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Transgender Americans—like all Americans—deserve Medicare coverage; nevertheless, their access to healthcare is at risk.
The U.S. House of Representatives passed a budget bill that promises a sweeping dismantling of critical public programs that millions of people rely on, including food stamps, Medicaid, and federal education loans. Buried inside the bill’s thousand-plus pages are provisions that specifically target healthcare for transgender people, including an outright ban on Medicaid coverage for transgender people of all ages.
These provisions are the latest escalation of the immense and overwhelming political attacks on transgender people in America over the last several years, which already include a ban on transgender military members, limitations on participation in sports for children, and openly spreading falsehoods about transgender youth and the healthcare they receive. Instead of focusing on the stigma, violence (which is disproportionately experienced by Black transgender women), and discrimination transgender people face every day that results in severe health disparities, higher rates of poverty, and premature deaths, legislators all over the country are enacting policies that perpetuate these very issues.
Between this congressional budget legislation and the Trump administration’s assaults on transgender youth, military service members, and veterans, concern is growing that this administration’s war on transgender people will soon include efforts to strip transgender Medicare beneficiaries of essential medical coverage. Medicare was created with the intention of ensuring that American adults have access to vital healthcare services as they age and can no longer work, and it has grown to become one of the most well-supported and positively viewed government programs of our time. Weaponizing the Medicare program to impose a political agenda in place of expert medical standards of care would be a deeply concerning development with serious ramifications not just for transgender Medicare beneficiaries but for the practice of medicine in America as a whole.
The issue policymakers should be tackling is not banning medical care for transgender youth or adults but rather ensuring that all people, including Medicare beneficiaries, can access the medical care they need.
According to expert standards of care in transgender health, medical care for transgender people is carefully tailored to align with the recommendations of healthcare providers and each person’s individual needs. To examine the frequency and trends of one particular form of care—gender-affirming surgical procedures—for Medicare beneficiaries, my team and I recently published a study using Medicare claims data. While these surgical procedures are not part of the routine standard of care for transgender youth, they are a medically necessary and important part of care for many transgender adults.
We found that gender-affirming surgeries are exceptionally rare in the Medicare program and that transgender Medicare enrollees in the South are less likely to receive surgery compared to those in the Northeast with similar characteristics (e.g., race, ethnicity, age). These findings stem from discriminatory policies that result in inaccessibility. Medicare beneficiaries face barriers to receiving gender-affirming surgeries because of a lack of access to surgeons, inconsistent and unclear coverage policies, coverage denials, and high out-of-pocket costs. These barriers represent structural forms of stigma that may be particularly elevated for racial and ethnic minoritized populations due to racism. Thus, the issue policymakers should be tackling is not banning medical care for transgender youth or adults but rather ensuring that all people, including Medicare beneficiaries, can access the medical care they need.
Transgender people are under political, social, and legal attack with such intensity that it is easy to lose sight of who—and how many people—are actually directly impacted. To put our study’s findings into context: In 2019, 37.9 million people received their Medicare benefits through Traditional Medicare (our study focused on those with Traditional Medicare and excluded those with private plans, known as Medicare Advantage). Of these nearly 38 million people, we were able to identify about 35,000 transgender adults, which is 0.09% of the Traditional Medicare population. Of this small number of Medicare beneficiaries who are transgender, 1.4% received a gender-affirming surgery in 2019. In other words, less than one one-hundredth of a percent—or 0.001%—of this Medicare population was transgender and received gender-affirming surgery.
Not only is the number of transgender Medicare beneficiaries small and the number who received gender-affirming surgeries much smaller, we also observed a decrease in the number of transgender Medicare beneficiaries who received gender-affirming surgeries over time. This downward trend is unique to the Medicare program, further highlighting access issues for transgender people with Medicare coverage.
To put an even finer point on it: We included a cisgender, or non-transgender, cohort in our study because the same surgeries transgender people need are also often received by cisgender people (e.g., hysterectomies). Overall, each year, about 0.5% of our cisgender cohort underwent procedures that could be considered gender-affirming for transgender people. Our team wanted to see if transgender Medicare beneficiaries face any disadvantages in receiving needed surgical care compared to cisgender beneficiaries. We found that, unlike transgender people, there were no significant differences in the receipt of surgery based on where cisgender people lived. In other words, a cisgender person residing in New York was just as likely to receive a surgery they need as another cisgender person in Texas with similar characteristics. Our findings indicate that transgender adults with Medicare may be uniquely unable to access needed care both because of who they are and where they live.
It is timely and crucial to highlight the facts about gender-affirming care and the Medicare program: Our study suggests that transgender Medicare beneficiaries already face unique access issues when seeking medically necessary care. Just like all Medicare beneficiaries, transgender people are deserving of Medicare coverage. Just like everyone else, transgender people should have the ability to access the care that they need from providers they trust without politically motivated, anti-science barriers imposed by the federal government. Yet transgender people continue to be singled out in political attacks that deny them access to care and services that remain accessible to non-transgender people. This issue has already made its way to the U.S. Supreme Court—which could have dire consequences for the health of transgender people of all ages.
