In late December 2024, news outlets and advocacy organizations reported that U.S. President Joe Biden signed a defense bill restricting gender-affirming care for transgender children of military personnel.
"President Biden Signs Defense Bill Blocking Health Care For Trans Military Children, First Anti-LGBTQ+ Federal Law Enacted Since 'Defense of Marriage Act,'" declared a news release (archived) from the Human Rights Campaign. Some reports, like those from Fox News (archived), CBS News (archived) and NBC News (archived), bore headlines calling the purported restrictions a "ban"; others, like Politico (archived), said the legislation "restricted" gender-affirming care. Some headlines, like Reuters' (archived), simply said the gender-affirming care provision was controversial without attempting to explain what it does.
The defense bill signed by Biden prevents TRICARE, a government-sponsored health insurance program for military personnel, from covering gender-affirming care under certain circumstances. However, due to the vague language in the bill, it is unclear how exactly TRICARE will interpret the new policy. Thus, Snopes cannot yet definitively provide a true or false rating for this story.
Snopes reached out to TRICARE and will update this story if
How the Gender-Affirming Care Restriction Became Law
Biden signed HR 5009, also known as "Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Year 2025," on Dec. 23, 2024. The 794-page spending bill, a version of which is passed annually, provided funding for several federal departments, including the Department of Defense. The 2025 legislation authorized $895 billion in military spending for various programs, including boosting pay for service members, U.S. assistance to Israel and resources for a more confrontational posture toward China.
But the bill also banned TRICARE from covering gender-affirming care for minors "that could result in sterilization." Here is the bill's full provision on gender-affirming care for minors:
SEC. 708. PROHIBITION OF COVERAGE UNDER TRICARE PROGRAM OF CERTAIN MEDICAL PROCEDURES FOR CHILDREN THAT COULD RESULT IN STERILIZATION.
Section 1079(a) of title 10, United States Code, is amended by adding at the end the following new paragraph: ''(20) Medical interventions for the treatment of gender dysphoria that could result in sterilization may not be provided to a child under the age of 18.''.
House Speaker Mike Johnson, a Republican from Louisiana, reportedly insisted on including the restriction, according to reputable news sources like The Associated Press. There is also a video on C-SPAN's Instagram page of Johnson taking credit for the provision: "We banned TRICARE from prescribing treatments that would ultimately sterilize our kids," he said. Snopes reached out to Johnson's team to confirm his role in passing the ban and will update this story if we receive a response.
Despite signing the bill, Biden said in a Dec. 23 news release that he "strongly opposes" the gender-affirming care restriction and the provision "targets a group based on that group's gender identity and interferes with parents' roles to determine the best care for their children." Biden's release said the provision would impact thousands of children. "No service member should have to decide between their family's health care access and their call to serve our Nation," the release continued.
The Senate passed the legislation on a vote of 85-14; in the House of Representatives, a majority of Democrats voted against the bill, but it passed 281-140. A Democrat from Washington state, Rep. Adam Smith, said in a statement he would oppose final passage of the defense bill due to the provision on gender-affirming care. He said Speaker Johnson "upended" a traditionally bipartisan process and including the section "puts the lives of children at risk." Smith is the ranking member of the House Armed Services Committee, which means he typically coordinates the minority party's — in this case, the Democrats' — activities on the committee.
Beneficiaries of TRICARE can seek health care elsewhere, and the legislation also does not ban military families from seeking other health care insurance to pay for the gender-affirming treatments that TRICARE is prohibited from offering under the bill.
However, purchasing health insurance can be prohibitively expensive, and prices are predicted to continue increasing as of this writing. Gender-affirming care paid for out-of-pocket is also prohibitively expensive for many families; puberty blockers, for example, can cost anywhere from $4,000 to $25,000 a year without insurance.
The Potential Impact on Gender-Affirming Care Coverage
TRICARE provides insurance coverage for about 9.5 million beneficiaries, including active-duty service members and their families, retired service members and their families, dependent parents and parents-in-law, and even former spouses of military members who haven't remarried. A full list of those eligible for TRICARE is available on its website.
A 2019 study in the peer-reviewed journal JAMA Pediatrics found that from October 2009 to April 2017, at least
As of this writing, TRICARE's website (archived) said it covers hormone therapy and psychological counseling for gender dysphoria. The insurance does not generally cover gender-affirming surgeries, but active-duty service members may request a waiver for medically necessary gender-affirming surgery. However, the page was last updated on Sept. 17, 2024, so it does not reflect how TRICARE might respond to the defense bill's provision.
TRICARE also notes that its list of covered services is not all-inclusive and that the program "covers services that are medically necessary and considered proven." The American Medical Association affirms that gender-affirming care is often medically necessary and is linked to "dramatic reductions in suicide attempts," lower rates of depression, anxiety and substance use and other lifesaving benefits — but that trans patients often face hurdles to accessing this care, regardless of how necessary it is.
It's difficult to determine what will fall under the legislation's ban on treatments "which could result in sterilization." According to the Southern Poverty Law Center, a civil rights organization, opponents of gender-affirming care for children often use the term "sterilization" to "create fear and disgust." The center calls the use of "sterilization" rhetoric "medically inaccurate terminology."
Gender-affirming surgery — which can result in permanent infertility depending on the surgery — is rarely performed on minors in the United States, and the majority of such surgeries that are performed are chest reductions.
Doctors who treat trans youth say puberty blockers, which are prescribed to both cisgender and transgender youth, do not cause infertility on their own, but may cause infertility if a patient moves from puberty blockers to starting hormone replacement therapy, which involves taking either estrogen or testosterone. Emerging research published in peer-reviewed journals suggests that for trans people, taking either estrogen or testosterone does not result in permanent infertility.
Snopes reached out to legal experts to ask how the bill's language may be interpreted by the courts. We'll update this story if we receive more