In a social media post last week, President Trump noted that what Democrats are demanding in exchange for their cooperation in reopening government would require more than $1 trillion in spending and “force Taxpayers to fund Transgender surgery for minors.” Indeed, taxpayers are already funding such surgeries via Obamacare subsidies — and Democrats have shut the government down as they demand that Covid-era enhanced Obamacare subsidies, which expire on Dec. 31, keep flowing to insurers covering these treatments.
Insurers Are Covering WHAT?
Take Colorado, which requires all insurers to cover so-called “gender affirming care” as an essential health benefit. The state’s Division of Insurance lists all the surgical and hormonal treatments that insurers cover. The list, which runs the gamut from facial feminization to gluteal implantation and implantation of testicular prostheses, includes treatments that many Americans would at best find wasteful and at worst consider morally objectionable and offensive:
Of particular note: Nothing on the Colorado website indicates that these treatments are only available to adults who have reached age 18, suggesting that insurers may be covering — and taxpayers may be paying for — procedures performed on minor children.
Unfortunately, Colorado is not an outlier. The Movement Advancement Project notes that 24 states have “nondiscrimination” provisions in their insurance markets. In these states, insurers that cover procedures like mastectomies for breast cancer must also cover the same procedure as part of so-called “gender affirming care.”
When individuals receive Obamacare Exchange subsidies to defray the cost of their premiums for these insurance policies, taxpayers are funding these treatments. And if Congress extends the enhanced Exchange subsidies — as Democrats have shut down the government to force Republicans to do — they will throw more taxpayer dollars toward funding these treatments.
Executive Action Insufficient
In June, the Trump administration finalized a rule prohibiting states from including “specified sex-trait modification procedures” in their essential health benefits, beginning next year, in an attempt to prevent taxpayer dollars from being used to fund such procedures.
While helpful, this action has inherent limitations: First, a coalition of blue states has already filed suit challenging the rule, and a court could at any time strike down the rule for the upcoming plan year. Second, the next Democrat administration almost certainly will take action to nullify the rule if courts do not do so sooner — and indeed, could end up requiring all states to include transgender interventions in their benefit packages. Third, money is inherently fungible. Any federal dollars that subsidize the non-transgender portion of premiums will by definition make the transgender portion more affordable.
Therefore, the only complete solution is a legislative one: Congress should specify that no federal funds may flow to plans that cover transgender procedures. This position echoes that of the pro-life community, which has said for the 15 years since Obamacare’s passage that no federal funds should go to plans that cover abortion.
Some Republican lawmakers have suggested that “political realities” may force them to pass some type of extension of the enhanced Obamacare subsidies. But lawmakers should recognize that voting for any type of subsidy extension without addressing the transgender issue legislatively would “force Taxpayers to fund Transgender surgery,” as President Trump rightly observed. Abandoning one of the key issues that defined last year’s election — and giving taxpayer funds to treatments many Americans find morally objectionable — would bring with it political realities of its own.
