House passes defense policy bill that bans gender-affirming care for transgender children

Washington (CNN) — The House voted on Wednesday to pass a critical defense policy bill known as the National Defense Authorization Act, which includes a ban against gender-affirming care for some transgender children that further inflamed the politics around the must-pass piece of legislation.

The legislation, which was the result of a bipartisan compromise, includes a provision that would prevent the military’s health program, TRICARE, from covering gender-affirming care for transgender children of service members. The effort to prohibit these treatments to children has overshadowed some of the bipartisan provisions of the bill, including a 14.5% pay raise for junior enlisted service members. It also keeps the politically charged conversation of transgender health care on center stage, as it has been a prominent campaign issue throughout this election season.

Wednesday’s vote was 281 to 140 with 124 Democrats and 16 Republicans voting against the legislation. The bill will next need to go to the Senate.

Previous efforts to legalize a ban against gender-affirming care in the final version of the NDAA failed.

Democratic Rep. Adam Smith of Washington state, the top Democrat on the House Armed Services Committee, announced Tuesday that he would vote against the bill. Smith came out against the legislation after it passed a key procedural hurdle on Tuesday, even though he helped negotiate the deal.

“Blanketly denying health care to people who need it—just because of a biased notion against transgender people—is wrong,” Smith said in a statement. “The inclusion of this harmful provision puts the lives of children at risk and may force thousands of service members to make the choice of continuing their military service or leaving to ensure their child can get the health care they need.”

Smith criticized House Speaker Mike Johnson for pandering to “the most extreme elements of his party” by including the provision.

Johnson, a Louisiana Republican, meanwhile touted this ban as part of Republicans’ broader effort to cut $31 billion in “inefficient programs, obsolete weapons, and bloated Pentagon bureaucracy.”

“We banned TRICARE from prescribing treatments that would ultimately sterilize our kids, and we gutted the DEI bureaucracy,” Johnson said Tuesday.

Even some moderate Republicans say Democrats are on the wrong side of this issue, and argue these types of programs should be eliminated from the federal government.

“Citizens don’t want their tax dollars to go to this, and underaged people often regret these surgeries later in life,” GOP Rep. Don Bacon of Nebraska told CNN. “It’s a bad hill to die on for Democrats.”

Several studies have shown that most people who opt for gender-affirming care don’t later regret their choices — including an October 2022 study in the Netherlands that found 98% of transgender youth who had started gender-affirming medical treatment in adolescence continued to use those hormones around five or six years later in adulthood. Among 3,306 UK Gender Identity Development Service patients included the Cass Review analysis, fewer than 10 patients detransitioned to their birth-registered gender.

Gender-affirming health care for children has been a deeply polarizing issue, one Republican candidates ran on in this year’s election, and Democrats have acknowledged since the disappointing results in November that the party has work to do to establish its position on culture war issues.

Gender-affirming care is a multidisciplinary approach that includes medically necessary and scientific evidence-based practices to help a person safely transition from their assigned gender – the one a clinician assigned them at birth, based mostly on anatomic characteristics – to their affirmed gender – the gender by which the person wants to be known.

Depending on a person’s age, such care can include mental health and support groups, legal help and sometimes medical help like hormones or surgery when a person is past puberty.

Some critics of the process suggest that children should wait until adulthood to transition, but the American Academy of Pediatrics says in its guidelines that this approach is “outdated,” in part because it assumes that gender identity becomes fixed at a certain age, and the approach is based on “binary notions of gender in which gender diversity and fluidity is pathologized.”