House Passes ‘Big, Beautiful Bill’ That’s a Vicious Attack on Abortion and Gender-Affirming Care

The budget bill would "defund" Planned Parenthood, closing nearly 200 clinics, and prohibit Medicaid from covering healthcare for transgender people, no matter their age.

By Susan Rinkunas | May 22, 2025 | 3:22pm

Photo: Getty Images Abortion Politics

House Passes ‘Big, Beautiful Bill’ That’s a Vicious Attack on Abortion and Gender-Affirming Care

Just before 7 a.m. on Thursday, the House passed a spending bill that would cut taxes for the wealthiest people and companies in the U.S., while slashing programs that help those working to make ends meet. It’s what President Donald Trump has for months been calling the “big, beautiful bill,” which of course means it’s ugly and vicious.

The bill targets healthcare in multiple ways, and between 8 million and 15 million people could lose their insurance altogether thanks to work requirements and the end of assistance to pay monthly premiums. For people who retain coverage, devastating changes would include: banning Medicaid from being used for non-abortion services at Planned Parenthood, banning Medicaid from covering gender-affirming care for people of any age, and blocking insurance plans purchased on the exchanges from covering abortion or gender-affirming care. These are proposals ripped out of Project 2025. And, once again, attacks on trans people are following the anti-abortion playbook, as excluding abortion from Medicaid was one step in the long road leading to total abortion bans.

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The bill still has to pass the Senate, but it is a brazen attack on people’s lives and dignity. Last week, disability rights activists disrupted a House hearing on the Medicaid cuts and 25 people, including several wheelchair users, were arrested.

The bill, H.R. 1, passed by one vote, 215–214. Only two Republicans joined Democrats to oppose it: Reps. Thomas Massie of Kentucky and Warren Davidson of Ohio, while Andy Harris of Maryland voted “present.” That slim margin means there’s a world where, if Rep. Gerry Connolly (D-Va.) were still alive, the bill might have failed. (In that world, some of the GOP holdouts might have voted yes, but we’ll never know.)

Medicaid is a health insurance program for people with low incomes, pregnant people, children, and people with disabilities. It’s jointly funded by the federal government and the states. States could decide to allot money to cover gender-affirming care, like some have done with abortion, but that would lead to a patchwork system.

The bill initially banned Medicaid from covering trans minors’ healthcare, but an amendment introduced Wednesday night stripped out the words “for minors,” meaning the provision would apply to people of any age. Republicans have long argued that parents who support their trans children should not be able to help their kids get healthcare recommended by a doctor, and they are now trying to limit adults from getting care to which they themselves consent. The bill defines “procedures” that Medicaid cannot cover to include surgeries and hormone therapy.

House Republicans' managers amendment to the reconciliation bill is outIt now explicitly prohibits Medicaid from covering gender-affirming health care for transgender people *overall*The reconciliation bill initially only targeted people under 18amendments-rules.house.gov/amendments/R…

— Oriana González (@oriana.bsky.social) 2025-05-22T01:42:15.724Z

The bill also bans marketplace plans that people purchase from covering gender-affirming care. In a vile move, this provision is listed under a section as “addressing waste, fraud, and abuse.” Life-saving healthcare is none of those things.

🚨 In addition to banning gender affirming medical treatment through Medicaid, Trump's reconciliation bill PROHIBITS health insurance purchased through Obamacare exchanges from offering transition care. Detransition care, though, is specifically protected. CALL YOUR HOUSE REPS!

— Ari Drennen (@aridrennen.bsky.social) 2025-05-22T04:39:18.548Z

Now onto abortion.

The budget bill text doesn’t address Planned Parenthood by name, but rather it blocks funding from abortion providers that receive more than $1 million in Medicaid payments per year. What conservatives call “defunding” is a misnomer; there’s no line item in the budget for Planned Parenthood. The Hyde Amendment prevents federal funding from covering abortion in nearly all cases, but some abortion providers accept Medicaid for other services like birth control, cancer screenings, and STI testing and treatment. Any money Planned Parenthood gets from Medicaid is a result of people using their insurance at the clinics. (The organization also gets federal grants to provide low- and no-cost birth control for low-income people through a program called Title X. The Trump administration is attacking that program and freezing grants, citing its executive orders against diversity, equity, and inclusion initiatives.)

The nonpartisan Congressional Budget Office estimated that blocking Planned Parenthood from Medicaid would increase the federal deficit by $300 million over 10 years, as fewer people are able to access services like birth control and more people give birth. The last time Republicans considered doing this in 2017, the CBO’s estimated cost was a smaller $130 million, chalked up mostly to the fact that “the number of births in the Medicaid program would increase by several thousand per year.” (There is also a pending Supreme Court case about whether states can kick Planned Parenthood out of their Medicaid programs, with a decision expected next month.)

But, Planned Parenthood said on Wednesday that if the bill passes, nearly 200 of its clinics would close, with 90% in states where abortion is still legal. “The number of Planned Parenthood health centers in abortion access states could be cut in half,” their press release read. So this bill could affect anyone who gets care from the organization, no matter what kind of insurance they have, and it could further reduce options for abortion-seekers traveling to other states.

Finally, as with gender-affirming care, the amended bill also attacks the insurance plans that people purchase for themselves. Per Politico’s Alice Ollstein, it would ban Obamacare plans from covering abortion, and insurance companies that sell plans to people that continue to cover abortion care could face penalties.

In addition to defunding Planned Parenthood, the bill the House passed this a.m. includes a last-minute change that would make it difficult-to-impossible for private plans on the Obamacare exchanges to cover abortion. Some states, including NY and CA, require such coverage.

— Alice Miranda Ollstein (@alicemiranda.bsky.social) 2025-05-22T12:33:23.392Z

There is already a longstanding ban on federal funding for abortion. This is a new extension into the private insurance market that sets up a state/federal clash starting next year if the bill becomes law. Insurers would be penalized and denied federal $ if they use OTHER money to pay for abortions.

— Alice Miranda Ollstein (@alicemiranda.bsky.social) 2025-05-22T12:34:15.438Z

This particular bill, a budget reconciliation measure, only needs 50 votes to pass the Senate, not the normal 60 to overcome the filibuster. (There are 53 Republican Senators.) There is hope that a Senate official called the parliamentarian, who enforces the chamber’s rules, would strip out some provisions like “defunding” abortion providers for being extraneous to a budget bill. The parliamentarian did exactly that in 2017 and the proposal died. Such a ruling would instead require the Senate to pass these policy preferences with 60 votes. But as Mark Joseph Stern wrote in Slate, Republicans are warming up to the idea of overruling the parliamentarian, and they just did it to repeal California’s vehicle emissions standards.

Even if pro-choice Republican Senators like Susan Collins and Lisa Murkowski vote against the bill, it could still pass the upper chamber and go to Trump’s desk. Act accordingly.

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