The amount of effort, time, and resources being used to target (and scapegoat) such a marginalized group—and to limit their ability to access medically necessary care, no less—is harmful, imbalanced, and malicious. It is also anti-science. Gender-affirming care is cost-effective, associated with improved mental health outcomes, and considered medically necessary by every major medical organization in the U.S., including the American Medical Association, the American Psychological Association, and the American Psychiatric Association. Polling shows most Americans do not want policymakers to focus on the transgender community. With severe federal budget cuts looming, policymakers should, instead, do something useful and positive: They should act to ensure that all people, including transgender people, can get the healthcare they need.
"The Trump administration is trying to write us out of that history," said one transgender writer. "We will not let them."
They were on the front lines of the most famous uprising for LGBTQ+ civil rights in history, but the Trump administration has erased mention of transgender and queer people from the official website of the national monument marking the event.
The National Park Services' (NPS) website for Stonewall National Monument in New York City now welcomes visitors with the lines: "Before the 1960s, almost everything about living openly as a lesbian, gay, bisexual (LGB) person was illegal. The Stonewall Uprising on June 28, 1969 is a milestone in the quest for LGB civil rights and provided momentum for a movement."
Previously, the site said "lesbian, gay, bisexual, transgender, or queer (LGBTQ+) person."
This, despite the fact that queer and transgender people including Marsha P. Johnson and Sylvia Rivera—who, according to a still-standing NPS web page, threw the second Molotov cocktail at police—were front-and-center during the six-day uprising at the Stonewall Inn gay bar on Christopher Street in Greenwich Village.
In a statement posted on Instagram, the Stonewall Inn and its Stonewall Gives Back Initiative said they are "outraged and appalled" by the NPS move, adding that "this blatant act of erasure not only distorts the truth of our history, but it also dishonors the immense contributions of transgender individuals—especially transgender women of color—who were at the forefront of the Stonewall Riots and the broader fight for LGBTQ+ rights."
The statement continues:
Let us be clear: Stonewall history is transgender history. Marsha P. Johnson, Sylvia Rivera, and countless other trans and gender-nonconforming individuals fought bravely, and often at great personal risk, to push back against oppressive systems. Their courage, sacrifice, and leadership were central to the resistance we now celebrate as the foundation of the modern LGBTQ+ rights movement.
The decision to erase the word "transgender" is a deliberate attempt to erase our history and marginalize the very people who paved the way for many victories we have achieved as a community. It is a direct attack on transgender people, especially transgender women of color, who continue to face violence, discrimination, and erasure at every turn.
Also gone from the NPS site is a page previously containing an interactive "Pride Guide" for visitors "to explore the legacy and history of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people and places."
Stonewall National Monument—which was dedicated by then-President Barack Obama in 2016—commemorates the 1969 Stonewall Uprising at and around the Stonewall Inn, a gay bar in Greenwich Village.
Police raids of LGBTQ+ spaces were a frequent fact of life during a time when consensual same-sex sexual relations, cross-dressing, and even dancing with members of the same sex were illegal. On the night of June 28, 1969 New York City police raided the mafia-owned Stonewall Inn, ostensibly to investigate illegal alcohol sales and find "three-article rule" violators to arrest, provoking the six-day uprising that is widely credited with sparking the LGBTQ+ rights movement.
This is the New York Daily News' front-page coverage of the Stonewall Uprising. (Photo: New York Daily News)
Although there were earlier uprisings—like the 1966 trans-led Compton's Cafeteria Riot in San Francisco—Stonewall became synonymous with the ongoing struggle for LGBTQ+ equality.
While attempts to marginalize and separate the fight for transgender rights from the wider LGBTQ+ movement are nothing new—Rivera lamented this "gay liberation but transgender nothing" ethos a generation ago—such efforts have accelerated in recent years, fueled by the far-right and prominent figures in the "trans-exclusionary radical feminist" (TERF) movement, author J.K. Rowling, anti-trans gay activists, and others.
The NPS' move is part of Trump's wider war on transgender people that began during his first administration and continues today with the president's executive orders aimed at delegitimizing transgender identity, cutting off federal support for gender-affirming healthcare, pushing for a ban on trans women and girls from female sports, renewing his first-term prohibition on trans military enlistment, and other insidiously discriminatory and dangerous moves.
Transgender activists and their allies aren't taking the Trump's administration's latest move sitting down. A protest took place at the monument site on Friday afternoon, with others vowing future action.
#Stonewall today
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— bonnjny.bsky.social (@bonnjny.bsky.social) February 14, 2025 at 9:42 AM
"The Trump administration is trying to write us out of that history," Media Matters LGBTQ program director Ari Drennen asserted on social media. "We will not let them."
Lamenting that "the federal government is attempting to erase us and take away our history," researcher and self-described "transgender menace" Allison Chapman said on the social platform Bluesky, "This Pride, we riot."
The Democrats' problem isn't "wokeness," but rather their failure to counter the Republicans' cruel anti-trans narrative.
