. This article will also be available on Mira’s publication, The Free Radical.
Thursday morning, the GOP-controlled House of Representatives stayed up all night to pass an amended version of the Trump regime’s massive budget reconciliation bill also known as HR 1, that would ban Medicaid coverage for trans healthcare for all ages, on a party-line vote of 215-214.
The amendment, introduced by House Speaker (and former Alliance for Defending Freedom attorney) Mike Johnson hours before the vote, turned a prior minors-only prohibition into a sweeping ban for all ages, as reported by The Independent.
The provision additionally bars trans healthcare from being included as a required Essential Healthcare Benefit in Affordable Care Act plans, using similar language as the HHS rule that MadyCast News reported on earlier this year. The Medicaid ban would take effect in 2026, and the ACA restrictions in 2027, if the bill is signed into law as written. Trans people face marginalization that forces many into income brackets that disproportionately rely on public healthcare programs.
President Trump celebrated the bill’s passage on Truth Social yesterday morning, including the phrase “transgender for everybody” among a list of far-right social grievances that he says “will NEVER AGAIN happen!” An official digital White House article later falsely referred to lifesaving trans healthcare as “chemical castration and mutilation,” reflecting the genocidal intent motivating the deadly anti-trans provisions that could put hundreds of thousands of lives in danger.
The bill was rushed through committee votes in the dead of night with unprecedented speed, and then passed through the full House of Representatives just hours later. It now heads to the Senate, where it will face a heavy appetite for changes as Republican Senators hammer out disagreements over specific items. It’s uncertain whether the bill has the support of all 53 Republican Senators, but it will fail if more than three Republicans object to the bill.
The bill passed the House partially because multiple elderly Democrats died in office this year after refusing to step down despite old age or terminal illness, which meant Republicans were able to shed more votes while still passing their agenda. These decisions mirror how former Supreme Court Justice Ruth Bader Ginsburg’s refusal to step down during the Obama administration eventually resulted in Trump replacing her with the pivotal conservative justice who overturned Roe v. Wade after her death in 2020.
Experts weigh in on devastating policy impacts
This bill first hit headlines earlier this year, when Republicans passed a budget resolution that started the reconciliation bill process for Trump’s proposed tax cut, spending, and immigration package that extended tax cuts from his first administration. In the months after, word spread among federal lobbyists that the resolution effectively mandated massive cuts for Medicaid.
This finally came to fruition when, in the middle of the night on Sunday, May 11, extensive Medicaid cuts were introduced as a core part of the bill. These cuts included Section 44125, which banned any Medicaid-covered trans healthcare for minors, and threatens to return the accessibility of trans care to how it was before the Affordable Care Act enshrined protections into law, when only the richest trans people could access care through the healthcare system.
In a phone conversation with Madycast News, Bobby Kogan, the Center for American Progress’ Senior Director of Federal Budget Policy, said that his group estimated that 7.6 million people would lose health insurance due to the bill, which “would be the largest Medicaid cut in US history… more than twice the size of the [previously largest] Reagan cuts.”
Kogan further described this as the “largest transfer of wealth from the poor to the rich in a single bill in all of US history,” adding that the impacts of this bill would predominantly affect disabled, Black, Indigenous, immigrant, and LGBTQ+ communities. He concluded that its impacts would be “leaving marginalized groups much worse off.”
In a post on Bluesky Kogan revealed the bill would cut anywhere from $716 to $792 billion from public health insurance. He adds that it would cut an additional $295 billion from the SNAP food assistance program. CBS News reports the bill would also add $4 trillion to the national debt, a figure supported by several leading Republican opponents, such as Sen. Rand Paul. Economists have argued that exploding budget deficits risk the long-term status of the United States as an economic superpower.
According to a report by the Center for Budget and Policy Priorities, whose press team sent it to MadyCast News, wealthy Americans would save tens of thousands per individual due to these cuts, while low-income Americans would suffer a loss of income in return, a reality exacerbated by Trump’s tariffs.
The impact on lifesaving trans healthcare could be similarly devastating in scale. The Williams Institute at the UCLA School of Law focuses on LGBTQ+ policy research and has tracked this bill very closely.
According to the institute’s Interim Executive Director Christy Mallory, “180,000 transgender people nationwide have Medicaid as their primary source of health insurance. We're talking trans people that rely on this [for care], and that's just adults.”
She continued, “We don't actually have the estimates of youth. The data are virtually impossible to get, we're able to kind of just look at adults and use that as a sense of the extent to which people rely on this care.”
As of 2024, over 7 million children were enrolled in CHIP, according to official statistics from the Medicaid office. It is unclear how many are trans, but roughly 0.34% of children have a gender dysphoria diagnosis, according to a study released earlier this year. And studies like these are prone to undercounting, since they rely on medical records.
However, Mallory added an important caveat: “It wouldn't stop [private] insurers from offering care, it's just about who is going to be able to afford that insurance and get that care — if people are already on Medicaid, they can't afford to get the private insurance that would guarantee them access to care, in which case, they'd either have to rely on maybe a [potential] state program that comes through or have to pay for it out of pocket.”
