House Democrats will face a tough vote this week on the final compromise annual defense bill that includes pay raises for troops but also bans coverage for U.S. service members’ children who seek transgender care.
All Democrats present on Tuesday opposed a procedural vote to advance the historically bipartisan legislation, 211-207, but will face a final vote as early as Wednesday. Congress has passed the annual package for the past 63 years.
Rep. Adam Smith, the ranking Democrat on the House Committee on Armed Services, announced in a statement that he will vote against the major defense policy package.
The Washington state lawmaker said that “blanketly denying health care to people who need it — just because of a biased notion against transgender people — is wrong.”
“The inclusion of this harmful provision puts the lives of children at risk and may force thousands of service members to make the choice of continuing their military service or leaving to ensure their child can get the health care they need,” Smith said following the procedural vote.
President Joe Biden has not said if he will sign the bill into law.
Pay raise, housing upgrades
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The almost $900 billion National Defense Authorization Act for fiscal year 2025 is expected to approve an across-the-board 4.5% pay raise for troops, as well as a 10% pay increase in April for the military’s most junior members.
The law would also allow for improvements to military housing and new methods for preventing and assessing traumatic brain injuries caused by blast exposure.
A few far-right wishlist items made it into the bill’s final version, including a hiring freeze on diversity, equity, and inclusion positions and a prohibition on any federal funds used for so-called “critical race theory” in military education—though the section carves out academic freedom protections for instructors.
Trans coverage prohibition
A four-line provision in the 1,800-page package gaining the most attention would expressly bar coverage for children under the military’s TRICARE health program for “medical interventions for the treatment of gender dysphoria that could result in sterilization.” The bill does not specify which interventions it will disallow.
The medical community describes gender dysphoria as an inconsistency between an individual’s expressed gender and their birth sex. According to medical literature, the event frequently causes emotional discomfort, as well as an elevated risk of self-harm.
Rep. Mark Pocan of Wisconsin, the chairman of the Congressional Equality Caucus, asked Democrats to vote against the final agreement.
“For a party whose members constantly decry ‘big government,’ nothing is more hypocritical than hijacking the NDAA to override servicemembers’ decisions, in consultation with medical professionals and their children, about what medical care is best for their transgender kids,” Pocan said in a statement Tuesday afternoon.
Rep. Teresa Leger Fernández, one of the bill’s managers, spoke on the House floor Tuesday, criticizing the measure, which “fails to acknowledge that a lack of care leads to death and leads to suicide.”
The New Mexico Democrat accused House Republicans of thinking they know “better than the parent and the doctor as to what care your child should get. That is insulting to our Marines, to those who serve in our Navy, to those who are deployed overseas and in our bases around our own country.”
Speaker praises TRICARE ban
During his weekly press conference on Tuesday, U.S. House Speaker Mike Johnson praised the bill’s “landmark investments” and salary boost.
“It’s really important right now. We improved housing for our military families and other benefits, and it’s also why we stopped funds from going to CRT in our military academies. We banned TRICARE from prescribing treatments that would ultimately sterilize our kids, and we gutted the DEI bureaucracy,” said the Louisiana Republican.
A Democratic-led push to repeal the transgender coverage provision failed in the House Rules Committee on Monday.
Smith informed the committee that the clause is “fundamentally wrong” due to the widespread recognition of gender dysphoria among medical practitioners.
“The treatments that are available for it, including puberty blockers and hormone therapy, and also psychiatric help, have proven to be incredibly effective at helping young people, minors, who are dealing with suicidal thoughts, dealing with causes of massive confusion that have led them to have anxiety and depression,” said Smith.
Mental health therapy, hormone therapy, and surgery are all alternatives for treatment, while the World Professional Association for Transgender Health only supports teenage surgery in rare cases for those who satisfy stringent requirements. Some gender-affirming surgeries result in sterilization, and the association suggests that teenagers and their families seek counseling regarding their restricted fertility preservation alternatives.
Smith informed the committee on Monday that around 6,000 to 7,000 children of US service members are now undergoing treatment for gender dysphoria. The House Armed Services Committee did not respond to a request for more information on that number.
Up until September 2016, military health insurance did not cover gender-affirming care for service members’ children. A statistical analysis published in JAMA Pediatrics in March 2019 found that a little over 2,500 military-affiliated adolescents received the medication between October 2009 and April 2017 during about 6,700 different appointment visits.