Act Now to Protect Our Healthcare

The Centers for Medicare & Medicaid Services (CMS) has proposed a rule that would prohibit states from requiring coverage for gender-affirming care as part of their Essential Health Benefits (EHB) under the Affordable Care Act (ACA). This means that starting in Plan Year 2026, states could no longer require ACA marketplace individual and small-group insurance plans to cover puberty blockers, hormone therapy, or gender-affirming surgeries as essential benefits.

While state-level nondiscrimination laws requiring coverage for this care would remain in effect, this would prohibit states such as Colorado and Vermont from enforcing their trans-inclusive EHBs and would stop other states from clarifying their own essential benefits coverage.This change would severely limit access to medically necessary care for transgender people, potentially creating barriers to coverage and treatment even in states that are already working to protect their trans residents. 

Essentially, this is an effort by the Trump administration to change insurance requirements so they can deprive trans people of the care that we need. 

Tell this administration to get their hands off our healthcare! 

What Do We Want? 

We demand the protection of trans healthcare access and the preservation of Affordable Care Act (ACA) provisions that support trans individuals, including: 

• Gender-affirming care as an essential health benefit (EHB). 
• Health coverage access for DACA recipients. 
• No new barriers to insurance enrollment or subsidy access. 
• Fair and accessible enrollment rules that don’t disproportionately harm trans people.

What does the proposed rule do? 

• Bans gender-affirming care as an essential health benefit. 
• Strips DACA recipients of healthcare coverage. 
• Adds new, unnecessary barriers to enrollment in ACA plans, disproportionately affecting trans people. 
• Makes it harder for low-income people to access subsidized care. 

Why is this so important?

Trans people have fought for decades to access medical care - and especially to get our essential health needs covered by insurance. In the 1960s and 1970s, some trans healthcare was covered under government plans. But in 1981, after a wave of major conservative backlash pushed Ronald Reagan into office, his administration banned CMS from covering gender-affirming care. It was only in 2014 that President Obama's administration required Medicaid to cover gender-affirming procedures! 

Our progress is very real - and also very recent. Our fight is ongoing, and no matter what, we won't back down! 

By the numbers

• 33% of transgender people avoided health care because they feared mistreatment or discrimination​. 
  • 48% of transgender people of color reported being mistreated by a health care provider, including verbal harassment, refusal of treatment, or physical abuse​. 
• Nearly one in four (24%) trans immigrants reported avoiding medical care due to fear of discrimination or deportation​. 
• Access to gender-affirming care has been shown to significantly reduce suicide risk and improve mental health outcomes​. 
  • 42% of transgender adults have attempted suicide at some point in their lives.
  • This rate is significantly higher among transgender people of color​. 
• Nearly one-third (31%) of respondents had no health insurance at some point in the past year, often due to discrimination or lack of coverage for transition-related care​. 
  • 50% of respondents who had insurance reported having to educate their providers about transgender-related care​. 
  • 35% of transgender people of color experienced a coverage denial for transition-related care, which disproportionately affects immigrant trans people​.

What Are Regulations? 

Regulations like these don’t change the law. They are meant to help people understand the law and follow it. Regulations (sometimes called “rules”) explain how the government interprets the law. Without clear and accurate regulations, businesses or officials may misunderstand the law or simply refuse to follow it. 

What’s a Public Comment? 

In order to adopt or change a regulation, the government is required by a federal law to first get feedback from the public on what they think about the proposed change, by asking people to submit public comments. A public comment is a chance to fight back! Government agencies must review and respond to public comments before finalizing a rule. Your voice matters!

Will I be heard? 

By law, the federal government must summarize and consider public comments before implementing a new rule. A large number of comments forces the government to study the issue closely and explain itself—and it’s the best way to show widespread public support. This can lead to a proposed regulation being adopted or even strengthened.  This administration has been acting in lawless and unpredictable ways, and this is just one way that we can push them to follow the rules. Submitting comments is a way to make your voice heard directly by the people writing regulations that could have a big impact on trans people’s lives. 

Mass comments have stopped harmful policies before, and agencies must legally respond to concerns raised by the public. We can delay, weaken, or stop this rule by flooding them with comments. We've provided an example comment for you, but make sure to personalize your message! 

What should I say?

• Write about what gender-affirming care has meant to you. as either a trans person or an ally. 
• Emphasize that healthcare is a basic human right, and that everyone deserves access to life-saving care.
• Pull in some of the statistics that we provide above! 
• If you're concerned about security, you can always use a last initial or an alias. 
• For more ideas on telling your story, check out our Testifying Guide! 

ACT NOW: Submit your comment by April 11, 2025! 

• Tell the Trump administration that trans health care is essential! 
• Demand that DACA recipients keep their ACA coverage. 
• Reject the attack on low-income and marginalized people’s access to health care.