What is lost in the debate over extending Obamacare subsidies are the specific treatments and services subsidized by federal dollars. President Donald Trump recently acknowledged this, posting on social media that Senate Democrats would “force taxpayers to fund transgender surgeries for minors.” Continuing the enhanced Obamacare subsidies would provide additional taxpayer dollars for insurance plans that cover procedures that many Americans find morally objectionable.
According to the Movement Advancement Project, 24 states require insurers to cover transgender procedures. For example, the Division of Insurance notes that “in 2023, Colorado became the first state in the nation to explicitly include gender-affirming health care services in its benchmark health insurance plan for essential health benefits.” A spreadsheet lists the services offered: All individual and small group plans in Colorado include nose reshaping, “facial feminization surgery” and testicular prosthetic implantation, among many other genital and non-genital surgeries. Nowhere on its website does Colorado indicate that such surgeries can only be performed on enrollees over the age of 18.
In states that require coverage of transgender procedures, all Exchange participants purchase this coverage along with their plan. The subsidies that offset the premium costs of most enrollees represent federal dollars that fund transgender treatments. And the spending bill proposed by Senate Democrats, which would permanently extend a subsidy increase first introduced in 2021, represents forced taxpayer financing of sex change procedures, as the president noted.
DEMOCRATIC STATES LOOK AT TRUMP ADMIN FOR ENDING GENDER HANDLING SURGERIES FOR MINORS
In June, the Trump administration attempted to limit federal funding for transgender procedures, removing “specified procedures for changing gender characteristics” from Obamacare’s essential health benefits. But this regulatory action has inherent limitations. For starters, removing such procedures from essential health benefits, as the rule itself admitted, would only shift costs from the federal government to the respective states; taxpayers would still fund healthcare, albeit at the state rather than federal level. Even that scenario depends on the rule taking effect, despite legal challenges. If the rule goes into effect, a future Democratic administration will almost certainly repeal it upon taking office.
And blue states continue to use federal Obamacare subsidies to advance the transgender agenda, despite the Trump administration’s actions. A California law that went into effect in March requires insurance companies and medical providers to undergo “cultural competency training.” Training sessions should discuss “the distinction between personal values and professional responsibilities” regarding transgender procedures.
The sessions, which focus on “the lasting impact of historical and contemporary exclusion, microaggressions and oppression” on the transgender community, also require “facilitation by [transgender, gender diverse, or intersex]Forcing insurance company personnel to attend this type of indoctrination under the auspices of “cultural competency training” not only violates the First Amendment and federal conscience protections surrounding sterilization procedures. It also amounts to a transfer of resources, through insurers’ receipt of Obamacare subsidies, from federal taxpayers to groups that promote ideological goals.
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In many ways, the Obamacare subsidy debate represents a repeat of last year’s presidential campaign. By tying an expansion of increased Obamacare subsidies to government spending legislation, Senate Democrats are also pushing for, as the president said, “forced[ing] Taxpayers will fund transgender surgeries for minors as the price of reopening the government. They’re doing this even as Kamala Harris admitted that Trump’s famous ad during last year’s campaign represented a “winning message” for the once and future president.
The wording of that ad – “Kamala Harris is for they/them, President Trump is for you” – now defines the stakes. Republicans can extend the increased Obamacare subsidies, or they can refuse to spend more taxpayer money on the transgender agenda. Which side will they choose?
