In the early morning hours of May 22, the U.S. House of Representatives passed a sweeping and deeply harmful budget bill, dubbed the “Big Beautiful Bill” by supporters, that cuts gender-affirming care from all federal insurance programs. The bill bans Medicaid, CHIP, and ACA exchange plans from covering hormones, puberty blockers, and surgeries related to gender transition. It targets transgender people of all ages, not just youth.
Just the day before, Pittsburgh’s Central Outreach Wellness Center, a vital healthcare provider for more than 90,000 LGBTQ+ people, announced it would stop offering gender-affirming care to patients under the age of 19, forced by an executive order from President Trump. The executive order threatens clinics that treat trans people under the age of 19 with loss of federal funding and legal retaliation.
“This administration is tough on the LGBTQ community,” said Dr. Stacy Lane, founder of Central Outreach. “The executive order puts the entirety of Central Outreach’s practice in jeopardy.”
A National Emergency for Trans Health Care
Passed by a single vote (215 to 214), the federal budget bill is poised to upend health care access for trans people across the country. Every House Democrat voted against the bill, joined by just two Republicans. A last-minute amendment removed the word “minors” from the gender care restrictions, meaning all trans people, regardless of age, will be affected.
The bill includes a ban on Medicaid and CHIP coverage for gender-affirming care, a ban on ACA (Obamacare) insurance plans covering gender-affirming procedures, and $500 billion in cuts to Medicare and an expected loss of insurance for 13.7 million people.
According to the Williams Institute, 152,000 transgender Americans rely on Medicaid. The bill’s gender care ban strips away coverage for these individuals, many of whom already live in states that offer no other support.
“Congress should be working to make healthcare more affordable, not banning coverage of medically necessary care or pulling the rug out from underneath millions of Americans,” said Rep. Mark Takano (D-CA).
Back in Pittsburgh, Central Outreach had to make the painful choice to comply with the Trump executive order in order to protect the rest of its services and staff. “Parents, doctors, and their patients should be making these decisions. Not the government,” said Dr. Lane.
Central Outreach confirmed that, for now, patients aged 18 and under will no longer receive hormones or puberty blockers; patients who already started treatment at age 18 at Central may continue under a “grandfathered” clause; and all patients 19 and older will still receive gender-affirming care with no changes.
Without compliance, Central Outreach risks losing access to Medicaid and the 340B drug discount program, essential to its HIV prevention work and care for uninsured patients. The clinic also faced threats to the medical licenses of its staff.
“Support trans youth now more than ever,” Dr. Lane emphasized.
In the wake of the announcement, the Blue Moon bar released a passionate statement on social media defending Central Outreach.
“This is NOT the moment for infighting in our community, finger-pointing, or grandstanding. This is an EMERGENCY and we need to work TOGETHER to protect the most marginalized and vulnerable members of our LGBTQ+ community who are under attack,” Blue Moon’s post on Instagram read.
Community organizations like the Hugh Lane Wellness Foundation are continuing to offer support for trans youth, but they are bracing for additional political attacks.
What You Can Do Right Now
Here’s how you can act right now:
- Write your Pennsylvania state reps. Demand the state declare itself a sanctuary for gender-affirming care.
- Support local orgs like Hugh Lane, Allies, and Central Outreach, who are still doing life-saving work under extreme pressure.
- Share stories and organize. Make it clear that the LGBTQ+ community and its allies will not back down.
- Vote like lives depend on it. Because they do.
This isn’t just about one clinic, or one city, or even one law. This is about a national effort to legislate trans people out of existence and the queer resistance rising to meet it.
We fight because we must.
We fight because we love.
We fight because we are still here.
