In recent months, panic has spread across the United States as questionable reports about the federal budget reconciliation bill, popularly known as Donald Trump’s favored “One, Big, Beautiful Bill,” spread throughout social media.
Officially known as HR 1, this bill is broad in its attacks on marginalized Americans — both documented and undocumented immigrants face attacks under this bill, alongside sweeping Medicaid cuts that would endanger millions of lives, especially disabled Black and Indigenous people of color. Spawning the most panic, however, is the more recent provision that aims to ban all trans recipients of Medicaid from gender affirming care coverage.
Mady Castigan and myself reported on this last month, revealing that HR 1 would remove all federal funding for trans recipients of gender affirming care, borrowing language from prior care ban attempts. While states would still be able to provide their own funding for gender affirming care – especially trans refuge states like Minnesota, which have passed legislation that protects gender affirming care under state law – most trans Medicaid recipients will nevertheless see themselves losing care if this HR 1 is signed into law.
The effects of this are sweeping. In a phone conversation, the Williams Institute’s Interim Executive Director, Christy Mallory, revealed that “180,000 transgender people nationwide have Medicaid as their primary source of health insurance. We’re talking trans people that rely on this [for care], and that’s just adults.”
She added that private insurers would still be able to offer this care, and while some would follow Medicaid’s lead, there would still be options for coverage. But these private insurance options are notoriously expensive, with out-of-pocket expenses accounting for most personal bankruptcy cases.
Up until our article, major reports of this were absent of potential solutions to this crisis, with popular online influencers spreading panic and confusion about what actually can be done. Notably, the first and only trans member of Congress Rep. Sarah McBride only gave a statement promising to protect this care after public pressure brought from our article brought awareness of this to her staff.
In spite of this, we discovered and outlined solutions that work in both this specific instance, and that can broadly change the landscape of trans rights internationally.
Specific to this situation, we broke how a single Senator can potentially halt HR 1 by invoking the Byrd rule, a procedural guideline that mandates any provisions not be “merely incidental.” In other words, any provisions of budget bills have to be directly related to budget expenditures that enable government funding. As such, the Senate Parliamentarian can rule that the gender affirming care ban – among other harmful provisions – be struck from the bill. While Republicans could then overturn this ruling, this is a difficult process, as such overturning has only happened a handful of times.
This opened up an avenue for action, with people pressuring their Senators to invoke this procedure through public templates. This has already resulted in some Senators, such as Elizabeth Warren, publicly advocating for the invocation of this provision.
But, as we discussed, this is only a short-term solution. Attacks on trans care will not end with this HR 1. Fortunately, long-term solutions exist, and have been outlined in detail by both this report and prior scoops by Free Radical and Madycast News in the realm of legislative activism. These solutions can be applied internationally.
For instance, groups like American Disabled for Attendant Programs Today (ADAPT) – who helped pass the Americans with Disabilities Act – protested the Medicaid cuts within this bill. Nearly two dozen activists were arrested at this protest, with their disruption getting the attention of Republicans in the midst of a hearing on this very bill. All activists are safe and out of jail, as of the time of our reporting.
The activist I spoke to, Lauren Alden, emphasized how this fight affects all of us. “Anything connected to the Medicaid cuts, we need to have voices there,” she said. “We gotta get these numbers together, we are all in this fight together.”
This is not the first time in American history that queer lives have been under attack – and solutions to fight for our existence already exist. Mady wrote a few months back about how Act Up activists of Los Angeles led boisterous protests sporting a diversity of tactics that ultimately led to countless lives saved.
The core lesson that both she and I recommend people take from their work is simple – we need mutual aid networks built from regular people willing to make a difference in however they can contribute. These networks are not something exclusive to America, either. Activists internationally have employed these historically and in the modern day, absent any intervention from nonprofits or lawyers to protect us.
Fundamentally, queer liberation is only achieved from horizontal, on-the-ground movements with people playing into their strengths and protecting marginalized members of their community. Just as Americans are learning that Democrats like CA Gov. Gavin Newsom will sell out trans people in an instant, so too are our siblings in the United Kingdom seeing this with Labour Party leader Keir Starmer’s betrayal of trans rights.
Politicians are not our friends. The only ones we can count on when times get rough is our community. We have provided examples of how to find groups that are near you throughout our article, and in this one. Liberation can be achieved for all of us, and if we learn from radical activists of the past, we can see this within our lifetimes. Working within the system oppressing us is doomed to fail – but working outside these systems, we may just see the fall of Western fascism.