Multiple defense bills on Congress' post-recess agenda would cement in law the Trump administration's restrictions on health care for transgender members of the military community.
The provisions could have a lasting effect on the lives of perhaps several thousand current and former Defense Department personnel -- both uniformed and civilian -- as well as veterans and their families.
And if last year's House debate on the National Defense Authorization Act, or NDAA, is prologue, partisan wrangling over the issue could complicate lawmakers' chances of clearing that key national security bill for the 65th consecutive fiscal year.
"Those issues are floating around, and I think it's a concern: trying to keep them out" of the NDAA and other defense bills, said Rep. Adam Smith, D-Wash., the top Democrat on the House Armed Services Committee, in a brief interview.
Sen. Tammy Duckworth, D-Ill., a member of the Senate Armed Services Committee, lost both legs and partial use of her right arm when a rocket-propelled grenade struck the Army helicopter she was co-piloting in Iraq in 2004. Duckworth is now a leading Senate advocate for transgender people in the services and in military families.
"When the helicopter I was co-piloting was shot down and I was bleeding to death on a dusty field in Iraq, I didn't care if the American troops rescuing me were trans, gay, straight or anything else," Duckworth said by email on Thursday. "If you're willing to sacrifice for our country and can kill the enemy with lethal precision, you shouldn't be denied the opportunity to serve."
Partisan Flashpoint
A year ago, House Democrats supported the fiscal 2025 NDAA during the Armed Services markup. Yet the normally bipartisan bill passed only narrowly on the House floor in a largely party-line vote. That is because most Democrats, including Smith, opposed it over "culture war" amendments that had been added during floor debate.
These included an amendment that would bar TRICARE, the military's health insurance program, from covering gender-transition surgeries and hormone treatments.
That amendment never made it into the final fiscal 2025 NDAA, though the bill did contain a ban on TRICARE coverage of gender dysphoria treatments for minor beneficiaries that "could result in sterilization."
Now conservatives have renewed their push.
The House intends to debate its fiscal 2026 NDAA in September, and the Senate may take up its own NDAA around the same time.
While the version of the fiscal 2026 NDAA that emerged from the House Armed Services Committee does not have provisions that pertain to transgender service members, their supporters fully expect to see amendments on the issue during floor debate.
Meanwhile, the Senate NDAA and two House-passed funding bills for the Pentagon in fiscal 2026 already contain conservative provisions restricting health care for transgender service members or adult dependents.
Specifically, the Senate's new NDAA would prohibit the use of Defense Department funds or facilities to support "sex change surgeries."
The House-passed Defense spending bill for the coming fiscal year would severely restrict the ability of military families with children affected by gender dysphoria to obtain hormone therapy, and it would limit their chances of arranging their duty stations around their family's health care needs. A similar provision was in the House-passed fiscal 2025 NDAA, but it was stripped out of the final version.
And the House-passed fiscal 2026 Military Construction-VA bill, which affects care for millions of veterans, would bar use of funds in the bill to obtain "surgical procedures or hormone therapies for the purposes of gender-affirming care."
Smith said Congress is going too far.
"If you want to have a reasonable conversation about what the right medical treatment is, that's fine," Smith said. "But doing outright bans on treatments that at least in some instances have proven successful is not something I think Congress should be doing."
Executive Actions
It is unclear how many transgender people have been serving in the U.S. military.
The figure was about 14,000 in 2018, according to the Palm Center, a now-defunct organization that used to track the issue.
According to the Defense Department statistics cited by Pentagon officials in May, about 5,000 service members were either diagnosed with gender dysphoria or voluntarily identified themselves as such.
The figure is probably an understatement, transgender servicemembers' advocates said. And it does not include Defense Department civilians, veterans, retirees who use TRICARE for Life insurance -- nor any adult dependents of those who are signed up for any TRICARE plan.
No law, up to now, has prohibited TRICARE from covering gender-transition surgeries, though service members who have sought coverage for such procedures have had to go through a painstaking bureaucratic process to make it happen, their advocates say.
But now the Trump administration, through a January executive order and subsequent Pentagon policy guidance, has barred people with gender dysphoria from serving in the military. The Trump administration has halted TRICARE coverage of all gender-transition surgeries. And it has made it so hormonal treatments can now only be obtained via civilian care outside of the military health system.