Gillian Branstetter, Communications Strategist at the ACLU's Women's Rights Project and LGBTQ & HIV Project, echoed this statement on Bluesky. “[The bill] would strip Medicaid funds for trans care (which is awful enough) but it would NOT prohibit private insurers from providing coverage for trans care,” she said.
The provision attacking ACA Essential Health Benefits uses similar language as the rule covered by MadyCast News in March. Contrary to rumors and misinformation on social media, Corinne Green explained in the article that the rule would not prohibit insurers from covering trans care on ACA plans, but could limit access in states that don’t have protections baked into law.
States that enshrine mandates for gender affirming care will offer the best protections for trans residents who rely on Medicaid or ACA plans. In 2024, trans Minnesota state Rep. Leigh Finke authored a bill, later passed into law, which guarantees coverage of trans care on all insurance regulated by Minnesota. Finke told MadyCast News that this means that “legally, the state of Minnesota would be required to pay for any care that the Trump administration cuts.”
Finke is worried that given the impact of the Medicaid cuts on state budgets, as “any Democratic state that does not have to pay for [trans] care likely won't.”
“There is serious urgency to put such requirements in place, and to push the states that do [have them] to hold the line," she emphasizes.
House Rep. Sarah McBride (D-DE), the first and only trans member of Congress, did not respond to a request for comment. As of the writing of this article, her only public comment on the bill is a short statement issued to The Independent: “It's one more example of health care that they're trying to rip away.” Her social media accounts do not mention the issue either, as of time of publication.
Matthew Cortland, a trans healthcare lawyer, wrote on Bluesky that this bill is “eugenics and murder by policy, all the way down,” a statement echoed by policy analyst and MadyCast News contributor Corinne Greene. Corland added that, contrary to some conceptions of the bill, it “does not ban care for cis people.” Like most trans healthcare bans, the bill specifically carves out exemptions for cis people seeking identical care–it’s sole purpose is to target trans people.
How trans people can fight back today: yell at Senators to snarl up the ban
Although some early reports misleadingly implied that the only obstacle remaining for this bill is a majority vote in the Senate, the anti-trans provision faces an uphill battle even without any opposition from Republicans.
Since HR 1 is a budget reconciliation bill that can pass without a filibuster, provisions must abide by special rules of congressional procedure such as the Byrd rule, which mandates that the budgetary impact of provisions must not be “merely incidental,” among other guidelines.
According to Bobby Kogan on Bluesky, Senators of both parties will spend the next few weeks debating whether each line of the bill passes these rules in front of the Senate Parliamentarian, who then rules whether the provision is in compliance with congressional procedures.
As an example, any Democratic Senator could raise a point of order contending that the provisions banning trans healthcare violates the Byrd rule, and argue that the budgetary impact is “extraneous” to the main intention of the provision.1 The Senate Parliamentarian could then rule that the care ban violates the rule and should be removed from the bill, or allow the provision to remain as-is.
However, Republicans could then overturn this ruling – and bypass the filibuster – by invoking what Democrats have called the “nuclear option,” with a simple majority vote. Democrats refused to use this procedure in 2021 to pass a $15 minimum wage, with moderates arguing that Republicans would only preserve the filibuster in the future if Democrats did the same.
But that future didn’t happen. Politico has reported that the GOP is already gearing up to overrule the Parliamentarian in order to repeal Biden-era EPA waivers that allowed California to set its own emission standards. Republicans could use a similar procedure to overturn the Parliamentarian if they rule against the gender care provision, among many others that are likely to be contested.
Despite this possibility, a Senator invoking the Byrd rule remains one of the strongest options trans advocates have to defeat the bill in the short-term, as overturning the Parliamentarian is a politically costly and extreme measure that has happened only a handful of times in the past.
Contrary to what some of them argue publicly, Democratic Senators have a litany of measures to fight this bill. In addition to attacking it with procedural rules, Senators can further slow down daily proceedings as the genocidal bill is debated by refusing unanimous consent on daily business. Trans people and cis allies alike must mount serious pressure on politicians, as history has shown they will fight back only when faced with massive public outrage.
The authors of this piece have provided the following email and phone templates for readers to send to their Democratic Senators, in the hopes of encouraging at least one Senator to raise a point of order on this provision and potentially kill it through procedural means. Readers who are represented by Republican Senators may want to send a more generic action letter, such as this A4TE action link. It is vital to resist this bill with every opening we find, whatever the odds may be.
How trans people can fight back tomorrow: Organizing communities
Despite the hopelessness and panic spurred by early reporting and misinformed social media users, resistance is both possible and ongoing. Mallory recommends that people “get in touch with their providers and get recommendations from them,” adding that “their doctors are in the best position to help guide them in terms of continued access to care.”
Many providers, especially local informed consent clinics, make detailed information on their provision of gender affirming care easily available, in light of ongoing legislative and executive attacks. Further, many doctors offer low-income support plans, with some exempting fees for low-income people. With the Medicaid section of the bill not taking effect until 2026 and the ACA portion not until 2027, people will have time to stockpile hormones as well.
