Urgent Need! 11:59pm EDT deadline to fight for gender-affirming care!
HHS Rule threatens to strip us of our health care rights
I’ll make this brief. There is an HHS rule being proposed right now that would significantly curtail insurance coverage gender-affirming care, specifically for plans under the Affordable Care Act (aka ObamaCare). The precise impact varies state-by-state, but any effects it has will be negative. You can read more about it here
HHS Rules go through a public comment period, typically 30 days or longer, but this one only got 22. The deadline for this one to “ensure consideration” is 11:59pm Eastern (9pm Pacific) on Today, April, 11th, 2025. Any comment is better than nothing - I’ve got thoughts below on easy talking points, and will share my whole verbatim comment shortly when I’ve written it (wanted to get this out).
The public comment form is here. (it contains a link to the proposed rule)
Even if all you can do is write “Please do not do this, it will unjustly harm transgender Americans,” that’s helpful! Any additional details or personal elements you can add will help even more.
How to comment
The form
There is a drop down field “What is this comment about” on the form. Choose “Individual”!
Anonymity
You can leave the comment anonymously! Do not out yourself or anyone else. Cis folx, please do not mention “I have a trans sibling” if that sibling is not already out publicly and ok with that. “I know a trans person” is much better.
Talking Points
The following are great talking points to include, but you can write your own or look at other public comments. (and feel free to leave your own talking point in the comments here).
Read about the rule
You can read more about the rule here:
Gender-Affirming Care is Medical Best Practice
All major medical organizations in the US endorse gender-affirming care, including the American Medical Association (AMA), American Psychological Association, American Psychiatric Association, American Acadamy of Pediatrics, and Endocrine Society. They do this based on study after study over decades showing that gender-affirming care is the right course of treatment for gender dysphoria. Given that this care is medical best practice, we should be improving insurance access to it, not limiting access to these life-changing and sometimes life-saving treatments.
The HHS Should Never Curtail Access to Medically Necessary Care
In the debates over the Affordable Care Act, much was said by Republicans about the potential for beuarocrats to be making health care decisions that should be left between the patient and the relevant medical professionals. The phrase “death panels” was on the lips of many politicians. This rule attempts to do the very thing Republicans rallied against. It is one thing to make illegal a treatment that is found by medical organizations to be unsound and harmful (e.g., lobotomy). But to override the evidence-backed medical consensus is anti-science, anti-medicine, and anti-patient. It curtails freedom of individuals.
The precedent being set could then be used for any number of other treatments, for example vaccines, mental health medications, and weight loss medications (all of which HHS Secretary RFK Jr. has expressed skepticism about, see here and here).
These are all critical parts of our health care system, and tens of millions of Americans rely on them.
Make no mistake - all efforts to limit or eliminate access to gender-affirming care set precedents that can harm so many others.
Limiting Insurance Coverage for Gender-affirming Care is a Functional Ban for Many Transgender Americans
Gender-affirming care, though used by a tiny fraction of Americans, can be prohibitively expensive if insurance coverage is unavailable. Surgeries can cost thousands or even tens of thousands of dollars, just like anyone else having reconstrctive surgery.
This is not a case where these patients can easily cover their own costs - instead, this is a functional ban for many trans people, who disproportionately experience poverty.
Summary
In conclusion, limiting access to gender-affirming care will result in reduced quality of life and increased mental health issues among those with gender dysphoria. Those will, in turn, lead to a higher number of deaths of despair. Our country should be ensuring that every American has access to the health care they need in order to flourish and live long, happy, healthy lives.
Ok, your turn!
The public comment form is here.
Even if all you can do is write “Please do not do this, it will unjustly harm transgender Americans,” that’s helpful! Any additional details or personal elements you can add will help even more.
Thank you so much!
-Celeste
Here's what I submitted. Feel free to borrow some of these thoughts if you like, but please DO NOT copy and paste it as your own comment, as I believe duplicates of the same comment are treated like a form letter and given less weight.
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I am opposed to the change being made to disallow gender-affirming care (called in the bill as sex-trait modification) in ACA insurance plans, described in "Prohibition on Coverage of Sex-Trait Modification as an EHB (§ 156.115(d))". I am transgender, and while my employer plan provides the benefits I need, I want to advocate for those of my trans siblings who rely on the ACA for their care. Those who look to the ACA often do so because they have no other recourse, and to prevent insurance companies from offering them the life changing services they need is both cruel and simply unnecessary.
Gender-affirming care is the proven treatment for gender dysphoria, endorsed by leading medical groups such as the American Medical Association, American Psychological Association, American Psychiatric Association, American Acadamy of Pediatrics, and Endocrine Society. They explicitly support public insurance such as the ACA to cover such care, as in the AMA's statement that it "supports public and private
health insurance coverage for treatment of gender dysphoria" (https://www.ama-assn.org/system/files/2019-03/transgender-coverage-issue-brief.pdf). To roll back such coverage counter to the best, proven, medically necessary care is directly harming the people of this country.
Though I wish to see all gender-affirming care allowed in the insurance, I'd like to speak specifically about one aspect of the medical care in more depth: puberty blockers. These medicines are already being used safely and effectively, and will continue to be used regardless of this proposal, to treat early-onset (aka precocious) puberty. For many transgender people, puberty at any age is devastating, bringing about unwanted and traumatic physical changes, and medical intervention in the form of puberty blockers has a critically positive effect on their well-being. This is a time-sensitive treatment, as many changes caused by puberty (such as development of breasts, periods, or a deeper voice) are irreversible once they occur. All of these could be delayed or prevented with proper timely medical intervention, saving the patient from life-long dysphoria which results in anxiety, depression, and suicidal thoughts and actions. Furthermore, puberty blockers obviously should not be classified as any form of 'mutilation', as nothing whatsoever is being destroyed. The entire point is to prevent bodily changes which would cause harm to the patient in the form of worsening gender dysphoria and all that entails. Finally, the human body can resume puberty naturally if/when the patient discontinues use of blockers, so there is no significant permanent effect, especially when contrasted with the significant long term effects (increased dysphoria, anxiety, depression, suicide) of forcing unwanted puberty to continue. Just as puberty blockers are an effective medical treatment for early-onset puberty, they are effective during adolescence and should not be arbitrarily withheld from those who need them.
Transgender people like myself occupy a small percentage of the population, but the care we need has an exceptionally large impact to our bodies and minds, making it not only necessary but also of great societal value. According to EDGE data set referenced in this proposal, "0.11 percent of enrollees ... utilized sex-trait modification" in the given plan year. Since about 1% of people in the US are transgender, that means about a tenth of those people even access this care, a disproportionately small population. Disallowing insurance companies to offer this care will not result in significant cost savings, the only effect will be to significantly negatively affect the people who need this care the most.
Please reconsider the logic of banning gender-affirming care (aka sex-trait modification) from ACA covered plans. This ban has a disproportionately negative impact and is being driven by politicians' fear-mongering opinions, as opposed to the recommendations by leading medical professionals and organizations. Please allow trans people (and all people) to access the medically necessary care they need through the insurance they rely on.
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Quick notes for those who are going to comment:
In this proposal they have a special term for gender-affirming care: "sex-trait modification". Potentially, using the language of the bill "sex-trait modification" may be useful to readers of the comments. I'm going to use both terms when commenting.
This proposed HHS rule affects many things, among which is gender-affirming care. When making comments, they say to specify which part you are commenting on. The relevant part to gender-affirming care (aka sex-trait modification) is the section "Prohibition on Coverage of Sex-Trait Modification as an EHB (§ 156.115(d))".