Defense bill bans transgender medical coverage for children in military families

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WASHINGTON — House Democrats will face a tough vote this week on the final compromise annual defense bill that includes pay raises for troops but also bans coverage for U.S. service members' children who seek transgender care.

All Democrats present Tuesday opposed a procedural vote, 211-207, to advance the historically bipartisan legislation, but will need to contend with a final vote as early as Wednesday. Congress has enacted the annual package for the last 63 years.

Rep. Adam Smith, the top Democrat on the House Committee on Armed Services, said in a statement he plans to vote against the massive defense policy bill.

The Washington state lawmaker said that "blanketly denying health care to people who need it — just because of a biased notion against transgender people — is wrong."

"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 following the procedural vote.

President Joe Biden has not indicated whether he will sign the bill into law.

Pay raise, housing upgrades

The nearly $900 billion National Defense Authorization Act for fiscal year 2025 is set to green-light an across-the-board 4.5% pay raise to troops, plus a 10% pay hike in April for the military's most junior soldiers.

The bill would also pave the way for upgrades in military housing and new protocols for preventing and assessing traumatic brain injuries caused by blast exposure.

Also making it into the bill's final version were a few far-right wishlist items, including a hiring freeze on diversity, equity and inclusion positions, and a prohibition on any federal dollars used for so-called "critical race theory" in military education — though the section carves out academic freedom protections for instructors.

Trans coverage prohibition

Gaining the most attention is a four-line provision in the 1,800-page package that would expressly prohibit coverage for minors under the military's TRICARE health program for "medical interventions for the treatment of gender dysphoria that could result in sterilization." The bill does not define which interventions would be prohibited.

Gender dysphoria is defined by the medical community as incongruence between a person's expressed gender and their sex assigned at birth. The experience often leads to mental distress, including increased risk of self-harm, according to the medical literature.

The chair of the Congressional Equality Caucus, Rep. Mark Pocan of Wisconsin, urged Democrats to vote no on the final package.

"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 Tuesday afternoon.

Rep. Teresa Leger Fernández, one of the bill's managers, spoke on the House floor Tuesday, decrying the provision that "fails to acknowledge that the lack of care leads to death, leads to suicide."

The New Mexico Democrat accused House Republicans of thinking they know "better than the parent and the doctor as to what care your child should get. That is insulting to our Marines, to those who serve in our Navy, to those who are deployed overseas and in our bases around our own country."

Speaker praises TRICARE ban

U.S. House Speaker Mike Johnson, during his weekly press conference Tuesday, praised "landmark investments" and the pay increase included in the bill.

"It's really important right now. We improved housing for our military families and other benefits, and it's also why we stopped funds from going to CRT in our military academies. We banned TRICARE from prescribing treatments that would ultimately sterilize our kids, and we gutted the DEI bureaucracy," said the Louisiana Republican.

A Democrat-led effort to strike the transgender coverage provision failed Monday in the House Committee on Rules.

Smith told the committee that the provision is "fundamentally wrong" because gender dysphoria is widely recognized by medical professionals.

"The treatments that are available for it, including puberty blockers and hormone therapy, and also psychiatric help, have proven to be incredibly effective at helping young people, minors, who are dealing with suicidal thoughts, dealing with causes of massive confusion that have led them to have anxiety and depression," said Smith.

Treatment options include mental health therapy, hormone therapy and surgery, though the World Professional Association for Transgender Health only recommends adolescent surgery under narrow circumstances that must meet numerous criteria. Some gender-affirming surgery causes sterilization, and the association recommends counseling for adolescents and their families about limited options to preserve fertility.

Smith told the committee Monday that anywhere from 6,000 to 7,000 children of U.S. service members are currently receiving treatment for gender dysphoria. The House Armed Services Committee did not respond to a request for further explanation of that number.

Gender-affirming care was not covered by military health insurance for service members' children until September 2016. A statistical analysis published in JAMA Pediatrics in March 2019 concluded that just over 2,500 military-affiliated youth received the treatment between October 2009 and April 2017 during roughly 6,700 separate office visits.

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