In the wake of the Democrats' devastating loss last month, there has been no shortage of arguments and analyses about what went wrong and how the party should move forward. It has been deeply concerning to see some of these arguments taking Republican fearmongering and propaganda as a basis, particularly on the subject of transgender rights. Falling for Republican propaganda will not only bring terrible harm to the most vulnerable members of society; I believe it is also a losing political strategy for Democrats. Instead, the Democratic Party must be vigilant against Republican propaganda, and must proactively counter it.
The Democrats' failures in messaging on transgender rights were evident throughout the campaign. Despite the Biden-Harris administration's progress - such as signing executive orders aimed at curbing discrimination, expanding health care access, and raising awareness of the societal barriers and violence that transgender people regularly experience - the Harris campaign appeared to studiously avoid discussing transgender people at all.
Democrats must make clear to the public that while Republicans cynically claim to be "protecting children," they are in fact doing the opposite.
One of the few exceptions, and thus the most visible mention of trans people by Kamala Harris during the campaign, was in her October 16 interview on Fox News. When the host, Bret Baier, challenged the Biden-Harris administration's policy supporting gender-affirming medical care for prisoners, Harris had an opportunity to make a defense on moral grounds. Instead, she counterattacked by pointing out that the Trump administration followed the same laws, and thus the argument was "throwing...stones when you're living in a glass house." By doing so, she implicitly condoned the narrative that gender-affirming care is a luxury rather than a necessity, or, worse, somehow wrong or shameful, rather than a fundamental human right that should be afforded to all, including incarcerated people.
Setting aside for a moment the moral aspect, try to coldly consider the political message this phrasing sent to voters. After the provision of gender-affirming care was presented as though it were a problem, the Democrats seemed to be saying, 'it is a problem that both we and the Trump administration failed to deal with.' Meanwhile, the Republicans were promising to 'solve' it in the next administration. So why would an uninformed voter, after hearing both parties apparently acknowledge a 'problem' but only one party offer to 'solve' it, be expected to support the Democrats?
If Democrats want to be seen as competent, then they must stop catering to the Republicans' fearmongering and dehumanizing narrative and instead proactively counter it. Democrats must stand up and say yes, our policy is to support the provision of gender-affirming care, and we are proud of this policy. It is not a problem, but a protection of our citizens' basic human rights. The Democrats already campaigned on messages of freedom, self-determination, and bodily autonomy; these are precisely the values that must be applied not only to cis Americans, but to trans Americans as well. It is indeed somewhat astonishing that the Democrats failed to consistently articulate as simple a concept as: our platform of freedom and bodily autonomy also applies to trans people.
Of course, Harris was not the only high-ranking Democrat to weaken their own political position by failing to stand up for trans rights. Senate candidates Colin Allred and Sherrod Brown both ran television ads legitimizing Republican fearmongering about trans kids playing in school sports. After the election, Representative Seth Moulton went farther, portraying trans children as a physical danger to cis children, saying he didn't want his daughters to be "run over on a playing field" by trans students. Trans kids already suffer from bullying, abuse, and depression at significantly higher rates than their cis counterparts, and it's not hard to see why, when even Democratic lawmakers are demonizing them.
Democrats... appear to implicitly accept the premise of the supposed 'problem,' but do not offer a solution. Again, how is a rational but uninformed voter supposed to respond?
Again, let us try to dispassionately consider the potential political effect of such messaging (absurd as it is to set aside the ethical aspects of politicians attacking already marginalized children). The Republicans claim that trans kids are some sort of malign threat, and advertise policies to neutralize this 'threat' by denying them legal protections, further isolating them, and trying to erase the very existence of their identities. In other words, Republicans have presented a (manufactured) 'problem' and a (monstrous) 'solution.' Democrats, meanwhile, appear to implicitly accept the premise of the supposed 'problem,' but do not offer a solution. Again, how is a rational but uninformed voter supposed to respond?
The only logical path forward is for Democrats to explicitly renounce the Republicans' false premises. Trans children are not a threat to cis children, whether on the playground or in the bathroom, and bullying of trans kids not only by other students but by adult politicians is an outrage. Democrats must make clear to the public that while Republicans cynically claim to be "protecting children," they are in fact doing the opposite.
Unfortunately, there is no time to lose. Trump has announced a stream of extremist anti-trans appointees to key administration roles, including Secretary of Education (Linda McMahon), Secretary of Health and Human Services (Robert F. Kennedy, Jr.), Secretary of Defense (Pete Hegseth), and Secretary of State (Marco Rubio), among many others, who will enable the Republicans to make good on their promises to destroy protections for trans students, prevent access to healthcare and housing, purge transgender servicepeople from the military, promote anti-trans bigotry abroad, and deny transgender people the ability to openly exist in society. Not to mention the possibility of using the military to go after Trump's "enemy from within," which presumably includes trans people and their allies, whom Trump described as representing "a great evil."
The Democrats must unify to counter the Republicans' anti-trans propaganda and impending anti-trans agenda, not only to prevent the further oppression of millions of transgender Americans, but also to maintain credibility as a political movement.