The Pentagon is seen during a military flyover on May 2, 2020. The U.S. Senate on Wednesday cleared the annual defense authorization bill. (U.S. Air Force photo by Tech. Sgt. Ned T. Johnston/Released)

WASHINGTON — The U.S. Senate on Wednesday cleared a national defense authorization bill celebrated for troop pay raises but condemned by Democrats for targeting transgender children in military families, sending the bill to President Joe Biden’s desk.

Senators voted 85-14, with one, Vice President-elect J.D. Vance, not voting, to approve the $884.9 billion National Defense Authorization Act that received bipartisan praise for the pay bump, upgrades to military housing and investments in artificial intelligence and other advanced technology.

But the annual legislation drew ire this year from Democrats for a provision banning the military’s health program from covering certain treatments for youth experiencing gender dysphoria, defined by doctors as the mismatch between a person’s sex assigned at birth and the gender they experience in everyday life.

The U.S. House passed the defense package Dec. 11 with a bipartisan 241-180 vote.

The White House has not released its position on the bill, as it generally does with legislation ready for the president’s signature.

Wednesday’s Senate vote marks the 64th year in a row Congress has passed the defense package, a historically bipartisan process.

This year’s vote breakdown did not stray far from the Senate tallies for the defense legislation over the last five years.

The bill does not release funding for the Pentagon, but rather it outlines how any defense money will be spent. Congress will need to approve allocation of dollars in separate appropriations legislation.

Gender care

A short section tucked in the 1,800-page policy roadmap for 2025 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.”

Democrats maintain the ban will affect thousands of military families, though the Pentagon has declined to comment on any figures. The Pentagon also did not respond to a second inquiry from States Newsroom about whether the Defense Department tracks numbers of service members’ transgender children.

Treatment for gender dysphoria can include mental health measures, hormone therapy and surgery.

The provision comes as more than 20 states have banned or limited gender-affirming care for transgender minors, according to the Association of American Medical Colleges. The UCLA School of Law Williams Institute found that 113,900 youths aged 13 to 17 live in states that ban such treatments.

While the bill does not specifically delineate the types of interventions it intends to prohibit, a publicly available summary from the GOP-led House Armed Services Committee named “hormones and puberty blockers.” The summary, titled “Restoring the Focus of Our Military on Lethality,” also highlighted language in the legislation to ban certain race-related education in Defense institutions and a freeze on any Pentagon diversity, equity and inclusion, or DEI, hiring.

Sen. Jack Reed, chair of the Senate Committee on Armed Services, said he shared his Democratic colleagues’ frustrations and characterized the ban on care coverage for transgender youth, which he voted against during the committee process, as “misguided.”

“Ultimately, though, we have before us a very strong National Defense Authorization Act. I am confident it will provide the Department of Defense and our military men and women with the resources they need to meet and defeat the national security threats we face now,” Reed, of Rhode Island, said on the floor ahead of the vote.

Sen. Roger Wicker, the committee’s ranking member, praised the “immense accomplishments” in the defense package, including the 4.5% pay bump for all service members, plus an extra 10% raise for the most junior enlisted troops.

“We made investments in Junior ROTC and recruitment capabilities, both of which will help solve the military’s manpower crisis. This bill stops the Department of Defense from paying for puberty blockers and hormone therapies for children. We blocked the teaching of critical race theory in military programming, and we froze diversity equity and inclusion hiring,” the Mississippi Republican said before voting commenced.

‘Cheap political points’

Sen. Tammy Baldwin, the first openly LGBTQ person elected to the Senate, said on the floor Tuesday that for the first time in her 12 years in the Senate, she would oppose the annual defense bill.

The Wisconsin Democrat, who voted against the bill Wednesday, said the commitment to the historically bipartisan exercise was “broken because some Republicans decided that gutting the rights of our service members to score cheap political points was more worthy.”

“Some folks estimate that this will impact between 6,000 and 7,000 families in the military. I, for one, trust these service members and their families to make their own decisions about health care without politicians butting in,” she continued.

