Republicans in Washington have vowed to cut off medical treatment for most trans Americans — and may try to do so next year once Donald Trump takes over. Democrats in Congress can likely stop it from happening if they stand together and hold the line, but it’s unclear if they will.
For the last few years, the GOP has coalesced around an idea that would short-circuit essentially all trans health care in America: banning federal funds from going to businesses that provide health care specific to changing one’s sex or gender identity, including hormones and surgeries. It would essentially signal to the private sector that if it wants federal dollars, it needs to stay away from sex- or gender-affirming care, and bow down to right-wing pundits who aim to, in their own words, “eradicate” and “erase” this form of health care.
Language in House Republicans’ most recent funding bill for the Health and Human Services Department would do just that — ban money from any federal program to entities that do “social transitioning” or drugs and surgery for “gender dysphoria.” Gender dysphoria is the specific diagnosis doctors use to justify those medical interventions. This legislation has not gotten a vote yet and would need to be reintroduced next Congress to be considered. But it has been a top priority for Republican lawmakers in the House, and Trump himself has promised he’d ask Congress “to permanently stop federal taxpayer dollars from being used to promote or pay for these [trans] procedures.” (You can hear all his promises on trans health care in this short campaign video.)
Bans like these can lead to the private sector discontinuing behaviors altogether — and once they are in place, they are hard to get rid of: The Hyde Amendment, enacted in the 1970s, led to most abortions no longer being performed in hospitals, and is continually renewed each year.
Medical groups and civil rights advocates in D.C. tell Rolling Stone they believe that if a Hyde-level ban on federal funding were enacted, many hospitals will simply prioritize federal dollars over continuing this highly specialized form of medical care. So much medicine is performed through hospital systems and universities that this could mean ending access for many.
Surgery for many — canceled. Hormonal treatments — ended. A specialized field of medicine backed by reams of evidence demonstrating its need and benefits, practiced for more than half a century in the U.S. — ostracized, suddenly and loudly. It is hard to quantify how painful a funding ban legislation could be to the American trans community, except to say it would almost certainly lead to lost medical care, forced menopause for some who lose hormones, and, in the bleakest scenarios, waves of suicides.
“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,” says Asa Radix, head of the World Professional Association for Transgender Health. “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?”
Is this the end?
It’s easy to assume that even without Congress, Trump 2.0 could be an enormously painful experience for people who are trans or gender diverse — up to 1.5 percent of the American adult population per recent surveys.
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. Trump’s 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 performed surgeries and provided hormone medications “to children and adults.”
Trumpworld is not concerned with the consequences of these policies, which could well lead to suicides. In recent weeks, when pressed by Rolling Stone, multiple Republicans in the president-elect’s inner circle and incoming members of his second administration responded with, at best, shrugs, doubt, or scoffs at the premise that their policies and rhetoric will endanger lives, including those of trans minors.
When asked about the risk of these deaths, one source whom Trump has already chosen to be an official in his next administration dismissed the concern, and then simply replied that the president-elect and his staff won’t yield to “emotional blackmail from the left.”
Like many presidential actions, all of Trump’s activity in trans health care will take a lot of time. Very little of it would have to be permanent if Democrats manage to retake the White House in four years.
A federal funding ban would be a different story.
Since the 1970s, every year, Congress has routinely re-enacted the Hyde Amendment, banning some federal funding to most abortions even under full Democratic control. That’s because the government funding process is ordinarily subject to the Senate legislative filibuster, which requires 60 votes to overcome, a margin of control rarely held by either political party these days. While many in both parties want to rid themselves of the filibuster, influential figures in the chamber — namely Sen. Mitch McConnell — say they want it preserved through the Trump 2.0 era.
By that same token, should Republicans decide to force this issue in a funding fight in the incoming Congress, Democrats would have more than enough power to stop a ban on federal funds to entities performing trans-centric health care through the government funding process (assuming Congress continues to operate under the rules it has in the past).
Right now many in the LGBTQ+ advocacy community, as well as some Democratic lawmakers and staff, are quietly terrified the party might let Republicans enact it anyway, should they be forced to choose between funding the government or allowing the medical system to continue to provide this care unabated.
At a minimum, anxious Democrats and advocates believe that party leaders will capitulate on trans health care coverage in federal funding negotiations on the margins, allowing language that bans government-backed insurance plans from covering these services.
This conflict is actually playing out before Trump has taken office or the GOP controls the Senate. Democrats just this week compromised on a military authorization bill that will ban TRICARE and other Defense Department health plans from covering care for servicemembers’ trans children. Rep. Adam Smith, the top Democrat on the House Armed Services Committee, said he may vote against a procedural rule allowing for passage of the overall bill because of that language.
Stopping any sort of trans health care funding ban would almost certainly require all Democrats to stand as a bloc. If six Senate Democrats sided with Republicans to pass a funding bill with the ban language, it would overcome the legislative filibuster.