The bill may face legal challenges if it’s signed into law, although the outcome of such lawsuits may vary heavily depending on the outcome of Skrimetti v. US, a Supreme Court case deciding the legality of trans healthcare bans for minors. The final ruling is expected in June.
Another avenue people can look at in order to buy trans folk more time is direct legislative activism. As previously reported by Free Radical and Madycast News, activists across the country have been fighting in courtrooms and capitol buildings for decades, with these fights proving invaluable in halting efforts of the far-right to strip LGBTQ+ individuals of fundamental human rights.
Advocates may want to push their state legislators to codify protections for gender affirming care, similar to Rep. Finke’s law in Minnesota. In addition, activists could pressure Democrats to repeal these provisions in 2027 and beyond if they retake control of Congress and eventually the presidency.
There are even examples of people taking direct action to oppose HR 1. Disability rights organization American Disabled for Attendant Programs Today (ADAPT), known for leading protests that led to the passing of the Americans with Disabilities Act, held a protest two days after the Medicaid cuts were added to the bill’s language. The group’s action saw over 90 disability activists, many in wheelchairs, protesting inside the United States Capitol building during a hearing on HR 1.
“ADAPT has been fighting for disability rights for over 40 years at this point. We had a ton of folks in the hallway, and then five of us were able to get into the chamber,” Lauren Alden, a spokesperson for the protesters, told MadyCast News.
She continued, “20 people stayed in the hallway, got arrested, and then [meanwhile] in the chambers, we started by holding up signs. We saw the cops coming towards us because we're not supposed to have signs in there. We started chanting ‘No Cuts to Medicaid.’ … It was kind of awesome because instead of bringing us right out the door... they paraded us right in front of them, the whole meeting. … so we got to really keep chanting and yelling at the Republicans as we walked by them.”
Alden added that the activists, whose ranks include many trans and queer people,were treated “pretty well,” and that every activist has since been released from jail either through fine payments or court hearings. She further mentioned that this was a spontaneous change in plans, after originally coming to DC to protest the National Governors Association in support of community-based services.
Afterwards, she says, “[other activists] went to Speaker Johnson's office demanding a meeting. Of course, he didn't come out… Then the bill came up while we're there. So we knew immediately that we had to change our plans around a little bit and go there.”
Alden emphasized that this bill impacts disabled individuals just as severely as it impacts other groups. She mentioned that substance abuse services, HIV care, behavioral support, home care attendance, and nursing home support are just a few of the many essential medical services that disabled people rely on. “Anything connected to the Medicaid cuts, we need to have voices there,” she said, emphasizing the movement’s “three keys” of community living — services, wages, and housing for disabled people and healthcare workers.
She also gave strong weight to the value of collaboration across marginalized groups and within local communities. “We gotta get these numbers together, we are all in this fight together.”
ADAPT’s actions provide one example for how trans people can chart a path forward – getting connected to their local community. As the fights against the AIDS genocides in the ‘80s and ‘90s showed, a diversity of direct action tactics is required to protect queer and trans communities.
This bill and the other genocidal attacks upon trans communities make it clear that LGBTQ+ people cannot afford to wait around for nonprofits or legal challenges to save us–the community needs direct and aggressive defiance from the grassroots to build a movement.
Currently, mutual aid networks exist in communities across the country, with many offering support for trans people to meet their essential needs through mutual self-reliance, such as alternative methods of obtaining necessary healthcare. Activists must further create and expand these networks with all due speed.
Activist networks are routinely sprouting and branching out, finding new ways to provide for their local community without relying on harmful state and corporate institutions. With many raising concerns about Democratic leaders capitulating to pressure, the most infamous example being California Gov. Gavin Newsom, the need for people to rely on their neighbors is becoming ever more clear.
The best time for people to get plugged into their communities is now. Many actions won’t be found on social media, but are just as if not more impactful than many approaches one may see making daily headlines. Examples of how to find groups near you are abundant online.
Fundamentally, the working class and marginalized groups can rely on neither the state nor capitalist institutions for their safety. Attempts to work within the system are only measures to buy us time, and will continuously become less effective as the need for community resistance and resilience grows. Every one of us exists under the boot of Western fascism, and only together can we abolish the systems that keep us there.
—Edited by David Forbes
Thank you for reading this article. This work represents the most comprehensive analysis of the anti-trans provisions in HR1 as to date, and it could not be possible without support from readers like you. If you would like to support our ability to continue to publish this journalism, please subscribe for free or paid below, and share our articles. If you use the share or refer buttons below, you can receive a paid subscription for free. —m
The budgetary impact of trans healthcare on the overall federal budget is extremely minimal, since trans people make up a small percentage of its recipients, and trans-specific care is just a percentage of the care trans people receive.
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Thanks so much for reporting on what's happening and leaving the door open for a little hope. I called my senators. I'm bracing for my Medicaid to be taken away but am grateful for everyone who's fighting against that.
We can't let the transphobe take residence in our heads. We have to be out there fighting. I do bodily autonomy work so we need to fight for our care and for Planned Parenthood. Over 1m patients would lose their PP Clinic. Many of us outside the cities get HRT there. The fight is for the right to properly care for our bodies. Repro rights and the right to be authentically in our bodies are basic rights. We must win this battle.