1. United States
2. Mich.
3. Letter

I am writing to urge you to oppose the healthcare proposal from Senators Bill Cassidy and Mike Crapo that is scheduled for a vote on Thursday. This bill would trade temporary healthcare subsidies for permanent restrictions on gender-affirming care, and I cannot support using the rights of transgender Americans as a bargaining chip. The proposal offers modest Health Savings Account contributions of $1,000 to $1,500 annually for those with Bronze and Catastrophic ACA plans in exchange for unprecedented restrictions on medically necessary care. Unlike the abortion provision in the bill which includes medical necessity exceptions, transgender Americans would be prohibited from using HSA funds for gender-affirming care even when medically necessary. More concerning is the permanent amendment to the Affordable Care Act that would ban gender-affirming care from being considered an Essential Health Benefit starting in 2027. This means ACA-regulated insurance plans could not cover this care unless individual states mandate it separately and pay the full cost themselves. Currently only California, Colorado, New Mexico, Vermont, and Washington include transgender healthcare in their benchmark plans. The bill also eliminates federal Medicaid and CHIP reimbursements for gender-affirming care, forcing states to bear all costs. This provision was previously removed from the Big, Beautiful Bill in July after Senate Parliamentarian Elizabeth MacDonough ruled it targeted policy rather than spending under the Byrd Rule. If these provisions become permanent law through a healthcare deal, removing them would require 60 Senate votes rather than a simple majority. Meanwhile, the subsidies being offered are temporary. Republicans would have no incentive to extend subsidies in future negotiations once they have achieved permanent restrictions on transgender healthcare. I urge you to reject this proposal and refuse to sacrifice the healthcare rights of transgender Americans for temporary measures. Please vote no on Thursday.