In a major victory for transgender rights, Senate Parliamentarian Elizabeth MacDonough has struck down the GOP’s attempt to block gender-affirming care through Medicaid and CHIP from the “One Big Beautiful Bill” (OBBB) reconciliation package. This bipartisan procedural decision clears the way for continued federal coverage of essential transition-related healthcare.
What MacDonough Did and Why It Matters
On June 26, MacDonough ruled that the amendment banning Medicaid coverage for gender-affirming care, added by Rep. Jodey Arrington and Sen. Roger Marshall, violated the Senate’s strict Byrd Rule, which prohibits provisions lacking a clear budgetary impact. While GOP leaders, including Sen. John Thune, aimed to enshrine this ban, MacDonough’s procedural check keeps Medicaid funding for gender-affirming care protected, at least for now.
For thousands of trans people who depend on Medicaid, the ruling means continued access to hormone treatments, puberty blockers, surgeries, and mental health support. It’s a lifesaving outcome for communities that already face significant barriers in accessing care.
Trans Community Leaders React
Advocacy groups went public almost immediately after the decision. Trans Equality Now shared a celebratory update on Facebook: “MAJOR UPDATE: The Senate Parliamentarian has struck the anti-trans ban on Medicaid coverage for gender-affirming care…” LGBTQ Nation hailed it as a watershed moment, noting the ruling may have “just stopped anti-trans measures from passing.”
On Twitter, activist Eric Michael Garcia posted, “HUGE NEWS: The Senate Parliamentarian has struck the ban on Medicaid dollars for gender-affirming care for trans people from the One Big Beautiful Bill!”
Trans communities, individuals, and families are expressing cautious relief; this is not a win yet, but a critical checkpoint. It reaffirms that trans people deserve medically necessary care, supported by legal safeguards and expert-backed procedures.
A MAGA Meltdown: Calls to Fire MacDonough
But conservative circles aren’t taking it lightly. True to form, MAGA loyalists are up in arms.
- Sen. Tommy Tuberville labeled MacDonough “woke” and demanded she be fired for blocking the Medicaid ban.
- Rep. Marjorie Taylor Greene threatened to sink the entire OBBB bill because of this single procedural hold-up.
- Other hardline Republicans, like Rep. Greg Steube, demanded Vice President Vance override MacDonough’s ruling, calling it undemocratic and “unelected dictator” style.
These attacks reflect growing desperation within MAGA ranks: facing mounting political pressure, structural norms like the Byrd Rule are becoming new battlegrounds.
But What Comes Next?
MacDonough’s ruling isn’t permanent; Congress can rewrite or reintroduce the ban with budgetary justification, although it would require a new version that fits Senate rules. As for Republicans, their next move could range from challenging MacDonough’s position entirely to pursuing the same goal via executive orders or future legislation.
Yet right now, this procedural safeguard offers a breath of relief for trans people relying on Medicaid. Given that 180,000 transgender adults, many low-income, use Medicaid, and roughly 27 states already impose trans care bans on minors, preserving federal medication coverage matters deeply.
The Bottom Line
Today marks a procedural win. For trans people and their advocates, it’s a powerful reminder: the fight for gender-affirming care isn’t just politics; it’s about dignity, health, and recognition. There’s still a long road ahead, but in a national climate where federal rights are under attack, maintaining access to Medicaid-funded care is essential.
TransVitae encourages you to:
- Share your story if you rely on Medicaid for care; make your experiences heard by lawmakers.
- Stay informed: procedural rulings today can change quickly.
- Support organizations like the ACLU, Human Rights Campaign, and Trans Equality Now, they’re keeping the pressure on.
For now, we breathe easier, but keep watching. The MAGA backlash isn’t over, and they might try again. We must keep our voices loud for trans lives, trans families, and the care we deserve.