Majority Leader Chuck Schumer asked to withdraw Baldwin’s amendment to strip the language from the legislation. The request was approved immediately before Wednesday’s vote without a challenge. The leader’s office did not respond to a request for comment on the withdrawn amendment.

Twenty Democratic senators initially co-sponsored the amendment. They include Alex Padilla of California, John Hickenlooper of Colorado, Richard Blumenthal and Chris Murphy of Connecticut, Mazie Hirono and Brian Schatz of Hawaii, Dick Durbin of Illinois, Chris Van Hollen of Maryland, Ed Markey and Elizabeth Warren of Massachusetts, Amy Klobuchar and Tina Smith of Minnesota, Cory Booker and Andy Kim of New Jersey, Martin Heinrich of New Mexico, Ron Wyden and Jeff Merkley of Oregon, John Fetterman of Pennsylvania, Sheldon Whitehouse of Rhode Island and Patty Murray of Washington.

Kim, a former U.S. representative who was sworn in as a senator on Dec. 9, said House Speaker Mike Johnson’s insistence on the transgender provision in the bill “undermines trust in negotiations and sets a dangerous precedent for what is widely considered the last true space of traditional bipartisan legislation.”

“We are putting politics into a bill where it simply does not belong,” Kim said on the floor Tuesday.

Kim ultimately voted in support of the bill.

The chair of the GOP-led House Armed Services Committee, Rep. Mike Rogers of Alabama, told Capitol Hill reporters last week that Johnson did not consult him before keeping the language in the final version.

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.

Transgender rights opponents and a supporter rally outside of the U.S. Supreme Court as the justices hear arguments in a case on transgender health rights on December 4, 2024 in Washington, DC. The Supreme Court is hearing arguments in US v. Skrmetti, a case about Tennessee's law banning gender-affirming care for minors and if it violates the Constitution’s equal protection guarantee. (Photo by Kevin Dietsch/Getty Images)

A conservative U.S. Supreme Court appeared ready to side with Tennessee Wednesday in upholding the state’s ban on gender affirming care for minors, a case likely to set legal precedent on equal protection for transgender children.

A decision from the court isn’t expected until June 2025, but Republican-appointed justices such as Samuel Alito, Clarence Thomas and Brett Kavanaugh tipped their hands on how they would rule during three hours of oral arguments in Washington, D.C.

They were countered by the court’s liberal justices, Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson, who are outnumbered 6-3.

Conservative justices appeared leery of creating a protected class, but Jackson, for instance, indicated the law clearly discriminates on the basis of sex. Jackson used the Loving v. Virginia case that allowed racially integrated marriages to show that similar arguments were made against those types of unions some 50 years ago.

Three families with transgender children and Memphis Dr. Susan Lacy sued the state, then the federal government intervened on behalf of the plaintiffs who are challenging Tennessee’s ban on puberty blockers and hormone therapy to allow minors to make a sex transition.

Thomas, for instance, asked the federal government’s attorney why the case would be a matter of age classification, as opposed to sex. Alito and Kavanaugh raised questions about the United Kingdom and European countries dialing back support for gender affirming care.

In addition, Roberts said the court is “not the best situated to address issues” such as gender affirming care and should allow legislatures to make those types of decisions.

Tennessee lawmakers passed Senate Bill 1 in 2023 following an uproar over reports by a right-wing radio commentator that Vanderbilt University Medical Center was performing surgeries and administering puberty blockers and hormone therapy to children. Vanderbilt said it wasn’t performing surgical procedures when the issue erupted.

Gov. Bill Lee says Tennessee has a “compelling interest in encouraging minors to appreciate their sex, particularly as they undergo puberty,” and in blocking treatments “that might encourage minors to become disdainful of their sex.

