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From left: John Thune and Donald Trump
Cuts to Medicaid, SNAP, and more will harm the community.
Donald Trump’s “big, beautiful bill” on the federal budget stands to have a devastating effect on LGBTQ+ Americans — but at least the Senate version has removed a provision that would ban federal funding under Medicaid for gender-affirming care.
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The House of Representatives OK’d its version of the bill in May, and the Senate passed its version Tuesday morning on a 50-51 vote, with Vice President JD Vance breaking the tie. Three Republican senators joined all Democrats in voting against it — Rand Paul of Kentucky, Thom Tillis of North Carolina, and Susan Collins of Maine. Now it goes back to the House to reconcile the two versions. Trump wants the final bill on his desk by Independence Day.
The bill will extend the tax cuts from Trump’s first term, amounting to about $4.5 trillion and chiefly benefiting the wealthiest Americans. To offset the cuts, it will slash about $1 trillion from Medicaid, the joint federal-state health insurance program for low-income people and those will disabilities. It also includes cuts to the Supplemental Nutritional Assistance Program, or SNAP, which helps low-income Americans buy food, as well as to the Children’s Health Insurance Program and Planned Parenthood.
The House version banned Medicaid and CHIP funding for gender-affirming care for transgender people of all ages, but the Senate removed that section. "Last week, Senator Ron Wyden, an Oregon Democrat, invoked the Byrd Rule to challenge the anti-trans Medicaid ban, after the Senate Parliamentarian, Elizabeth MacDonough, said this would violate the procedural code — which blocks 'extraneous' policies from clogging up a budget bill," Erin in the Morning reports. But "the Senate GOP simply dropped the rule from the bill at the last moment, likely because they lacked the votes to push it through on party lines alone," according to the blog. U.S. Sen. Tammy Baldwin of Wisconsin and U.S. Rep. Sarah McBride of Delaware, the first out trans member of Congress, worked behind the scenes for its removal, sources said.
Still, any final version of the bill will undoubtedly result in suffering for LGBTQ+ people.
The nonpartisan Congressional Budget Office estimates the bill will kick nearly 14 million Americans off Medicaid. A disproportionate number of LGBTQ+ Americans have their health care covered by Medicaid, notes the Human Rights Campaign. This includes 21 percent of trans people and 40 percent of people living with HIV. About 22 percent to 25 percent of LGBTQ+ adults in the U.S. live in poverty, compared to about 16 percent of straight, cisgender adults.
Medicaid is the largest funder of HIV care in the nation, “and any cuts would jeopardize access to essential treatment for individuals living with HIV, undermining national efforts to end the epidemic,” HRC’s analysis says. With many LGBTQ+ community health centers relying on Medicaid dollars, they would likely have to cut mental health services, gender-affirming care, and testing for sexually transmitted infections.
Cuts to SNAP include stricter eligibility requirements, work mandates, and benefit reductions. These would disproportionately affect LGBTQ+ Americans as well. About 15 percent of LGBTQ+ adults — nearly 2.1 million people, including 250,000 trans individuals and 1.3 million lesbian and bisexual women — received SNAP benefits in the past year, according to a new report by the Williams Institute at the University of California, Los Angeles, School of Law, compared to 11 percent of non-LGBTQ+ adults. SNAP is the largest anti-hunger program in the U.S., supporting over 42 million people monthly.
Senate Majority Leader John Thune, a North Dakota Republican, praised his chamber’s version of the bill. “I appreciate the narrow margins they have over there [in the House] and the challenge the speaker and his team have in front of them, but I think we gave them a really strong product,” he said, as reported by The Washington Post. “I think we took what they sent us and strengthened and improved upon it, so I’m hopeful now when it gets sent over there, they deliberate how they want to handle it and find the votes that are necessary to pass it and let’s put it on the president’s desk.”
House Speaker Mike Johnson, a Louisiana Republican, and other House Republican leaders issued this statement: “This bill is President Trump’s agenda, and we are making it law. House Republicans are ready to finish the job and put the One Big Beautiful Bill on President Trump’s desk in time for Independence Day.”
House Democrats plan a fight. “All legislative tools and options are on the table,” Minority Leader Hakeem Jeffries said, according to The New York Times. These include what’s called the “magic minute,” something that “allows House leaders like Jeffries to speak for an unlimited amount of time on the floor,” the Times explains.
HRC President Kelley Robinson condemned the measure in this statement: “At every moment since this bill was introduced, its MAGA supporters have tried to hide its cruelty, lie about its consequences, and distract people from the insidious ways it would make life harder for all Americans — including LGBTQ+ people. But the American people know the truth: this bill will kick millions of people off their health care in order to give tax breaks to the wealthy. It will jeopardize access to essential HIV prevention and treatments while also eroding the ability of Planned Parenthood to continue to serve all who rely on it for an affirming environment and essential reproductive care. Republican Sen. Thom Tillis of North Carolina asked the essential question during debate on the bill — ‘What do I tell 663,000 people [in North Carolina] in two years or three years, when President Trump breaks his promise by pushing them off of Medicaid because the funding’s not there anymore?’
“Still, this fight isn’t over. As this bill returns to the House of Representatives, every American needs to contact their Member of Congress now and tell them to reject this cruel and hateful bill.”
HealthHIV likewise denounced it. “Programs like Medicaid aren't line items in a budget, they're the backbone of care in this country,” said a statement from HealthHIV Director of Advocacy Scott Bertani. “They’re not just safety nets, they’re launch pads for HIV innovation in prevention and treatment, and for long-term health. Gutting them to finance tax breaks for the wealthiest Americans is reckless and deeply inequitable.”
So did Sinead Murano-Kinney, Advocates for Trans Equality health policy analyst, who responded with the following statement: “We are deeply disappointed that the Senate passed budget cuts on the backs of working families, including thousands of trans people, who were already struggling to pay for health care and making ends meet. Everyone deserves access to medically necessary healthcare, free from the interference of greedy, extremist politicians. These cuts ensure that everyone in our country is less healthy and safe. If there is a silver lining, it is that, despite the Republicans’ repeated efforts to include discriminatory restrictions on the use of federal funds for transition-related care in the bill, this provision was removed before the bill was passed. Fortunately, Republicans’ efforts to make trans people and their health care into political scapegoats failed. This failure is in no small part, thanks to the wisdom of the Parliamentarian and the actions of Senators who respect and will fight for their trans constituents’ well-being and access to lifesaving care. … This bill still contains many provisions that will endanger the health and well-being of millions of people across the country. For sure, the ‘defunding’ of Planned Parenthood will jeopardize many trans people’s ability to access reproductive care, routine healthcare, and transition-related healthcare. But today, we are relieved that a significant anti-trans provision was removed. … This fight is by no means over. We will continue to fight dangerous restrictions on coverage of transition-related health care as this bill now advances along its trajectory.”
