GOP Uses Defense Bill To Strip Care From Military Families’ Trans Kids

WASHINGTON — House Republicans have tucked a provision into a must-pass defense bill that would strip health care from military families’ transgender kids, putting parents in a position of having to choose between their careers in the military and providing medically necessary health care for their loved ones.

The language slipped into the National Defense Authorization Act, which the House is voting on later this week, is buried on page 399 of the 1,813-page bill. Republicans added it at the last minute, after Democrats had worked with them to help craft the legislation.

It’s just one sentence: “Medical interventions for the treatment of gender dysphoria that could result in sterilization may not be provided to a child under the age of 18.”

The GOP has been relentlessly campaigning on restricting trans rights — Republican candidates spent a whopping $215 million on ads vilifying transgender people in this election cycle — and they’ve now found a way to tie trans issues to legislation that authorizes federal spending for the military.

Speaker Mike Johnson (R-La.) said Tuesday that he’s “proud” of the NDAA bill and specifically pointed to its provision that blocks TRICARE, the military’s health care program, from covering the costs of gender-affirming health care for servicemembers’ kids.

“We banned TRICARE from prescribing treatments that would ultimately sterilize our kids,” he told reporters at a press conference.

Johnson’s claim and the bill’s language are misleading. Young children who receive gender-affirming care are not being sterilized. The procedures that Republicans have often pointed to when talking about trans health care — surgeries performed on a patient’s genitals — are, as a rule, only done on consenting adults and are only done after consultations with medical professionals.

The kind of gender-affirming care trans kids who haven’t hit puberty yet typically get is mental health support and guidance for social transitioning. Once a kid hits adolescence, they may begin to take puberty blockers, medicine that delays the changes of puberty. This doesn’t cause permanent physical changes; when someone stops taking puberty blockers, their natural puberty resumes.

Older trans children and teens may add in sex hormones like estrogen or testosterone. There are possible long-term effects on fertility if they remain on these hormones long-term, depending on when they began hormone replacement therapy. The patient, the patient’s family and their doctors ultimately decide whether to proceed with, pause or forgo any of these interventions; many trans people opt not to pursue hormones or surgery.

Johnson said Tuesday he expects a “large vote” on the NDAA this week. He’s essentially daring Democrats and any Republicans to oppose the legislation, which authorizes more than $883 billion in defense spending priorities through Sept. 2025.

Nearly 300 pro-LGBTQ rights organizations wrote to House lawmakers on Monday, urging them to oppose the NDAA over its anti-trans language.

“Preventing thousands of family members from obtaining medically necessary care is a betrayal of the promise to our military families and an unnecessary threat to our national security,” reads the letter from the groups, including Human Rights Campaign, Lambda Legal and Physicians for Reproductive Health. “This care for the treatment of gender dysphoria, often referred to as gender-affirming care, isn’t ‘special’ or ‘experimental’ health care — it is ordinary health care supported by medical science and managed by physicians.”

The House spent part of Tuesday discussing and then voting on a procedural step to begin debate on the NDAA. This rule narrowly passed, 211-207. Every Democrat present voted against it and every Republican present voted for it. Thirteen people missed the vote.

Shortly afterward, Rep. Mark Pocan (D-Wis.), chair of the Congressional Equality Caucus, urged all Democrats to oppose the bill later this week.

“For a party whose members constantly decry ‘big government,’ nothing is more hypocritical than hijacking the NDAA to override servicemembers’ decisions, in consultation with medical professionals and their children, about what medical care is best for their transgender kids,” Pocan said in a statement.

Democrats seem poised to hold the line. Even Washington Rep. Adam Smith, the top Democrat on the House Armed Services Committee who helped craft the bill before the GOP slipped in the anti-trans rider, said he’ll oppose it now.

“The inclusion of this harmful provision puts the lives of children at risk and may force thousands of service members to make the choice of continuing their military service or leaving to ensure their child can get the health care they need,” Smith said in a statement. “For that reason, I will oppose final passage of the FY25 NDAA in its current form.”

During Tuesday’s debate on the House floor, some Democrats took the opportunity to rip the anti-trans provision. Rep. Mary Gay Scanlon (D-Pa.) pointed out the U.S. military is already struggling with recruitment and retention, and stripping people’s kids’ access to health care will only make it worse.

“The evidence is clear: Gender-affirming care of various types is life-changing and life-saving for the children who need it,” Scanlon said. “Our soldiers need to be able to focus on their missions, not [worry] whether their children are able to get medical treatment they need.”

But Rep. Austin Scott (R-Ga.), who supports the anti-trans provision, said Democrats upset about it are just looking for a reason to oppose the NDAA. He argued the merits of blocking trans kids’ health care should be self-evident.

“We’re talking about children under the age of 18, and we are saying we’re not going to allow a surgical procedure on them that could lead or result in sterilization,” said the Georgia Republican. “I don’t understand why we’re even having this discussion.”

Scott’s comments suggest he doesn’t understand how transgender health care works. A July 2024 study by Harvard School of Public Health researchers underscores what he may not realize: Almost no trans teens get gender-affirming surgery, let alone genital surgery.

Specifically, this study found no instances of gender-affirming surgeries in youth under the age of 15, and for teens aged 15 to 17 and adults aged 18 and older, the rate was 2.1 per 100,000 people and 5.3 per 100,000 people, respectively. The majority of these were also chest surgeries, not genital surgeries, and would not “sterilize” the patient.

It’s not clear how many transgender kids are enrolled in TRICARE or relying on coverage for gender-affirming care. One analysis in 2022 found that 2,500 minors sought care for gender dysphoria through TRICARE in 2017, and 900 received puberty blockers or gender-affirming hormones.

Scott also may not realize ― or care ― that the NDAA provision still allows TRICARE to cover all kinds of gender-affirming treatments for cisgender kids under the age of 18.

This might include breast reduction surgery for cisgender men with gynecomastia, a noncancerous condition that causes enlarged breast tissue in men. It could also include hormone treatments for cisgender women with polycystic ovary syndrome, which causes higher levels of testosterone and extra hair growth.

There’s a chance, albeit a small one, that Democrats could force Republican leaders to strip the anti-trans provision from the bill.

Given the House GOP’s razor-thin majority, Democrats could find just enough Republicans to join them in rejecting the NDAA. Some of the more fiscally conservative GOP members may not be happy with the bill’s large price tag and may be willing to oppose it over that.

The math in the House could also get scrambled. Of the 13 lawmakers who missed Tuesday’s very close vote, four were Democrats and nine were Republicans. It’s possible that more Democrats will come back and some GOP members won’t, or others won’t present for the final vote.

The House is likely to vote on the NDAA bill on Wednesday or Thursday.