The American Civil Liberties Union, ACLU Tennessee, Lambda Legal and Akin Gump Strauss Hauer & Feld filed suit against Tennessee, claiming the equal protection rights of transgender children were violated. The law was struck down in U.S. District Court, but that decision was overturned by the 6th Circuit Court of Appeals, and the U.S. Supreme Court agreed to hear the case.

Tennessee’s legal strategy is based on the premise that the 2023 law prohibiting puberty blockers and hormone therapy for young people is based on “medical purposes,” not a child’s sex.

In contrast, attorneys for the plaintiffs said Senate Bill 1 created a blanket ban on gender affirming care based entirely on a minor’s desire to change sexes. They pointed out children suffering from gender dysphoria could be prone to suicide if they don’t receive puberty blockers or hormone treatments that enable them to start the transition toward a sex different from their birth sex.

Attorneys for the plaintiffs say the Supreme Court should give the matter “heightened scrutiny,” or a closer examination, because it involves discrimination against transgender children rather than review it under standard “rational basis,” which is typically used when a law doesn’t involve a constitutional right.

Elizabeth Prelogar, solicitor general for the Department of Justice, told the justices the state of West Virginia enacted a law that set up requirements for undergoing gender affirming care, whereas Tennessee passed a blanket ban affecting children seeking to transition to another sex.

Justice Kagan made the point that the law is based on “transgender status” and not sex alone. She also said Tennessee appears to want to “conform to sex stereotypes.”

Kavanaugh stuck with the argument that some transgender people want to switch back to their original sex when they get older but are physically unable to make the change.

“How do we as a court choose which set of risks is more serious when we constitutionalize?” Kavanaugh said.

Tennessee Lookout is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Tennessee Lookout maintains editorial independence. Contact Editor Holly McCall for questions: info@tennesseelookout.com. Follow Tennessee Lookout on Facebook and X.

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No.

U.S. Sen. Tammy Baldwin, D-Wis., has not stated support for gender-affirming surgeries for minors.

A claim about Baldwin supporting “sex change surgeries” for children was made in an Oct. 8, 2024, ad from the Senate Leadership Fund, a conservative super PAC.

It alluded to Baldwin saying transgender kids deserve to “get the health care they need.”

Her October 2023 post included one by Wisconsin Gov. Tony Evers, who promised to veto legislation (vetoed in December) that would have banned medical transition for minors.

Baldwin’s campaign said Baldwin supported the veto because doctors could have been disciplined even for counseling LGBTQ+ youths.

The fund cited to Wisconsin Watch instances of Baldwin supporting gender-affirming care, defined by the World Health Organization as social, psychological, or medical interventions, including surgery, to “affirm an individual’s gender identity.”

In Wisconsin, transgender care for children is prescribed with parental involvement. It involves no medication until puberty and no surgery in most cases until adulthood.

This fact brief is responsive to conversations such as this one.

Sources

Senate Leadership Fund: SLF: “What Happened” 30s – WI

Google Docs: Screenshot of Senate Leadership Fund 10/8/24 Baldwin ad

Open Secrets: Senate Leadership Fund

X: Sen. Tammy Baldwin on X: “Trans kids deserve to feel safe and welcome in Wisconsin, not discriminated against. They deserve the freedom to just be kids, play sports, and get the health care they need,

X: Gov. Tony Evers post

Wisconsin Watch: Wisconsin Gov. Tony Evers vetoes trans youth care ban

Google Docs: Tammy Baldwin campaign email 10/11/24

Google Docs: Senate Leadership Fund email 10/9/24

World Health Organization: Gender incongruence and transgender health in the ICD

Advocate: Republican opponent attacks out Sen. Tammy Baldwin by lying about her support of gender-affirming care

The Guardian: Wisconsin Senate race tightens as rival attacks Baldwin over LGBTQ+ support

Semafor: Anti-trans ads didn’t work in 2022. Republicans think this time will be different.

Wisconsin Republican Party: ICYMI: Tammy Baldwin continues crusade against biological females — honored by advocates of gender transition treatments for children

Has Tammy Baldwin supported ‘sex change surgeries’ for children? is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.