To sample how vulnerable Senate Democrats might feel about this subject, Rolling Stone asked the 13 Democrats up for re-election in the midterms for comment on whether they supported the Republican language. We heard back from three: Sens. Cory Booker of New Jersey, Chris Coons of Delaware, and Jeff Merkley of Oregon, all of whom say they are opposed to banning federal funds to businesses performing trans health care.
We did not hear from many senators up for re-election whose states have been competitive in the last decade — John Hickenlooper of Colorado, Jeanne Shaheen of New Hampshire, Gary Peters of Michigan, Mark Warner of Virginia, Jon Ossoff of Georgia, and Tina Smith of Minnesota.
Notably, the top Democrat on the Senate Appropriations Committee — Patty Murray — has been one of the few lawmakers to forcefully say Democrats should not abandon trans people. “Democrats absolutely do not need to sacrifice trans people’s rights — or anyone else’s rights for that matter — to win elections,” Murray said in a statement provided to trans rights activist Erin Reed.
But when asked if Democrats would hold the line against a funding ban, Rep. Pramila Jayapal (D-Wash.) — the mother of a trans child — said: “To be frank I’m worried about that.”
Plenty of time to waste
If you ask them, Democratic staff, political advisers, lobbyists, and civil rights advocates will admit they hadn’t prepared to defend trans people at the national level right now.
Ever since Trump and the GOP spent big on ads about sex changes and sports in the 2024 election, and won, there’s been a sudden crisis of faith sweeping the Democratic Party apparatus and the LGBTQ+ movement over the cause of trans rights.
“If we’re going to stand up for trans folks and take all these votes even if they’re unpopular — and I think we should take these votes — then we actually have to message this in a way that can actually convince people,” Jon Favreau, a former Obama White House speechwriter and co-host of the podcast Pod Save America, tells Rolling Stone.
To be clear, Democrats have had almost a decade to prepare a message on trans rights since North Carolina’s then-governor Pat McCrory enacted a bathroom ban in 2016 — and then lost re-election. Since then, more than half of U.S. states have enacted bans on trans health care for people under 18 without a similar state-wide backlash against politicians, and multiple states have enacted similar restroom restrictions.
So what happened? Why has the Democratic Party been caught flat-footed?
Despite arguments over pronouns and drag shows becoming thick background noise in American pop culture, the relatively small political advocacy circle in Washington around LGBTQ+ issues whom the Democratic Party apparatus relies on underestimated the likelihood that Republicans would run a national political campaign with significant anti-trans advertising. As the campaign season proceeded, they continued to point to examples of such strategies failing candidates like McCrory or Daniel Cameron, who lost to Democratic Gov. Andy Beshear in bright-red Kentucky after making anti-trans rhetoric a centerpiece of his campaign.
“We knew that it was going to be deployed against folks in debates, in hostile reporter questions. I didn’t think they were going to spend this amount of paid media on it,” says Lanae Erickson, senior vice president for social policy and politics for Third Way, a centrist D.C.-based nonprofit that advises Democratic staff.
Even today, unlike the Republican Party, there is no comprehensive messaging strategy for Democrats on trans rights or health care. Nor is there a significant lobbying spend in Washington for the trans community specifically, meaning there is little institutional knowledge for members of Congress to rely on for messaging; when Rolling Stone quizzed Democratic staffers in Congress about whom they consult to get talking points on trans rights, almost all gave us the same two word answer: good question.
The only group they frequently cited was Human Rights Campaign, a large political advocacy and lobbying umbrella organization first founded in the 1980s to advocate for gay marriage that expanded in the 1990s to address the entire LGBTQ+ rainbow.
Top personnel at HRC acknowledged in an interview with Rolling Stone that transphobia has become more commonplace in the cultural dialogue since 2016 and McCrory’s defeat in North Carolina. Still, they were very surprised by the GOP’s bet on anti-trans advertising in this past election. So many Americans still understand little of the trans experience. They fret that a conversation about trans rights needs to be done outside of a national campaign, where partisanship can take any issue and polarize it.
The Trump campaign’s anti-trans ads were a multi-purpose attack. They included the tagline, “Kamala is for they/them; President Trump is for you.” They were not simply an effort to marginalize trans people but sought to paint Harris as generally disconnected from voters’ concerns, and they commingled conversations about sex changes with rhetoric that was tough on immigration and crime.
So when Trump and the Republicans decided to spend substantial sums on this new strategy in the 2024 election — the organization specifically told the Harris campaign to tread delicately if Democrats chose to respond to the ads Trump ran on football games, HRC’s director of government affairs David Stacy tells Rolling Stone.
The organization did not at the time believe the anti-trans attack ads had a “meaningful impact” on swinging the vote one way or the other, and thought it would be incredibly difficult to present a response without it backfiring somehow.
“I don’t think we were saying yes or no, don’t do an ad,” he says. “I think folks were definitely cognizant of the fact that you know if you do an ad that cuts too hard, it has a really negative impact on the trans community. I think people were trying to avoid doing that as well.”
