In June, the Supreme Court’s decision to uphold Tennessee’s total ban on gender-affirming care for young people was the biggest setback to LGBTQ rights in decades. If Trump’s so-called “Big Beautiful Bill” (BBB) becomes law, it will almost certainly go even further. The fact that across the country grassroots networks are forming to coordinate hoarding HRT shows there is a strong mood towards solidarity and resistance, but these efforts can’t replace free, accessible and high-quality healthcare for trans people, women, and everyone.
Gender-Affirming Care Is Life-Saving Care
Young trans people in particular have been a vulnerable and effective target of the right. But rapid and immediate access to gender-affirming care for young people has dramatic benefits. A Stanford medical study of over 27,000 trans adults showed access to gender-affirming care reduces the odds of “severe psychological distress” by 222% for those who began hormones in early adolescence. Odds of previous-year suicidal ideation were 135% lower in trans people who began hormones in early adolescence. In addition, participants who began hormones in early or late adolescence had lower odds of past-month binge drinking and lifetime illicit drug use than those who began hormones in adulthood.
When young trans people are denied this care, the effects are devastating. The Trevor Project’s 2022 report of over 34,000 trans and nonbinary youth found two-thirds reported experiencing symptoms of depression, more than half seriously considered suicide, and nearly 1 in 5 transgender and nonbinary youth attempted suicide. Access to gender-affirming care was decisive for the state of their mental health.
For-Profit Health Insurance: Discrimination & Denial
Even before Trump’s bill, trans people faced all sorts of issues accessing healthcare. A report last year from the Center for American Progress found that 40% of transgender respondents—and 56% of trans respondents of color—said their health insurance companies denied coverage for gender-affirming care, which includes treatments like hormones and surgery. It also found that 48% of trans respondents, including 54% of trans respondents of color, said their health insurance companies covered only some gender-affirming care or had no providers in-network.
The same arbitrary systems designed to deny care to everyone snag trans people too. For example, many insurance companies label certain procedures “male” or “female”—like an ultrasound, mammogram, or a prostate exam—and automatically deny claims from a patient whose gender doesn’t match the label. Many call their insurance carrier and are told services will not be covered, and on that basis never attempt to file a claim in the first place. Most ordinary people are not aware that unless a denial is in writing, it is not an official denial and cannot be appealed.
Win Free Healthcare For All
While the outcome of Trump’s budget isn’t certain, it is just the latest in a series of vicious attacks on working-class people, especially immigrants and trans people. Only a determined mass movement in the streets can win healthcare that is truly free and affordable for all. This movement can only be built on the basis of rejecting Trump’s divide-and-rule, and will require real resources from working-class organizations, like unions, to succeed. The movement will need to overcome all sorts of obstacles, including labor leaders and the Democratic Party, who undercut the kinds of working-class methods needed to win lasting change.
The Democratic Party is a party that is funded by billionaires and healthcare CEOs, and it viciously opposes any move towards free healthcare for all. In 2016, Bernie Sanders’ insurgent campaign attracted millions, especially his calls for free healthcare. The Democratic Party leadership worked behind the scenes to sabotage Bernie’s campaign, paving the way for Trump’s first term. Under Biden, despite controlling both the House and the Senate, the Democratic Party still refused to take any meaningful action for healthcare reform. More recently, the Democratic Party has taken to scapegoating trans people (among others) for Biden’s stunning defeat, paving the way for more attacks from Trump.
Unions need to use their resources to play a key role, but unfortunately, many labor leaders have shied away from talking about free healthcare for all. This is because they are worried about jeopardizing their relations with Democratic Party politicians or because they incorrectly view free healthcare as a threat to the healthcare offered through their union contract.
Four national presidents of massive unions, Randi Weingarten of the American Federation of Teachers (AFT), Lily Eskelsen Garcia of the National Education Association (NEA), Mary Kay Henry of the Service Employees International Union (SEIU), and Lonnie Stephenson of the International Brotherhood of Electrical Workers (IBEW), voted against free healthcare to be included in the Democratic Party’s platform. In addition, when leaders like Sean O’Brien of the Teamsters, talk about how it’s hard to defend “illegal immigrants,” it also makes it easier for Trump to scapegoat immigrants as a justification for attacking Medicare.
The key to winning free healthcare for trans people, immigrants, and everyone else lies in building a mass movement, and mass movements can only be built on the basis of solidarity. Fierce and determined resistance to ICE deportations in Los Angeles, Minneapolis and Omaha made the June 14 “No Kings” rallies the largest single day of protest in US history.
The next step is to expand on the idea behind “No Kings” and to put forward a clear program of demands that actually improves the lives of working-class people. This would include free healthcare, including gender-affirming care for minors too, but also demands for a green union jobs program to combat climate change; taxing billionaires to fund schools, housing and transportation; and ending imperialist wars.