Republicans in Washington have made a firm pledge to halt medical treatment for the majority of trans Americans. This decision could potentially take effect next year once Donald Trump assumes power. Democrats in Congress hold the key to preventing this from happening if they unite and stand firm. However, it remains uncertain whether they will take action.

Trans Health Care at Stake: The Battle for Medical Access

Background and GOP's Plan

For the past few years, the GOP has centered around an idea to disrupt all trans health care in America. They aim to ban federal funds from going to businesses that provide specific health care for changing one's sex or gender identity, including hormones and surgeries. This would signal to the private sector that it must avoid sex- or gender-affirming care to receive federal dollars and comply with right-wing pundits' demands to "eradicate" and "erase" this form of care.The language in the House Republicans' latest funding bill for the Health and Human Services Department would achieve just that - prohibiting money from any federal program to entities that engage in "social transitioning" or provide drugs and surgery for "gender dysphoria." This diagnosis is used by doctors to justify these medical interventions. Although this legislation has not yet been voted on and would need to be reintroduced in the next Congress, it is a top priority for Republican lawmakers in the House, and Trump himself has promised to ask Congress to "permanently stop federal taxpayer dollars from being used to promote or pay for these [trans] procedures."

Impact on the Private Sector and Medical Care

Bans like these can have a significant impact on the private sector. Once in place, they are difficult to remove, as seen with the Hyde Amendment enacted in the 1970s, which led to most abortions no longer being performed in hospitals and is renewed annually. Medical groups and civil rights advocates in D.C. believe that if a similar Hyde-level ban on federal funding is enacted, many hospitals will prioritize federal dollars over continuing this highly specialized form of medical care. Since much medicine is performed through hospital systems and universities, this could mean an end to access for many.

Consequences for the Trans Community

Surgery for many trans Americans could be canceled, and hormonal treatments could end. A specialized field of medicine that has been practiced for over half a century in the U.S. and is backed by evidence of its need and benefits is now being ostracized. It is difficult to quantify the pain a funding ban legislation could cause to the American trans community, but it would likely lead to lost medical care, forced menopause for some who lose hormones, and in the worst-case scenarios, waves of suicides.Asa Radix, head of the World Professional Association for Transgender Health, says, "I think if they had to make the choice of, 'Do we provide this care and potentially have to close our doors to everybody,' they probably won't do it. It's very disturbing. Legislation like this - even if it hasn't passed - creates an environment where people are incredibly afraid. This is the type of issue where people actually feel suicidal. Are we going to see folks dying by suicide because potentially of laws like this being passed?"

Trump's Actions and the Incoming Administration

Trump, who once said Caitlyn Jenner could use any bathroom at Trump Tower, ran for the Republican nomination this year on a pledge to end any federal government promotion of transition "at any age" and disqualify hospitals treating trans minors from Medicare and Medicaid. His incoming vice president, J.D. Vance, as a senator, introduced legislation banning federal funds to entities performing trans health care and compared trans people to perverts. Trump's choice to run the Health and Human Services Department, Robert F. Kennedy Jr., has said people may be saying they're trans because of pollution. One of Trump's top advisers and financial backers, Elon Musk, days ago endorsed throwing doctors who perform trans health care to people under 18 in prison. A leading candidate to run Trump's Federal Trade Commission, Andrew Ferguson, has promised to use the agency to "investigate the doctors, therapists, hospitals, and others" that perform surgeries and provide hormone medications "to children and adults."

The Democratic Dilemma

Right now, many in the LGBTQ+ advocacy community, as well as some Democratic lawmakers and staff, are terrified that the party might let Republicans enact a funding ban on trans health care. At a minimum, they believe that party leaders will compromise on trans health care coverage in federal funding negotiations, allowing language that bans government-backed insurance plans from covering these services.Stopping any sort of trans health care funding ban would require all Democrats to stand together. If six Senate Democrats sided with Republicans to pass a funding bill with the ban language, it would overcome the legislative filibuster. Democratic staff, political advisers, lobbyists, and civil rights advocates admit they were not prepared to defend trans people at the national level. Since Trump and the GOP's focus on trans issues in the 2024 election, there has been a crisis of faith in the Democratic Party and the LGBTQ+ movement.Despite having almost a decade to prepare a message on trans rights since North Carolina's bathroom ban in 2016, the Democratic Party was caught off guard by the Republican's anti-trans advertising. There is no comprehensive messaging strategy for Democrats on trans rights or health care, and there is little lobbying spend specifically for the trans community. The only group they frequently cite is the Human Rights Campaign.Top personnel at HRC acknowledge that transphobia has become more common since 2016 but were surprised by the GOP's bet on anti-trans advertising. They worry that a conversation about trans rights needs to be done outside of a national campaign to avoid partisanship.The Trump campaign's anti-trans ads were a multi-purpose attack, not only to marginalize trans people but also to paint Harris as disconnected from voters' concerns and commingle conversations about sex changes with tough rhetoric on immigration and crime.

The Beltway Narrative

In light of the election results, a Beltway narrative has emerged that Democrats' support for trans people hurt Harris and others in their elections. Senate Democrats are frustrated with Majority Leader Chuck Schumer, and more moderate members are speaking out. However, there is little evidence that Harris or Democrats' support for trans rights was the deciding factor in the election.Democratic pollster Molly Murphy said the Trump campaign's anti-trans ads were "sticky" but did not shift the Harris campaign's numbers or the state of the race. The most damaging Trump ads for Harris revolved around video clips of her arguing that "Bidenomics is working."Some Democratic staff believe this fight over trans care will test the party's broader commitments to social justice and the enthusiasm of ordinary Democratic voters. The Congressional Progressive Staff Association called for congressional Democrats to "uphold our founding principles and defend those who are marginalized."Dial 988 in the U.S. to reach the National Suicide Prevention Lifeline. The Trevor Project, which provides help and suicide-prevention resources for LGBTQ youth, is 1-866-488-7386. Find other international suicide helplines at Befrienders Worldwide (befrienders.org).