A new Trump rule could make health care more expensive for transgender people
This story was originally reported by Orion Rummler of The 19th, and republished through Rewire News Group’s partnership with The 19th News Network.
Health-care costs for transgender Americans could increase starting in 2026, if a recently proposed rule from the Centers for Medicare & Medicaid Services (CMS) is finalized.
The agency wants to stop insurance sold on the individual and small-group marketplace from including gender-affirming care–a change that would affect coverage for trans people with marketplace plans. Experts say that insurers may drop coverage for all transgender people or trans patients might have to pay more out of pocket. The Affordable Care Act mandates that essential health benefits include hospitalization, prescription drugs and mental health services. Experts believe that this new rule could increase health care costs for transgender individuals and encourage insurance companies to deny gender-affirming claims, given the Trump administration’s opposition. Health insurance companies would be burdened by removing these restrictions, as gender-affirming services include hospitalizations, mental health screenings, and hormone prescriptions. These are all essential health benefits. They would allow plans that cover these services to do so, but they wouldn’t allow them to be included in cost-sharing or premium tax credit. So basically it would lead to an increase in cost.”
But, the proposed CMS rule also has the potential to impact even more people.
“There is a world in which this could raise out-of-pocket costs for trans people even on employer plans,” said Katie Keith, director of the Health Policy and the Law Initiative at the O’Neill Institute for National and Global Health Law at Georgetown University. Trans people’s deductibles and out-of pocket maximums may increase. Even if a patient’s gender-affirming care was covered by an employer plan, this policy would remove the spending cap required by the Affordable Care Act to keep those costs low, she said.
Ultimately, this means that transgender patients would face higher costs than cisgender patients for many of the same treatments, Keith said. CMS acknowledged in the proposed rule that certain medical conditions such as precocious sexual development require the same treatment as gender affirming care. The agency, which is located within the Department of Health and Human Services (HHS), is considering defining explicit exceptions to permit the coverage of such care as essential health benefits when it is for cisgender patients.
“They fully acknowledge these are general health-care services that anybody could need, and they only want to limit them as essential health benefits for the purpose of treating gender dysphoria. Keith stated that the policy is aimed at transgender people. In a survey conducted in 2024, the health policy nonprofit found that 24 percent of companies with 200 workers or more cover gender-affirming hormonal therapy. Meanwhile, 50 percent of large companies with more than 5,000 employees offer this coverage. Additionally, more than half of insurers providing silver plans–the most popular category in the ACA marketplace–currently cover medical treatments for gender dysphoria, according to a recent report from Out2Enroll, which reviews ACA plans for LGBTQ+ inclusion.
Even the 24 states that explicitly prohibit transgender exclusions in health insurance could be affected under the new CMS rule. According to the proposal, if a state demands coverage for gender-affirming services outside the essential health benefits of a plan, that state must pay the additional cost. CMS refers to gender-affirming care as “sex-trait modification,” citing President Donald Trump’s executive orders that inaccurately describe gender affirming care as “chemical and surgical mutilation.” CMS refers to gender-affirming care as “sex-trait modification,” citing President Donald Trump’s executive orders that inaccurately describe gender-affirming care as “chemical and surgical mutilation.”
“It’s intended to further the messaging of this administration that well-attested medical care for trans people is somehow not a valid form of medical care,” Hunt said.
In the past few months, the Trump administration has tried to restrict trans Americans’ access to gender-affirming care by withholding federal funds to hospitals. The White House is opposed to gender diversity in general and has directed the National Institutes for Health (NIH) to conduct a study on the regret rate of trans people receiving gender-affirming treatment. CMS has also told states not to use Medicaid funds for gender affirming care for minors. The issues would arise if gender affirming care was covered as an essential benefit by cisgender individuals instead of transgender people. The proposed policy is just one small piece of a larger proposal from CMS that, according to one estimate, could cause up to 2 million people to lose their health-care coverage in 2026.
