Democratic lawmakers on Capitol Hill are threatening to oppose the U.S. government’s defense spending bill for the next fiscal year over its inclusion of language that would prevent the Department of Defense (DOD) from providing health care coverage that funds transgender drugs and surgeries for minors.
Although the current draft was the product of negotiations between Republican and Democratic lawmakers, some Democrats have considered abandoning the final version amid its inclusion of banning gender transitions for children.
“The final text includes a provision prohibiting medical treatment for military dependents under the age of 18 who are diagnosed with gender dysphoria,” Democratic Rep. Adam Smith, who serves as the ranking member for the House Armed Services Committee, said in a statement.
“Blanketly denying health care to people who clearly need it, just because of a biased notion against transgender people, is wrong,” Smith continued. “This provision injected a level of partisanship not traditionally seen in defense bills. Speaker [Mike] Johnson is pandering to the most extreme elements of his party to ensure that he retains his speakership. In doing so, he has upended what had been a bipartisan process.”
Republican lawmakers included the language in the must-pass National Defense Authorization Act (NDAA) for fiscal year 2025, which was unveiled this past weekend. The primary function of the NDAA is to fund the nation’s military.
Republican lawmakers sought to include similar language related to gender transitions in last year’s NDAA but eventually abandoned the effort when they failed to get enough support in the Democratic-controlled Senate.
Under the proposal, taxpayer-funded health care programs provided by the DOD for members of the military and their families would prevent any coverage of transgender drugs and surgeries for anyone under the age of 18. It would not affect these services for adults.
Currently, the DOD offers coverage for transgender drugs for all ages, which includes puberty blockers and hormones through its TRICARE program, which serves about 9.5 million service members, military retirees, and dependents. TRICARE does not currently provide coverage for transgender surgeries.
According to a study published by the American Public Health Association in 2023, at least 25,000 children sought treatment for gender dysphoria through TRICARE in 2017 — and about 900 received transgender drugs such as puberty blockers or hormones. It’s unclear whether those numbers have increased in recent years.
A Republican effort to end the DOD’s policy to fund travel for military members and their families to obtain abortions was ultimately removed from the NDAA proposal.
In a statement, Republican House Speaker Mike Johnson said lawmakers “remain determined to confront increasingly hostile threats from communist China, Russia, and Iran, and this legislation provides our military with the tools they need to deter our enemies.”
“This legislation includes House-passed provisions to restore our focus on military lethality and to end the radical woke ideology being imposed on our military by permanently banning transgender medical treatment for minors and countering antisemitism,” he added.
Smith’s objection to the NDAA proposal comes as activist groups such as the American Civil Liberties Union (ACLU) and the Human Rights Campaign (HRC) are urging Democrats to vote against the legislation.
“Medical care should stay between families and their doctors but this provision would baselessly and recklessly inject politics into the health care military families receive,” Mike Zamore, the ACLU national director of policy and government affairs, said in a statement.
“Nobody should have to choose between serving the country and ensuring their child has the health care they need to live and thrive,” he added. “Members of Congress must vote against the defense bill because of the inclusion of this deeply harmful, unconstitutional provision.”
The ACLU is currently representing Tennessee families who are challenging a state law that prohibits doctors from providing children with transgender drugs and surgeries. The United States Supreme Court heard the case’s arguments on Dec. 4.
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Transgender issues dividing Congress
Most Democratic lawmakers openly support gender transitions for minors. However, following the 2024 election, the two House Democrats — Rep. Seth Moulton and Rep. Tom Suozzi — have accused their party of going too far to the left on issues related to transgenderism, particularly when it comes to biological boys who identify as girls playing in girls’ sports.
Meanwhile, Republican Sen. Roger Marshall is introducing a bill to prohibit surgical gender transitions of minors nationwide. The legislation is called the Safeguarding the Overall Protection (STOP) of Minors Act.
In a statement posted on X, Marshall, an OB-GYN physician by profession, said that most Americans “want a complete ban on any performance of mutilation, sterilization, and castration procedures on children,” which is what prompted him to introduce the bill.
As of December, transgender drugs and surgeries for children are prohibited in 24 states and another two states ban only the surgeries. Gender transitions for minors remain legal in the remaining 24 states and several have enacted laws that explicitly protect access to those drugs and surgeries.
President-elect Donald Trump has said he supports a federal law banning the surgical gender transitions of minors. Some scholars have argued that the incoming Trump administration could use regulatory authority to restrict the gender transitions of minors nationally.