For two years, as states pushed anti-trans laws, Republicans in Congress filed dozens upon dozens of bills that would restrict transgender rights on a national scale — but most of those bills never advanced. Now, as a new GOP-controlled Congress signals that anti-trans legislation is a top priority and President-elect Donald Trump takes office, a wave of federal anti-trans laws and executive orders is on the horizon. 

How could congressional Republicans restrict health care for trans Americans? Will Democrats block anti-trans legislation? And what anti-trans policies can Trump enact without Congress? Here’s what trans people should know about how this new Congress, and the first days of Trump’s presidency, could shape their lives. 

What legislation can trans people expect from this new Congress? 

Federal bills brought in 2023 and 2024 show that congressional Republicans are focused on restricting trans health care and reinforcing traditional gender roles. According to the Trans Legislation Tracker, they have introduced bills to revoke federal funds from hospitals that provide gender-affirming care. Proposed bills also aim to charge doctors who provide that care to minors with felonies, redefine sex under the law to exclude trans people, ban trans people from the military, and dissuade state and federal governments from acknowledging that trans people exist. Many of these policies align with Trump’s own campaign promises.  

Blocking federal funds from being used in the provision of gender-affirming care has been the most popular anti-trans proposal in Congress. So far, 52 Republicans have endorsed a bill to block federal funds from being used for minors’ gender-affirming care, while 49 Republicans endorsed a bill that would do the same thing for all trans Americans, without age restrictions. That bill advanced to the House Ways and Means’ Health Subcommittee in December. 

Although some Republicans who endorsed these bills are no longer in office, due to retiring or losing their 2024 reelection bid, these bills have garnered a significant amount of support in Congress compared with other proposed anti-trans policies. They would still need to be reintroduced in the current Congress to be brought to a vote and passed into law. 

Looking ahead, the House rules package for the incoming Congress lists anti-trans policy as a legislative priority. This document, which sets rules of engagement for the chamber, says that amending Title IX, the federal civil rights law prohibiting sex discrimination in schools, should be one of the first actions taken by the chamber. Republicans want to mandate that sex is “recognized based solely on a person’s reproductive biology and genetics at birth” when determining Title IX compliance in athletics. 

How would these bills affect trans people? 

Revoking federal funds for gender-affirming care would cut gender transition care for people who receive Medicare, Medicaid or a subsidized plan under the Affordable Care Act. One in five transgender adults receive insurance coverage through Medicaid, according to the 2023 KFF/Washington Post Trans Survey. Transgender adults in the United States are also more likely than cisgender adults to be uninsured, to have incomes below $50,000 per year and to be unemployed, the survey found — disparities that researchers have linked to systematic discrimination and transphobia. 

Many transgender people can’t afford to pay out of pocket for their health care. Without the ability to pay for prescription refills on hormones like testosterone and estrogen, trans Americans would face the prospect of having to suddenly stop hormone replacement therapy, which can cause adverse side effects like menopausal symptoms. 

Gutting federal funding for gender-affirming care could also have a chilling effect on hospitals and clinics. As states across the country banned hormone treatment and puberty blockers for trans youth, some medical practices halted care — and pharmacies stopped providing prescriptions — before they were legally required to. And hospitals would have good reason to prioritize federal dollars: in 2021, nearly half of state and local health and hospital expenditures were funded by the federal government, according to the nonprofit research organization Urban Institute.

Can these bills be blocked in a GOP-controlled Congress? 

Yes. Although Republicans now control both chambers, Democrats can filibuster bills in the Senate — derailing their advancement and stalling them permanently. Since 60 votes are required to end debate in the Senate, the filibuster means that legislation needs more support than a simple majority (51 votes) to pass. Republicans will still need some Democrats on board to pass most bills.

Republicans have indicated that they want to keep the filibuster, but, as Rolling Stone reports, it is unclear if enough Democrats in Congress are willing to use it to defend trans rights. Jael Holzman reports that LGBTQ+ advocates and some lawmakers are “quietly terrified” that Democrats may let Republicans enact a federal funding ban against gender-affirming care, if they have to choose between allowing the care to continue or funding the government. 

What anti-trans measures have already passed in Congress? 

Democrats have already compromised on anti-trans policies to get must-pass legislation through Congress. 

The $895.2 billion annual defense bill signed into law last month prevents the children of military personnel and veterans from having their gender-affirming care covered by TRICARE, through a last-minute addition from House Speaker Mike Johnson, a Republican. President Joe Biden signed the law before Christmas, noting that it will deny health care “to thousands of our service members’ children.” The Human Rights Campaign described the bill as “the first anti-LGBTQ+ federal law enacted since the Defense of Marriage Act in 1996.” 

This tactic began in earnest last year — though it was not successful. In 2023, House Republicans embedded an unprecedented amount of anti-LGBTQ+ provisions into must-pass bills to fund the federal government. These provisions included multiple attempts to restrict federal funding for gender-affirming care, which all failed. In the final version of the $1.2 trillion spending package to fund the federal government through the 2024 fiscal year, only one anti-LGBTQ+ provision remained: banning U.S. embassies from flying the Pride flag. 

In a new Republican-controlled Congress, those failed anti-LGBTQ+ provisions may return.

What anti-trans policies can Trump enact without Congress?

Even if anti-trans legislation is blocked, there are other ways to enact the president’s agenda.

Trump has pledged to carry out several anti-trans policies on day one of his presidency or soon after being sworn in. He is focused on restricting health care for transgender people through executive orders and directing change through federal agencies. 

Trump wants the Justice Department to “investigate Big Pharma” and hospital networks to determine if they have covered up side effects of gender-affirming care or “illegally marketed” hormones and puberty blockers. He has said he wants the Department of Education to inform states and school districts that any teacher or school official caught suggesting to a child that they might be transgender “will be faced with severe consequences,” including potential civil rights violations for sex discrimination. 

He has pledged to remove any health care provider or hospital that provides gender-affirming care to trans youth from the Medicaid or Medicare programs, on the grounds that providing such care violates the programs’ federal health and safety standards. Although Trump does not name a federal agency in this declaration, such a policy change would have to be done through the secretary of health and human services or rulemaking within the Centers for Medicare & Medicaid Services (CMS).

Trump also wants “every federal agency to cease all programs that promote the concept of sex and gender transition at any age” — a broad proposal to keep the idea of being transgender from being communicated to the public through the federal government.