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Donald Trump (right), joined by Speaker of the House Mike Johnson (left), speaks to the press at the U.S. Capitol following a House Republican conference meeting, in Washington, D.C., on May 20, 2025.
The Human Rights Campaign called the bill "cruel."
In the early hours of Thursday morning, while much of the country slept or was waking up, House Republicans rammed through a sweeping multitrillion-dollar domestic policy package that slashes Medicaid, restricts food assistance, and — in a stunning escalation — bans federally funded health care for transgender people of all ages.
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The legislation, dubbed the “big, beautiful bill” by President Donald Trump and shepherded by Speaker Mike Johnson, passed the House on a razor-thin 215-214 vote. Two Republicans, Reps. Thomas Massie of Kentucky and Warren Davidson of Ohio, voted with all Democrats to oppose it. Rep. Andy Harris of Maryland, the Freedom Caucus chair, voted present.
Related: House budget cuts could devastate LGBTQ+ people's health care: What you need to know
Related: GOP trans sports bill exposes children to genital inspections by sexual predators, Democrats warn
The bill would extend Trump’s 2017 tax cuts and deliver billions in new spending for immigration enforcement and the Pentagon. But it does so at a steep human cost: The Congressional Budget Office estimates 13.7 million people will lose health coverage. LGBTQ+ people — especially those living with HIV, people of color, and low-income families — are among the hardest hit.
And buried deep in a manager’s amendment added just hours before the vote were two provisions aimed squarely at transgender Americans. One strips all Medicaid and CHIP (the Children’s Health Insurance Program) funding for gender-affirming care, including puberty blockers, hormone therapy, and surgeries, not just for youth but for trans people of any age. A second bans coverage for those same services under the Affordable Care Act by excluding them from the definition of “essential health benefits.”
It’s the first time Congress has voted to essentially enact a nationwide ban on gender-affirming care, at least for those who cannot pay through private means.
Related: Democrats defeat Republican transgender sports ban bill in U.S. Senate
Medical experts across the country — including every major professional association, from the American Academy of Pediatrics to the Endocrine Society — have affirmed that gender-affirming care is safe, evidence-based, and lifesaving. But the House GOP ignored that consensus in favor of legislation that LGBTQ+ advocates say weaponizes government power against trans lives.
Related: What is gender-affirming care, who uses it, and do they regret it?
“Regardless of how any one of us personally feels about the issue of trans people's medical care, we should all be able to agree that the only people who should be making these decisions are patients, providers, and parents in the case of young people — not politicians,” said Rep. Mark Takano of California, chair of the Congressional Equality Caucus, in a statement following the vote. “If the GOP tax scam becomes law, more than 13.7 million Americans will lose their health insurance. But that doesn’t matter to Republicans in Congress — they need those cuts to pay for their billionaire buddies’ tax breaks. Attacks on the trans community are just the cherry on top for them.”
“This bill shows the true end goal for the MAGA regime is to target all transgender people and deny their existence — all while targeting the health programs that disproportionately serve the full LGBTQ+ community,” said David Stacy, vice president of government affairs for the Human Rights Campaign.
HRC President Kelley Robinson called the measure “cruel” and vowed immediate grassroots pushback.
“If the cuts to programs like Medicaid and SNAP or resources like Planned Parenthood clinics weren’t devastating enough, House Republicans added a last-minute provision that expands its attacks on access to best practice health care to transgender adults,” Robinson said in a statement. “These lawmakers have abandoned their constituents, and as they head back to their districts, know this: they will hear from us.”
LGBTQ+ people are overrepresented in nearly every program the bill cuts. More than one in five trans adults rely on Medicaid. HRC notes that roughly 25 percent of LGBTQ+ adults live in poverty, compared to 16 percent of straight, cisgender adults. LGBTQ+ people also face higher rates of food insecurity and homelessness, while facing being targeted by state-level bans on health care, books, and speech.
Data from the Williams Institute at UCLA School of Law underscores the stakes. New research finds that LGBTQ+ adults are nearly twice as likely as non-LGBTQ+ adults to rely on Medicaid as their primary source of insurance. Roughly 13 percent of LGBTQ+ adults — or 1.8 million people — are covered by Medicaid, including 180,000 transgender adults. That figure rises to 26 percent among low-income LGBTQ+ households and 19 percent among LGBTQ+ parents with children under 18, according to the report.
“Medicaid plays a critical role in providing access to health care for vulnerable LGBT populations, who face higher levels of poverty and disability than non-LGBT people,” said Brad Sears, distinguished senior scholar of law and policy at the Williams Institute. “Any proposals to restrict Medicaid eligibility and cut benefits must take into account the effects on sexual minority women, LGBT people of color, and transgender individuals.”
The American Civil Liberties Union is tracking 575 anti-LGBTQ+ bills in the U.S. in 2025 alone.
The federal bill now moves to the Senate, where the margin for passage is even slimmer. At least three Republican senators — Maine’s Susan Collins, Alaska’s Lisa Murkowski, and Jerry Moran of Kansas — have already voiced concerns about the bill’s impact on Medicaid and rural hospitals, The Hillreports. Sen. Rand Paul of Kentucky has announced he will vote no.
Still, Johnson has urged his Senate colleagues not to unravel the fragile coalition he assembled in the House. Republican leaders hope to send a final bill to Trump’s desk by July 4.
This is a developing story.
