As Congress debates ban on funds for gender-affirming care, trans advocates watch, worry

As Congress wrangles over a budget reconciliation bill that would deny federal funds to pay for gender-affirming care, Lee Blinder appreciates the fact that they live in Maryland, which would likely cover any federal shortfall if it came to it.

But that hasn’t made watching the debate any less worrisome, said Blinder, the executive director for Trans Maryland.

“There’s the practical impact — and then there’s the emotional impact,” Blinder said. “The emotional impact of watching elected officials, and those who are in these positions of authority over our lives, attempt to eliminate people’s access to life-saving care is a stressful process — the emotional devastation that occurs when you see your government making these steps to try to eliminate your access to basic care.”

Blinder’s remarks come as Congress is engaged in an on-again, off-again debate over transgender care funding as it fights over the budget reconciliation bill, a massive combination of tax and budget cuts that President Donald Trump has called the one, big beautiful bill. The measure would extend tax cuts, increase defense and homeland security spending, and slash spending on Medicaid and food assistance programs.

The House also included a provision to prohibit the use of federal funds for gender-affirming care, when the House originally sent the bill over to the Senate last month. That provision had been stripped out by the time the Senate sent its version of the 1,000-page bill back to the House this week, thus allowing federal funds for such care — not because senators had a change of heart, but because the Senate parliamentarian said that keeping the ban in the bill would require more than a simple majority for approval.

So far, the bill has passed by one-vote margins in both the House and Senate.

The bill stalled briefly in the House this week, when fiscal hawks complained about the cost of the bill, which could add as much as $3 trillion to the federal deficit over the next decade, according to Congressional Budget Office estimates. But among their problems with the bill was the fact that it would again allow federal funds for gender-affirming care.

“It’s an extraordinarily stressful time for transgender Marylanders,” said Blinder, who says there should not be a “poor tax” for transgender people who can’t afford gender-affirming care.

Unlike other states that have worked to restrict access to that medical care, Blinder noted that Maryland lawmakers have worked to protect gender-affirming care for some 24,000 transgender Marylanders.

In 2023, Gov. Wes Moore (D) approved the Trans Health Equity Act which says Maryland Medicaid “shall” cover gender-affirming care, granting lower income Marylanders access those procedures that they may not otherwise have been able to afford.

The state currently receives federal dollars to support those services. But under the Trans Health Equity Act, the state is expected to fund gender-affirming care, with or without federal support.

The Maryland Department of Health reports that in 2024, Maryland Medicaid spent $1.7 million to fund more than 1,600 unique office visits for gender-affirming care services. That figure currently includes about $900,000 in federal funding. A health department spokesperson said that the federal match for gender-affirming care “varies by eligibility group but is generally a 50% match.”

Senate Budget and Taxation Chair Guy Guzzone (D-Howard), said that it’s a cost that Maryland could probably absorb if federal funding was lost.

“It’s not insignificant … but the state could cover it,” he said.

Last week, Senate President Bill Ferguson (D-Baltimore City) said the General Assembly would likely have tried to backfill those dollars, among other cuts, “whatever we can and however we can.”

“Medical decisions are best made between a patient and their doctor,” he said. “I believe that in the state of Maryland, we protect people’s right to privacy and their relationship with their doctor, and we are covering medical care that is appropriately determined between that patient and their doctor. “

But Del. Kris Fair (D-Frederick) said that it’s not the size of the missing dollars that matters but the message toward the transgender community.

“It wouldn’t even make a small, teeny tiny dent in the question of our budget, which should tell you everything you need to know about what they’re actually doing here,” Fair said.

“The amount of money that’s spent on gender-affirming care is a pebble in an ocean of money.” he said. “People are trying to politicize a community that is simply trying to live and survive.”

While it was a “sigh of relief” when the gender-affirming care prohibition was cut from the Senate version of the bill, significantly increasing the chance that federal funds could still be used, Fair noted that the transgender community will still be affected by other provisions of the legislation, such as major cuts to Medicaid funding that could knock thousands of Marylanders off their health care coverage.

“If it goes through the way the Senate has passed that, the impact is still going to be deeply felt by the trans community, by other LGBTQ+ people, just because of the disproportionate percentages of people that rely on Medicaid,” he said.