
Donald Trump has been sabotaging lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) health care since day one. Right now, the Trump administration and Republicans in Congress are pushing for the largest cuts to health care in history to decimate Medicaid and the Affordable Care Act (ACA), all to fund tax breaks for billionaires and big corporations. As a result, 16 million Americans, including countless members of the LGBTQI+ community, will lose access to life-saving care.
But the threats to LGBTQI+ health care don’t end with the GOP tax bill. Republicans are escalating a series of attacks, from eradicating protections based on sexual and gender identity to cutting lifesaving research into cancer and diseases that primarily affect LGBTQI+ individuals. Meanwhile, Republicans in 26 states are enacting laws or policies to prohibit gender affirming care for trans youth, and 10 states continue to block Medicaid expansion, while the program provides critical health care access for LGBTQI+ Americans. The loss of critical life-saving coverage and services would be catastrophic for the LGBTQI+ community. Whether it’s eliminating access to preventive medicine, no-cost screenings, or banning gender-affirming care, Republicans’ war on health care is only getting more extreme.
Trump and His Admin Are Eliminating Protections and Advancements For the LGBTQI+ Community
Trump Reversed Several Biden Executive Orders That Protected LGBTQI+ Individuals. On Trump’s first day in office, he rescinded executive orders signed by President Biden, undoing several actions aimed at protecting members of the LGBTQI+ community. These executive orders include executive orders aimed at preventing and fighting against discrimination based on gender identity or sexual orientation, as well as advancing equity for LGBTQI+ individuals and establishing the White House Gender Policy Council. Getting rid of these orders removes protections for those in the LGBTQI+ community, as well as ending orders to improve public health and data collection for LGBTQI+ individuals and ending nondiscrimination protections, especially in health care.
Trump Admin Has Cut Over $800 Million from LGBTQI+ Health Research. The Trump Administration has cut over $800 million from research budgets looking into health concerns that primarily affect those in the LGBTQI+ community, including certain cancers, viruses, and sexually transmitted infections. As of early May, out of 669 research grants that the National Institute of Health has canceled, nearly half were related to LGBTQI+ health. In letters to programs that received these research grants, the NIH has stated that these cuts “no longer effectuates agency priorities” and in the cases that research based on gender identity was being conducted, they said that the research led to “unscientific” results that ignored “biological realities.” These cuts are compromising decades of work to put an end to the HIV/AIDs epidemic and are leaving health issues that disproportionately affect the LGBTQI+ community unchecked.
Republicans Are Pulling Medications They Don’t Like From The Market – Setting a Dangerous Precedent for LGBTQI+ Care
A Trump-Appointed Judge Is Working To Curb Access To Safe, Affordable Abortions. In April 2023, another Trump-appointed judge ruled against the FDA in a case seeking to remove a popular medication used to induce abortion from the market. Medication abortions are the most common, least expensive, and most accessible method for people to terminate pregnancy and the ruling impacts communities that already have difficulty accessing these key services.
Republicans Want to Pull Medications They Don’t Like Off The Shelves. The case could set a dangerous precedent for any federal judge to pull controversial medications off the market, regardless of the science behind approval decisions or the bureaucratic steps taken to prove safety and efficacy. As Lambda Legal has pointed out, “The trial court’s approach just as easily (or perhaps more easily) could be aimed at HIV-related medications and puberty blockers and hormone treatments, as well as medications for many other health conditions that are specially relevant for our communities.”
Republicans Are Taking Away No-Cost Preventive Care From LGBTQI+ People and Communities of Color
Republicans Are Curbing Access To No-Cost Preventive Services, Disproportionately Impacting LGBTQI+ People and Communities of Color. This month, the Supreme Court is expected to issue a decision in Kennedy et al. v. Braidwood (formerly Braidwood v. Becerra), a case in which far-right extremists have urged the Court to invalidate a key portion of the Affordable Care Act (ACA) that requires insurers to cover lifesaving preventive services for free. If the right-wing plaintiffs get their way, it will once again put Americans at the mercy of insurance companies and employers, allowing them to charge high out-of-pocket costs for critical preventive care and refuse to cover certain benefits entirely. In March 2023, a Trump-appointed judge decided against the federal government in Braidwood v. Becerra and struck down no-cost coverage of lung and breast cancer screenings, Hepatitis C screenings, HIV screenings, and PrEP medication. These changes have a disproportionate impact on historically marginalized populations like LGBTQI+ people and communities of color — curbing no-cost access to preventive services would create barriers to seeking needed care and exacerbate existing health disparities. Even if the Court rules against the plaintiffs, the Trump administration could be granted the ability to overturn health experts’ evidence-based recommendations regarding which preventive services insurers must cover, leaving existing coverage at risk.
