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Lost in the debate over extending enhanced Obamacare subsidies are the specific treatments and services those federal dollars subsidize. President Donald Trump recognized as much recently, posting on social media that Senate Democrats would “force Taxpayers to fund Transgender surgery for minors.” Indeed, continuing enhanced Obamacare subsidies would provide additional taxpayer dollars to insurance plans covering procedures many Americans find morally objectionable.
According to the Movement Advancement Project, 24 states have some requirement on insurers to cover transgender procedures. For instance, its Division of Insurance notes that in 2023, “Colorado became the first state in the country to explicitly include gender-affirming care services in its benchmark health insurance plan for essential health benefits.” A spreadsheet lists the services offered: all Colorado individual and small group plans cover nose reshapings, “facial feminization surgery” and implantation of testicular prostheses, among many other genital and non-genital surgeries. Nowhere on its website does Colorado indicate that such surgeries can only be provided to enrollees over age 18.
In states that require coverage of transgender procedures, all Exchange enrollees purchase this coverage with their plan. The subsidies offsetting most enrollees’ premium costs represent federal dollars funding transgender treatments. And the spending bill proposed by Senate Democrats, which would permanently extend a subsidy increase first enacted in 2021, represents forced taxpayer funding of sex change procedures, as the president noted.
In June, the Trump administration attempted to limit federal funding for transgender procedures, removing “specified sex-trait modification procedures” from Obamacare’s essential health benefits. But, this regulatory action has inherent limitations. For starters, as the rule itself admitted, removing such procedures from essential health benefits would merely shift costs from the federal government to the respective states; taxpayers would still fund the care, albeit at the state rather than federal level. Even that scenario depends upon the rule taking effect despite legal challenges. If the rule does go forward, a future Democratic administration would almost certainly withdraw it upon taking office.
And blue states continue to use federal Obamacare subsidies to advance the transgender agenda, notwithstanding the Trump administration’s actions. A California law that took effect in March requires insurance plans and medical providers to undertake “cultural competency training.” Training sessions must discuss “the distinction between personal values and professional responsibilities” with respect to transgender procedures.
The sessions, which focus on “the lasting impact of historical and contemporary exclusion, microaggressions, and oppression” on the transgender community, also require “facilitation by [transgender, gender diverse, or intersex]-serving organizations.” Forcing insurance company personnel to attend this kind of indoctrination under the auspices of “cultural competency training” does not just violate the First Amendment and federal conscience protections surrounding sterilization procedures. It also amounts to a transfer of funds, via insurers’ receipt of Obamacare subsidies, from federal taxpayers to groups promoting ideological objectives.
In many ways, the Obamacare subsidies debate represents a replay of last year’s presidential campaign. By linking an extension of enhanced Obamacare subsidies to government spending legislation, Senate Democrats are also insisting on, as the president said, “forc[ing] Taxpayers to fund Transgender surgery for minors” as their price to reopen the government. They are doing so even as Kamala Harris admitted Trump’s famous ad during last year’s campaign represented a “winning message” for the once and future president.
The wording of that ad — “Kamala Harris is for they/them, President Trump is for you” — defines the stakes now. Republicans can extend the enhanced Obamacare subsidies, or they can refuse to dedicate more taxpayer funds towards the transgender agenda. Which side will they choose?
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