Yet Trump's actions are not laws and so are not binding on subsequent administrations. The Biden administration overturned Trump's first-term restrictions on transgender military service, and Trump promptly undid Biden's orders.
'Conservative Win'
At issue on Capitol Hill later this year will be proposed laws, not executive actions.
The Senate Armed Services Committee approved earlier this month -- in a 14-13 party line vote -- an amendment to the fiscal 2026 NDAA by Sen. Tommy Tuberville, R-Ala., that prohibits the use of Defense Department funds or facilities "to perform or facilitate sex change surgeries."
Tuberville, who announced in May he will run for governor of Alabama in 2026 rather than seek reelection to the Senate, cited the provision as a "conservative win" in a statement.
Another win, he said, was a separate provision in the Senate NDAA that would aim to ensure the military service academies cannot permit "a person whose sex is male to participate in an athletic program or activity that is designated for women or girls."
To many conservatives, taxpayer funds should not be used to support something they consider to be unnatural and, some say, a detriment to military readiness.
"A man's assertion that he is a woman, and his requirement that others honor this falsehood, is not consistent with the humility and selflessness required of a service member," said President Donald Trump in his executive order mandating the ban.
Still, little evidence has been produced to suggest military readiness has suffered from the presence of transgender service members.
'Two Standards'
Advocates for transgender Defense Department employees and affected military families worry that the Senate NDAA proposal would prohibit by law medically necessary health care surgeries for not just active-duty service members but potentially also reservists, civilians, some veterans and retirees -- as well as any of their adult dependents.
The United States would have in effect two medical systems for gender-transition surgery, advocates say: one permitting a variety of treatments for gender dysphoria that are embraced by leading medical professionals; and a second for Defense Department employees and people who live in states with similar restrictions.
Some states allow Medicaid coverage of transgender care, while others do not. And Medicare does cover "medically necessary" gender-affirming care but only if certain conditions are met.
"It would set two different standards of care," said Cathy Marcello, the interim executive director of the Modern Military Association of America, referring to the changes in Pentagon treatment of transgender health care services.
"It matters that the NDAA would codify an anti-LGBTQ health care policy for adults in federal law," said Marcello, whose group advocates on behalf of LGBTQ+ members of the military and veterans community and their families. "That's a precedent we would not want the NDAA to set. That would be very hard to undo. It would set a pattern for other administrations."
Marine Corps-Sized Population
Marcello and other advocates for transgender individuals contend that Pentagon policies restricting health care for such people deny qualified personnel the opportunity to serve their country in the military -- and deny the country their skills and commitment.
The Palm Center estimated in 2020 that there are more than 205,000 transgender Americans of recruiting age -- more than the number of active-duty Marines.
Duckworth and 22 other Senate Democrats wrote Defense Secretary Pete Hegseth in June on Trump administration efforts to bar transgender service members and restrict federal support for their health care.
"Banning them from service will compromise good order and discipline, take deployable servicemembers out of the fight and create national security risks felt for years to come," the senators wrote.
'Exceptional' Dependents
As for the House--passed fiscal 2026 Defense appropriations bill, it would bar funding "to provide gender transition procedures, including surgery or medication, referrals for those procedures, or a change in duty station for these activities for a child through the Exceptional Family Member Program."
This provision would prohibit TRICARE doctors from prescribing hormone treatments or making referrals for that, advocates said.
The Exceptional Family Member Program provides a way for servicemembers with dependents who have special needs to ensure that fact is considered when assigning the location of duty stations.
That option would no longer be available under this provision, for instance, for military families with adolescents who seek hormone treatments -- making their military service conflict with their family's medical needs, transgender troops' advocates say.
"Every day, highly qualified, well trained DOD employees clock in and go to work serving their country, and they deserve dignity, respect, and our gratitude for their tireless work," said David Stacy, vice president of government affairs for Human Rights Campaign, a group that advocates for LGBTQ+ rights. "Instead, this administration and their enablers in Congress are trying to rip away access to surgical care that transgender employees' doctors have said they need. Those employees deserve better."
Ariel Cohen and Sandhya Raman contributed to this report.
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