The U.S. Capitol. surrounded by fog, on Tuesday, Dec. 10, 2024. (Photo by Jennifer Shutt/States Newsroom)

WASHINGTON — The U.S. House handily approved the annual defense policy bill Wednesday, despite late opposition from Democrats over a provision that bans military health insurance coverage for service members’ children seeking transgender care.

Lawmakers passed the historically bipartisan package 241-180. In the end, 81 Democrats supported the bill, and 16 Republicans voted against it. The measure now heads to the Senate.

Congress has approved the must-pass legislation for 63 years straight. President Joe Biden has not issued a statement yet on whether he will sign it into law.

The $884.9 billion bill includes a 4.5% pay increase for all troops, and an additional 10% bump for the military’s most junior enlisted ranks, from private to corporal. The bill also outlines improvements in military housing and child care.

The massive package is a policy bill, meaning it does not provide the Pentagon with funding but rather enshrines the Defense Department’s goals for the upcoming fiscal year. Congressional appropriators still need to approve any actual spending.

‘Lives of thousands of children at risk’

Among the Democrats who opposed the final legislation was the House Armed Services Committee’s top Democrat, Rep. Adam Smith. In a statement after the vote, Smith said he couldn’t vote yes, though there was “much to celebrate” in the text.

“However, the corrosive effect of Speaker Johnson’s insistence on including a harmful provision puts the lives of thousands of children at risk by denying them health care and may force thousands of service members to choose between continuing their military service or leaving to ensure their child can get the health care they need. This will be felt for generations to come,” Smith, of Washington state, said.

All Democrats present for a procedural step to advance the bill Tuesday voted against the defense package.

A four-line provision into the 1,800-page bill bans military TRICARE health insurance coverage for service members’ children who seek “medical interventions for the treatment of gender dysphoria that could result in sterilization.”

Treatment for gender dysphoria — an incongruence between a person’s sex assigned at birth and current gender expression — includes mental health measures, hormone therapy and surgery. The bill does not define which treatments are banned.

Smith, on the floor ahead of the vote, said the measure was included for “ignorant, bigoted reasons against the trans community,” and that it “taints an otherwise excellent piece of legislation.”

House speaker touts ban

Alabama’s Rep. Mike Rogers, chair of the House Armed Services Committee, told reporters on Capitol Hill Tuesday that House Speaker Mike Johnson “didn’t talk to me about it” before including the provision in the final text.

Johnson, of Louisiana, touted the measure Tuesday, as well as other provisions that freeze hiring of diversity, equity and inclusion positions, and prohibit federal funds for certain race relations education in Defense Department institutions.

Human Rights Campaign President Kelley Robinson criticized the House’s approval of the measure in the final bill, saying military members were used as “bargaining chips” for the issue.

“Military servicemembers and their families wake up every day and sacrifice more than most of us will ever understand. Those families protect our right to live freely and with dignity – they deserve that same right, and the freedom to access the care their children need,” Robinson said. 

“Today, politicians in the House betrayed our nation’s promise to those who serve. Not since the ‘Defense of Marriage Act’ passed almost 30 years ago has an anti-LGBTQ+ policy been enshrined into federal law. For the thousands of families impacted, this isn’t about politics. It’s about young people who deserve our support,” the campaign’s president continued.

Space Force controversy

Another provision in the bill will transfer certain Air National Guard functions and personnel to Space Force without permission from state governors — a measure that stirred opposition.

Roughly 1,000 Air National Guard space professionals serve in 14 units across seven states, according to the National Guard Association of the United States, which panned the measure.

The move could affect up to 33 personnel in Alaska, 126 in California, 119 in Colorado, 75 in Florida, 130 in Hawaii and 69 in Ohio.

Retired Maj. Gen. Francis M. McGinn, president of the National Guard Association, said in a statement Monday that the provision is an “existential threat to state authority over the National Guard.”

An amendment to strike the provision offered by Democratic Rep. Joe Neguse of Colorado failed in the House Rules Committee on Monday.

