GOP Tax Bill Would Cut...

Gender-Affirming Care From Medicaid For All Ages

The bill could threaten access to lifesaving health care for the 185,000 transgender adults on Medicaid.

By Lil Kalish

May 23, 2025

Marley Gotterer was recovering from surgery at home in New York when she first heard that House Republicans had passed a massive domestic policy package in the wee hours of Thursday morning.

She had prepared for nearly two years for her facial feminization surgery, a series of surgical procedures. She met with surgeons, therapists and case managers at Amida Care, a nonprofit health plan for LGBTQ+ Medicaid recipients and those living with HIV.

Her surgery, which was fully covered under Medicaid, has already made a huge difference in her life and for her mental health. She now feels an instant lightness when she sees herself in the mirror. She said she caught a glimpse of herself on a video call with friends and asked if someone had put a beauty filter on.

“I had intense gender euphoria and I felt at home in myself,” the 27-year-old comedian said. “I feel like there’s this new start in life that I’m excited about and hopeful for.”

But that hope has now been tempered.

The bill the House passed — called the One Big Beautiful Bill Act — outlines some of the largest cuts to Medicaid in U.S. history while proposing a $4 trillion tax cut for the ultra-wealthy. The bill would bar Medicaid and the Children’s Health Insurance Program from covering gender-affirming care for adults and minors alike, and would prohibit health plans offered under the Affordable Care Act from covering such care as an essential health benefit.

If the dramatic tax bill becomes law, it could jeopardize access to care for hundreds of thousands of trans adults and minors. Around 185,000 transgender adults rely on Medicaid as their primary source of health insurance, according to a report released this month by the Williams Institute at UCLA School of Law. Another study found that nearly 25% of trans adults are on Medicaid.

Research shows that transgender people are also more likely to be uninsured, underemployed and experiencing food insecurity compared to their cisgender peers, often due to high rates of employment discrimination and harassment in the workplace.

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Dr. David Johns, the executive director of the National Black Justice Collective, called the new GOP tax bill a calculated effort to try to erase trans people from public life.

“The same bill slashes Medicaid and SNAP benefits, guts civil rights and disability enforcement, and strips millions of Americans—disproportionately Black, Brown, poor, disabled, and queer—of access to basic health services,” Johns said in a statement. “This isn’t about fiscal responsibility. It’s about using trans lives as a political wedge to force through a budget that serves billionaires and punishes the most vulnerable.”