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What started as a ban on healthcare for trans youth has turned into a blanket prohibition on federally-funded healthcare for . President Donald Trump鈥檚 , referred to as the ‘One Big Beautiful Bill’ Act or HR1, also redefines sex in federal law.

The wide-ranging bill removes gender-affirming healthcare from Obamacare plans, dramatically cuts funding to Medicare and Medicaid, bans federal funding for clinics that offer abortion, institutes further tax cuts for the wealthy, and increases spending on immigration enforcement by over $150 billion 鈥� including $45 billion for new detention centres.

HR1 passed the House 215鈥�214 with every Democrat and two Republicans voting against it.

The bill now heads to the US Senate with only a simple majority needed for it to pass.听

The One Big Beautiful (anti-trans) bill to rule them all听

The bill originally only banned federally funded trans healthcare for children, but by Jodey Arrington of Texas removed the words 鈥渇or minors鈥� and 鈥渦nder 18 years of age鈥� from the text. This means would apply to all trans people who use a federally funded healthcare scheme 鈥� more than a quarter of a million people.

In a section titled ‘Prohibiting federal Medicaid and CHIP funding for gender transition procedures for minors’, the bill modifies the Social Security Act to ban funding for 鈥済ender transition procedures鈥�.

, the bill defines a 鈥済ender transition procedure鈥� as 鈥渁 means, with respect to an individual, any of the following when performed for the purpose of intentionally changing the body of such individual (including by disrupting the body鈥檚 development, inhibiting its natural functions, or modifying its appearance) to no longer correspond to the individual鈥檚 sex鈥� followed by a comprehensive list of gender affirming medical procedures.

It further defines a woman as 鈥渁n individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilises eggs for fertilisation.鈥�

It defines a man as 鈥渁n individual who naturally has, had, will have, or would have, but for a developmental or genetic anomaly or historical accident, the reproductive system that at some point produces, transports, and utilises sperm for fertilisation.鈥�

This restriction on 鈥済ender transition procedures鈥� would apply exclusively to trans people. Cisgender people would still be eligible for hormones and gender affirming surgery as these would not 鈥渃hange the body鈥� in a way that 鈥渘o longer correspond(s) to the individual鈥檚 sex鈥�.

In addition to instituting a rigid and reproduction-based definition of sex, this phrasing effectively erases many intersex people and ends recognition of non-binary people.

The ban on federally funded trans healthcare comes as Trump鈥檚 government expels trans people from the military, cuts funding to 17c起草社区IA+ health research, and shuts down 17c起草社区IA+ support services.

How this works in the context of US healthcare

In the US, people pay for their healthcare through a patchwork of private insurance and public schemes. Most Americans have private health insurance that is chosen and partly subsidised by their employer.

Medicare, a federal government scheme, pays for some healthcare for people over 65, and for some younger people with disabilities. Medicaid and the Children鈥檚 Health Insurance Program (CHIP) cover many healthcare costs for low-income adults, pregnant people, and children, with eligibility and benefits varying from state to state.听

The Affordable Care Act (ACA – also known as Obamacare) created online insurance marketplaces where people could compare and buy private health insurance policies. It also established subsidies for low-income households, banned insurers from denying coverage for pre-existing conditions, and made it compulsory for policies to cover essential services like maternity care, mental health treatment and prescription medication.

Trans healthcare isn鈥檛 explicitly called an essential service, but sex discrimination laws in the US have generally meant that healthcare that is available to cis people on an insurance policy (like hormones and surgery) is also available to trans people.

HR1 for trans people who are on Medicaid, CHIP, have an ACA policy, or have an insurance policy that operate to the same standard as an ACA policy.

If HR1 goes ahead, trans people on these plans would have to pay full-price for things like hormones, blood tests, endocrinologist visits, and surgery, out of their own pockets (like most of us here in Australia). This means most would not be able to afford to medically transition, or need years to save up.

According to a , approximately 276,000 transgender people use Medicaid. Many already live in states where gender affirming healthcare is restricted, but HR1 would impose a nationwide ban.

However, HR1 specifically guarantees coverage for those who want to de-transition.

One Big Beautiful Bill / HR1: What happens next?

The bill now heads to the Senate for review. From here, all Democrat senators and at least four Republicans would need to vote against the bill for it not to go ahead. There鈥檚 also a possibility that the legislation could be amended and sent back to the House for further debate.

Rejection is a real possibility 鈥� the bill contains a number of controversial proposals that have been criticised by both moderate and fiscally conservative Republicans.

听reports that some Republicans initially against the bill were summoned to the White House, and allegedly told that voting against it would be 鈥渢he ultimate betrayal鈥�.

However, as the bill is being passed as a budget reconciliation process rather than an ordinary piece of legislation, fewer options exist for filibuster or legal challenges.

The , which represents 17c起草社区IA+ lawmakers, condemned the bill as a 鈥淕OP tax scam鈥� that takes money from the poorest and gives it to the richest. 鈥淎ttacks on the trans community are just the cherry on top,鈥� said caucus chair Mark Takano.

鈥淩egardless of how any one of us personally feels about the issue of trans peoples鈥� medical care, we should all be able to agree that the only people who should be making these decisions are patients, providers, and parents in the case of young people鈥攏ot politicians,鈥� he said.

鈥淐ongress should be working to make healthcare more affordable鈥攏ot banning coverage of medically necessary care or pulling the rug out from underneath millions of Americans who rely on Medicaid. If we really want to honor the idea of freedom our nation was founded on, we have to protect every American鈥檚 right, including transgender people鈥檚 right, to access evidence-based care without government interference.鈥