Harris aides have explained their decision not to respond comprehensively to the attacks as stemming from ad testing that did not show that it was the most effective strategy.
“We tested a ton of responses to this. Direct responses. And none of them ever tested as well as her talking about what she would do [as president],” principal deputy campaign manager Quentin Fulks told Pod Save America.
Beltway narrative blues
In light of the disappointing election results, however, a Beltway narrative has calcified: Democrats’ support for trans people somehow hurt Harris and others in their elections.
Senate Democrats fumed at Majority Leader Chuck Schumer over it. The party’s more moderate members began speaking out. One lawmaker, Rep. Tom Suozzi of New York, said he didn’t support “biological boys” — referring to trans women — in girls’ sports. Another member, Rep. Vicente Gonzalez of Texas, has left the door open to supporting a bathroom ban in Congress, even though it was intended to target his transgender Democratic colleague, incoming Delaware Rep. Sarah McBride.
“We’re in a state of denial if we try to pretend that these attacks weren’t effective,” Rep. Seth Moulton of Massachusetts recently told Rolling Stone.
The thing is, there’s very little evidence that Harris or Democrats’ support for trans rights was in itself a political liability or what swung the election for Trump and Republicans, as opposed to economic concerns or immigration. Did it maybe make a dent with a few voters? Perhaps. But was it really the deciding factor in anything?
During the Harvard University Campaign Managers Conference last week featuring top strategists for both the Harris and campaigns, Democratic pollster Molly Murphy said the Trump campaign’s anti-trans ads were “sticky,” in that they “generated a lot of conversation.” But she said the ads didn’t shift the Harris campaign’s numbers or alter the state of the race. Murphy and Trump pollster Tony Fabrizio agreed the most damaging Trump ads for Harris revolved around video clips of the vice president arguing that “Bidenomics is working.” As Republicans tested potential attack lines and played snippets of Harris speaking, Fabrizio said people “just could not believe that she believed that.”
Speaking about the anti-trans ad campaign, Favreau of Pod Save America says: “The reporting on the ads has given it outsized importance in what it actually meant for the election. And the fact that those ads ran nationally… for most people talking about the election, they probably saw that ad more than other ads because it was on during sporting events.”
Moulton and many, many others have made this claim citing a single survey conducted after Election Day by Blueprint, a Democratic-aligned polling firm, that showed many Trump swing voters agreeing with the claim, “Kamala Harris is focused more on cultural issues like transgender issues rather than helping the middle class.”
Blueprint’s lead pollster, Evan Roth Smith, tells Rolling Stone that people are misreading his company’s data and overlooking the top two concerns — the economy and immigration — which ranked much higher as priorities to swing voters in the post-election poll.
“I don’t even see that in our data. I know there’s some people who look at the Blueprint data and see that. Democrats lost this election on the economy and also some immigration stuff. That’s why we lost,” says Smith, who believes it was “almost incidental that the way the Republicans exploited [our] failure was with the trans issue.”
Smith said if anything, Republicans successfully found a vulnerability in Democrats supporting small groups generally. But giving in to that would lead the party to stray away from a core tenet of its appeal — that it seeks to stand up for society’s most marginalized.
“What Republicans want the most is for the Democratic Party to collapse into some sort of prolonged public battle in the headlines and in chyrons over the role of trans people in the Democratic Party and whether or not trans people are responsible for making Donald Trump president,” he says. “Because when you disaggregate the cultural attack on the Democratic Party from the economic attack on the Democratic Party, which actually resonates, then all you’re left with is bullying — and bullying over something the electorate doesn’t really get worked up about.”
Some Democratic staff say this fight over access to trans care will prove to be a test of the party’s broader commitments to social justice and the stakes of this conflict may be the enthusiasm of the ordinary Democratic voter. The trans community may not be a large population, nor politically influential on its own, but the ordinary Democratic voter trans or not usually says they’re compassionate about protecting the nation’s most vulnerable and ostracized.
The Congressional Progressive Staff Association, an assembly of more than 1,600 staffers in the House and Senate, provided a statement exclusively to Rolling Stone calling for congressional Democrats to “uphold our founding principles and defend those who are marginalized.”
“In Congress, we will do everything in our power to block the passage of harmful legislation by amplifying the voices of those impacted, introducing amendments, and using Congressional procedure to slow the process or grind it to a halt,” reads the statement from the CPSA’s board of officers.
It continues: “While it is crucial to continue focusing on bringing down and reinvesting in the middle class, that’s not enough — we can walk and chew gum at the same time. Republicans are betting that when Democrats support trans rights, the public will think they aren’t focused on economic security. They fail to see that economic justice and social justice are intertwined. As progressives, we firmly believe we are strongest when we are united in the fight for liberty and justice for all.”
Asawin Suebsaeng contributed additional reporting to this story.
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).
