The secret Senate plan to roll back health care and why trans people must stop it

by Harper Jean Tobin, NCTE Policy Director

This might be our last chance to stop “Trumpcare” from becoming a reality. Trans people and their loved ones need to pick up the phone right now and call their Senators — and here’s why.

The House has already passed a bill that would take away health care from millions of people and hit trans people and their families especially hard — a bill that even President Trump has called “mean, mean, mean.” And now, the Senate vote to repeal the Affordable Care Act is just days away.

Senate Majority Leader Mitch McConnell plans to bring a health care bill to the Senate floor in the next few days. He knows that this bill is going to be a disaster for millions of Americans, which is why he’s been ramming it through behind closed doors, without letting the public or even many senators see what’s in it. The secrecy behind the Senate bill is unprecedented — but we know it will be dangerous, especially for transgender people and their families. They’re trying to railroad our health care, and we’ve got to stop this train. Here’s what’s going on now and why it matters for trans folks:

More of the same. Senate leaders are too scared to let us see what’s in the bill, but we know it’s going to take the same basic approach as the “mean” bill that already passed in the House: do away with essential protections that make health insurance affordable, allow insurance companies to charge more while covering less, and gut Medicaid.

For Medicaid, it’s even worse. In fact, for millions of low-income and disabled folks who depend on Medicaid, the Senate’s version of the bill will likely be even worse than the version that’s been passed through the House. We know that transgender people are more than twice as likely to live in poverty and also more likely to have disabilities, so a lot of trans people and their families rely on Medicaid. Senators are looking to make even deeper, crueler Medicaid cuts than the House did. These cuts would get worse with every passing year, forcing states to continually cut benefits and make it harder for people to be eligible for Medicaid.

Discrimination based on pre-existing conditions. What is a pre-existing condition? It’s anything in your medical records that an insurance company doesn’t like — a disability, an HIV diagnosis, or even just a history of seeking treatment for gender dysphoria. Before the Affordable Care Act was passed, insurance companies could refuse to cover people with a pre-existing condition or charge them sky-high premiums — and now that critical protection is on the chopping block. Some lawmakers have tried to claim that the repeal bill passed in the House still protects people with pre-existing condition, but they’re just trying to pull the wool over our eyes. It’s true that under that bill, insurance companies won’t be able to outright refuse to sell insurance for people with pre-existing conditions, but they’d be able to charge them such high premiums that affording insurance would simply be impossible.

Health care through your work? You’re not safe. With all the talk about the Exchanges and the Medicaid program, you might think people who get health insurance through an employer won’t be affected. In fact, millions could lose out on core protections in their job-based plans and end up paying a lot more. Repealing the Affordable Care Act would mean that it would once again be legal for insurance companies to impose dollar limits on how much they’ll cover over one year or over someone’s lifetime, including for people who are on job-based plans. The Center for American Progress estimates that 27 million people with job-based insurance could face annual coverage caps, and 20 million would face lifetime caps. These caps can be devastating for transgender people who are living with HIV or disabilities or who need major surgeries.

Setting back progress on HIV/AIDS. Last month, NCTE joined 132 other organizations in telling Senators that repealing the Affordable Care Act “would return America to a time when healthcare coverage was out of reach for too many people with HIV.” Medicaid cuts, higher premiums, less coverage, lifetime and annual limits, bringing back high-risk pools that have failed people with HIV in the past, and cutting key federal funding for HIV prevention and public health — all these things would have effects that “would be devastating to many people with HIV who would be left without affordable healthcare coverage options and would reverse recent gains in reducing HIV incidence and improving outcomes.”

Show us the bill! With apparently nothing but terrible ideas, it’s no wonder Senate leaders are determined to keep the details secret. We’ve got to make them #ShowUsTheBill and we’ve got to protect our health care. That means calling the Senate and turning up to speak out at events around the country in the next week.

Visit for more in-depth resources, news and issues affecting the transgender community. Follow NCTE on Twitter, Facebook and Medium for the latest perspectives on issues and developments.




A joint project of the National Center for Transgender Equality Action Fund and the National Center for Transgender Equality. Also at and

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National Center for Transgender Equality

National Center for Transgender Equality

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