Federal Government on the Verge of Defunding "Gender-Affirming Care"

Senators that support LGB issues need help to understand that GAC harms

“Vote for my Big Beautiful Bill!” Photo by Ross Sokolovski on Unsplash

H.R. 1, the budget bill known as the "Big Beautiful Bill," passed in the House just last week. As many know, an amendment championed by Representative Crenshaw, R-Texas, will remove all federal subsidies for pediatric “gender affirming care” (GAC). In the final hours of the House debate, several amendments were added to significantly strengthen the bill. As amended, H.R. 1 would prohibit the use of Medicaid and CHP funds for all GAC procedures and will also prohibit ACA plans from covering them. These provisions apply to both minors and adults, making the bill one of the most potentially significant pieces of legislation to reform the sex reassignment industry.

The LGB Courage Coalition unequivocally supports these provisions of H.R. 1. We have opposed “gender affirming care” for minors from our founding. While we recognize that patient autonomy is a key component of medical ethics, it is not the only component. For minors, GAC is impossible to justify. Children and their parents cannot consent to interventions that permanently remove healthy organs and destroy the function of bodily systems in the name of a pseudo-scientific concept such as gender identity. While adults may have the ability to provide informed consent, given the high rate of complications and poorly understood psychological outcomes, we believe that the government, whether it is state or federal, has no interest in subsidizing these procedures.

H.R. 1 will now go to the U.S. Senate and this is where your voice matters. H.R. 1 is a reconciliation bill, which means that it is subject to special rules in the House and Senate which are intended to streamline the process for passing laws dealing with budgetary and fiscal matters. Critically, they are exempt from the filibuster in the Senate. However, only one reconciliation bill may be brought in any given year. With 53 Senators, the Republican majority is in a position to pass H.R. 1, including the defunding provisions. Outside of the reconciliation process, there would not be enough votes to defeat the inevitable filibuster. If these provisions are stricken from the bill during deliberations it will be at least another year before there is another opportunity for this kind of reform, so it is critical that our voices are heard by our Senators now.

This is especially true of moderate Republicans, who, while friendly to the LGB community on issues such as marriage equality and civil rights, may not understand that pro-medicalization policies are not LGB-friendly. We need to let these Senators know that opposition to gender medicine is not bigotry. It is, in fact, a profoundly humane position that respects the dignity of gays and lesbians and the vulnerability of children and young adults.

Every Senator needs to hear this message, but here are some moderate Republican Senators who may be more vulnerable than others to the misinformation spread by the pro-medicalization lobby:

Susan Collins (Maine): Senator Collins is consistently identified as one of the most moderate Republicans in the Senate. She has a history of supporting LGB rights, notably co-sponsoring the Equality Act in 2019 and voting for the Respect for Marriage Act in 2022, which codified same-sex marriage protections. She tries to balance her positions to maintain her appeal to Maine’s mix of rural conservative and urban progressive voters. She has often been a key swing vote, emphasizing bipartisan legislation.

Lisa Murkowski (Alaska): Senator Murkowski is another prominent moderate, frequently breaking with her party on social issues. She voted for the Respect for Marriage Act in 2022. Her moderate positions are influenced by Alaska’s political landscape, which tends libertarian, and she’s known for working across the aisle, especially on issues like health care and women’s rights.

Thom Tillis (North Carolina): Senator Tillis is considered moderately socially liberal within the GOP, particularly for supporting the Respect for Marriage Act in 2022. He has supported bills opposing gender-affirming care. In 2023, he co-sponsored the Protecting Conscience in Healthcare Act, which prohibits government agencies and federally funded health facilities from requiring employees to participate in activities that promote "radical gender ideology." Still, given North Carolina’s starkly divided electorate, it is important to remind Senator Tillis that the LGB does not support public subsidies for gender medicine.

To voice your opinions to a Senator, simply do a browser search for their official webpage. Find the “Contact Us” or “Email Me” page and then leave your thoughts. You do not need to be a constituent to leave a comment. Let them know that you appreciate their support of LGB issues in the past but that medicalizing gender nonconformity is not a moderate position and harms same-sex attracted individuals and the LGB community.

Here are some sample letters to get you started.