Republicans Are Targeting PrEP, A Key Prevention Strategy For HIV. The 2023 ruling struck down a portion of the ACA guaranteeing access to pre-exposure prophylaxis (PrEP), a drug proven to substantially reduce the risk of contracting HIV. PrEP has been associated with a significant decrease in the number of new HIV diagnoses. PrEP is shown to lower the risk of infection from sex by more than 90 percent (more than 99 percent effective) and is widely viewed as a key prevention strategy for ending the HIV epidemic in the U.S. Thanks to ACA protections, the percentage of PrEP users has jumped from 3 percent of eligible patients in 2015 to 30 percent of eligible patients prescribed in 2021. The federal government’s 2022-2025 strategy to combat HIV recognized gay and bisexual men, particularly Black, Hispanic/Latino, and Native American men, Black women, and trans women as priority populations. Rural populations, especially gay and bisexual Native American men and Two-Spirit populations, have greater difficulty accessing preventive care for HIV.
- Ending ACA PrEP Protections Disproportionately Harms Black and Hispanic/Latino Gay and Bisexual Men. While 66 percent of eligible white people in America are prescribed PrEP, just 16 percent of eligible Hispanic/Latino Americans and 9 percent of eligible Black Americans are prescribed the lifesaving drug. Academic experts have concluded that Braidwood will disproportionately impact racial and ethnic sociodemographic groups at particularly high risk for HIV infection: “Even in our ‘best-case’ scenario, the predominant burden of new restrictions on access to PrEP will likely fall on Black and Latino gay and bisexual men, as well as transgender women, who already face significant barriers to HIV prevention and care.”
Ending ACA Cost-Sharing Protections Could Increase HIV Transmission By At Least 17 Percent In The First Year Alone. According to academic experts, ending the prohibition of cost sharing for PrEP will increase HIV transmission among men who have sex with men by at least 17 percent in the first year alone. Researchers at Yale have already determined that the Braidwood ruling could see coverage for PrEP drop from 28 percent to only 10 percent, mainly due to the fact that 80 percent of PrEP users are on commercial plans that would now have the ability to refuse to cover PrEP. A recent study found that PrEP medication costs nearly $350 for a 30-day supply on average. Outside of the cost of obtaining medication, PrEP users incur additional required charges as part of the care regimen like clinical visits and lab costs that can add up to thousands of dollars annually.
Republicans Are Pushing An Anti-Trans Agenda
10 Republican-Led States Continue To Block Medicaid Expansion, Which Serves Millions Of LGBTQI+ Patients. Republicans in 10 states continue to block Medicaid expansion, while the program provides critical health care access for an estimated 1.2 million LGBTQI+ adults, disproportionately trans and non-binary Black, Hispanic/Latino, Pacific Islander, and Native American people. LGB individuals are more likely to qualify for Medicaid based on income, and Medicaid covers about 21 percent of trans and non-binary people in the U.S.
Trump Signed an Executive Order Reinforcing the Gender Binary and Restricting Health Care for Trans Teens. Trump signed an executive order on his first day in office that redefined sex as a binary and removed acknowledgement of gender identity. This order has led to community health centers and HIV clinics’ funding being stripped away due to their programs for transgender individuals. Distribution of transgender specific health care messaging has also been eliminated, which will likely lead to a higher prevalence of disease, poor mental health outcomes, and decreased care. A few days later, Trump signed another executive order aimed at broadly banning health care for transgender youth. The order bans medical care for transgender youth who are dependents of federal employees and prohibits federal funding for any health care organization that provides lifesaving gender affirming care for trans people under 19 years old.
CMS Wants to Eliminate Gender Affirming Care from ACA Benefits. The Center for Medicare and Medicaid Services has also proposed a rule to eliminate coverage of gender affirming care as an essential health benefit in ACA plans starting in 2026. This means costs for gender affirming care would not be required to count towards out-of-pocket maximums, deductibles, or lifetime limits, effectively putting this type of care out of reach for many Americans.
Republicans Are Waging War On Trans People and Their Health Care. Across the country, Republicans have escalated their war on trans people and health. 26 states have enacted laws or policies prohibiting gender affirming care in some way. As of August 2024, 40 percent of trans youth, aged 13 to 17 years old, live in these 26 states. Anti-trans laws contribute to negative health impacts, including an increased risk of suicidality and substance use among trans and non-binary youths. Equitable access to health care services has always been a challenge for LGBTQI+ people. A 2018 survey found that 75 percent of people seeking gender-identity-based care have had negative experiences during physician visits. The fight to get insurers to cover basic care for trans patients—let alone gender-affirming care—has been a grueling, decades-long process, even with ACA protections and federal and state-level enforcement. New bans threaten to undo decades of work to provide trans people with access to affordable, gender-affirming care.