New requirements for blast exposure

The final bill also included a measure to prevent, assess and treat conditions, including traumatic brain injuries, suffered by service members repeatedly exposed to explosion pressure waves.

The legislation requires the Defense Department to establish the Defense Intrepid Network for Traumatic Brain Injury and Brain Health no later than Jan. 1, 2026. Other mandates include creating safety thresholds for blast exposure by early 2027, and establishing policies to encourage service members to seek treatment, without fear of retaliation, for brain trauma.

The department will also be required to report back to Congress on the safety initiatives and numbers of service members who seek treatment, among other data.

The safety provisions were championed this year by Sens. Joni Ernst, an Iowa Republican, and Elizabeth Warren, a Massachusetts Democrat, as well as House Democrat Ro Khanna of California.

States Newsroom interviewed a Washington state Purple Heart recipient in May who was among more than 100 troops who suffered traumatic brain injuries following an Iranian air strike on the U.S. Al Asad Airbase in Iraq in January 2020.

On the campaign trail in October, President-elect Donald Trump downplayed those troops’ injuries as “headaches.” That was not the first time Trump had disparaged the troops’ injuries stemming from the 2020 attack.

An aerial view of the The Pentagon, May 12, 2021. (Department of Defense photo by Air Force Tech. Sgt. Brittany A. Chase)

This story mentions suicide. If you or a loved one are suffering from thoughts of self-harm, dial 988 or visit 988lifeline.org to live chat with a mental health professional.

WASHINGTON — 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 Tuesday opposed a procedural vote, 211-207, to advance the historically bipartisan legislation, but will need to contend with a final vote as early as Wednesday. Congress has enacted the annual package for the last 63 years.

Rep. Adam Smith, the top Democrat on the House Committee on Armed Services, said in a statement he plans to vote against the massive defense policy bill.

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 indicated whether he will sign the bill into law.

Pay raise, housing upgrades

The nearly $900 billion National Defense Authorization Act for fiscal year 2025 is set to green-light an across-the-board 4.5% pay raise to troops, plus a 10% pay hike in April for the military’s most junior soldiers.

The bill would also pave the way for upgrades in military housing and new protocols for preventing and assessing traumatic brain injuries caused by blast exposure.

Also making it into the bill’s final version were a few far-right wishlist items, including a hiring freeze on diversity, equity and inclusion positions, and a prohibition on any federal dollars used for so-called “critical race theory” in military education — though the section carves out academic freedom protections for instructors.

Trans coverage prohibition

Gaining the most attention is a four-line provision in the 1,800-page package that would expressly prohibit coverage for minors 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 define which interventions would be prohibited.

Gender dysphoria is defined by the medical community as incongruence between a person’s expressed gender and their sex assigned at birth. The experience often leads to mental distress, including increased risk of self-harm, according to the medical literature.

The chair of the Congressional Equality Caucus, Rep. Mark Pocan of Wisconsin, urged Democrats to vote no on the final package.

“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, decrying the provision that “fails to acknowledge that the lack of care leads to death, 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

U.S. House Speaker Mike Johnson, during his weekly press conference Tuesday, praised “landmark investments” and the pay increase included in the bill.

“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 Democrat-led effort to strike the transgender coverage provision failed Monday in the House Committee on Rules.

Smith told the committee that the provision is “fundamentally wrong” because gender dysphoria is widely recognized by medical professionals.

“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.

Treatment options include mental health therapy, hormone therapy and surgery, though the World Professional Association for Transgender Health only recommends adolescent surgery under narrow circumstances that must meet numerous criteria. Some gender-affirming surgery causes sterilization, and the association recommends counseling for adolescents and their families about limited options to preserve fertility.

Smith told the committee Monday that anywhere from 6,000 to 7,000 children of U.S. service members are currently receiving treatment for gender dysphoria. The House Armed Services Committee did not respond to a request for further explanation of that number.

Gender-affirming care was not covered by military health insurance for service members’ children until September 2016. A statistical analysis published in JAMA Pediatrics in March 2019 concluded that just over 2,500 military-affiliated youth received the treatment between October 2009 and April 2017 during roughly 6,700 separate office visits.