How Trump’s ‘big, beautiful’ bill targets transgender medical procedures nationally

The Supreme Court on Wednesday upheld Tennessee’s ban on transgender medical procedures for minors — a controversial practice that could be outlawed nationally if President Trump’s “big, beautiful” bill clears the Senate intact.

The House-passed One Big Beautiful Bill Act includes a provision barring the use of taxpayer money to fund so-called “gender-affirming care,” for both children and adults.

The provision, championed by Rep. Dan Crenshaw (R-Texas), would ban Medicaid, Children’s Health Insurance Program (CHIPs) and Affordable Care Act (ACA) funds from being spent on puberty blockers, cross-sex hormones and irreversible surgeries, such as double masectomies and genital reconstruction.

The so-called “Crenshaw Amendment” — a last-minute addition to the massive piece of legislation —  specifically amends the Social Security Act, halting federal payments for what the provision deems as medically unnecessary procedures. 

The provision will have to survive the Senate’s strict rules governing the reconciliation process, specifically the Byrd Rule, to make it into the upper chamber’s version of the legislation. 

The Byrd Rule prevents the inclusion of measures deemed “extraneous” to the budget process. For instance, provisions that don’t directly affect spending or revenue.

The Byrd Rule is interpreted and enforced by the Senate parliamentarian.

Crenshaw’s office notes that taxpayers will save “about $2.5 billion over 10 years” if the provision becomes law. 

“That’s the estimated savings from blocking federal funding — via Medicaid, CHIP, and ACA — for gender transition procedures,” the congressman’s office states. “With transition costs running up to $75,000 per patient, the numbers add up fast. This amendment cuts it off—saving money and saving lives.”

Last month, Crenshaw vowed that his provision “will become law,” arguing that it is “long overdue.”

“Gender transition procedures are the lobotomy of our generation,” he said in a statement. “So-called ‘gender-affirming care’ isn’t healthcare — it’s fringe science with no proven benefit and massive risks.”

In a 6-3 decision, the Supreme Court found that Tennessee’s ban on transgender puberty blockers and hormone therapy treatments for minors does not violate the 14th Amendment’s Equal Protection Clause.

More than half of US states have similar laws on the books.

“Today was not just a win for basic biology and common sense, but for human decency, sound medicine, and the dignity and safety of children everywhere,” Sen. Roger Marshall (R-Kan.) said of the high court’s ruling.

“As a doctor for over 25 years, I understand the gravity of these harmful so-called treatments radical activists have been pushing on children. They leave permanent scarring, sterilization, and other horrible side effects,” he added.

“Make no mistake, there’s more work to do, and I remain committed to eliminating taxpayer-funded transgender procedures on both minors and adults.”

Marshall’s No Subsidies for Gender Transition Procedures Act is the Senate’s companion legislation to Crenshaw’s measure in the House.