This resource talks about the federal budget process and Medicaid. To learn more about the federal budget process and Medicaid, read this plain language guide.
Words to know
Affordable Care Act (ACA) – The Affordable Care Act is a law. The Affordable Care Act made it easier for people to get Medicaid. The Affordable Care Act gets called the ACA for short.
CHIP – CHIP stands for Children’s Health Insurance Program. CHIP is a program that gives health insurance to children whose parents can’t get Medicaid.
Essential Health Benefits (EHBs) – kinds of health care that ACA health insurance plans have to pay for. Essential Health Benefits get called EHBs for short.
Gender-affirming care – Gender-affirming care is a type of health care. Gender-affirming care helps people’ bodies look and feel like the gender they want to be seen as. Gender-affirming care gets called GAC for short.
Intersex – People who are born with traits that both boys and girls have.
Marketplace plans – Health insurance plans that cost less money. The ACA made marketplace plans.
Medicaid – A program run by the government to help people pay for health care and services. Medicaid helps people who do not have a lot of money. Medicaid also helps people with disabilities.
Medicaid expansion – When states decide to let more people get Medicaid.
Minors – people who are less than 18 years old.
Nonbinary – people who don’t want to be either a boy or a girl. You may hear non-binary people use words to talk about themselves, like: genderqueer, gender-fluid, and other words.
Private insurance – health insurance that is run by a company and not by the government.
Public insurance – health insurance that is run by the United States government.
Transgender – a person whose gender is different than people thought when the person was born.
What is gender-affirming care (GAC)?
The most recent version of the House budget reconciliation bill added some new rules. These rules are about getting health insurance to pay for gender-affirming care. Gender-affirming care (GAC for short) is a type of health care. GAC helps people’ bodies look and feel like the gender they want to be seen as. GAC can mean things like:
– hormone replacement therapy,
– top surgery,
– and more.
Many people who get GAC are transgender, nonbinary, or intersex. Transgender means that your gender is different than people thought when you were born. Nonbinary means that you don’t want to be either a boy or a girl. You may hear non-binary people use words to talk about themselves, like: genderqueer, gender-fluid, and other words. Intersex people are born with traits that both boys and girls have. They might be born with different genitals. Or they might be born with different hormones. Their body doesn’t fit into being a “boy” or a “girl”.
There are lots of different genders. But some people think there are only 2. When people are born, the doctor usually says “It’s a boy!” or “It’s a girl!” The doctor says this based on what someone’s body looks like. But sometimes the doctor is wrong. You don’t have to be a boy or girl just because of what your body looks like. Sometimes, a person who was told she was a boy is actually a girl. Sometimes, a person is not a boy or a girl. Sometimes, a person does not have a gender. Sometimes, a person feels like different genders at different times.
For example: Billy is transgender. When Billy was born, everyone thought he was a girl. But Billy knew he was a boy. Billy told people that he was a boy. Now, he lives his life as a man.
To learn more about transgender, nonbinary, and intersex people, read this plain language resource.
What does the budget reconciliation bill say about gender-affirming care (GAC) and health insurance?
Getting GAC through Medicaid and CHIP
The House version of the budget reconciliation bill talks about Medicaid and the Children’s Health Insurance Program (CHIP). Medicaid is a program run by the government to help people pay for health care and services. Medicaid helps people who do not have a lot of money. Medicaid also helps people with disabilities. CHIP is a program that gives health insurance to children whose parents can’t get Medicaid. Sometimes, parents make too much money to get Medicaid. But those parents do not make enough money to pay for private health insurance for their whole family. Private health insurance is run by a company and not by the government. CHIP helps parents get health insurance for their children.
The House version of the budget reconciliation bill says that Medicaid and CHIP can not pay for GAC for minors or adults. Minors are people who are less than 18 years old. That means if a minor gets health care through Medicaid or CHIP, their health care plan will not pay for GAC. If an adult gets health care through Medicaid, their health care plan will not pay for GAC.
It is wrong for the House to stop people from using Medicaid or CHIP to pay for GAC. The choice to get GAC should be made as a team. That team should be:
– the person who wants surgery,
– their caregivers,
– and their doctors.
GAC is medically necessary. That means if someone can’t get the GAC they need, their mental and physical health will be hurt badly.
Getting GAC through other kinds of health insurance
The House budget bill also makes new rules about GAC for adults. The new rules are about adults who have certain kinds of insurance. The House budget bill makes rules about GAC under the Affordable Care Act (ACA).
The ACA is a law. The ACA made it easier for people to get Medicaid. The ACA also gave states the option to let more people in their state receive Medicaid. This is called Medicaid expansion. Medicaid is public insurance. Public insurance is run by the U.S. government.
The ACA also made it easier for people to get some types of private insurance. Private health insurance is run by a company and not the U.S. government. The ACA made some types of private insurance cost less money. The types of private insurance that cost less money are called marketplace plans. To learn more about the ACA, read this guide.
ACA health insurance programs have to follow certain rules. One rule is that ACA health insurance programs have to pay for Essential Health Benefits (EHBs). EHBs are kinds of health care that ACA health insurance plans have to pay for. Right now, many kinds of GAC are an EHB under the ACA. That means that most kinds of health insurance have to pay for GAC. It is a good thing that GAC is an EHB. It means that many people can get help paying for their GAC through their insurance.
The House budget reconciliation bill says that GAC can not be an EHB for many ACA health insurance plans. That means many ACA health insurance plans would not have to pay for GAC. This would be bad for the transgender and nonbinary people who get health insurance through ACA plans.
This bill does not say that people have to stop getting GAC. But stopping GAC from being an EHB would make it a lot harder for people to get the care they need. It would make getting GAC a lot more expensive. And it would mean fewer health insurance companies will pay for GAC.
Gender-affirming care (GAC) is important health care. Health insurance should pay for GAC. It is wrong for the government to try to stop health insurance from paying for GAC.
What can we do to fight for GAC in the budget bill?
Even though the House passed their bill, the fight isn’t over. The Senate has not passed their version of the budget reconciliation bill yet. We have to take action now to stop cuts to Medicaid and gender-affirming care.
Making a law that some kinds of health care can not be an Essential Health Benefit will make it harder for people to get health care. Making it harder for people to get health care means that people will get fewer health care benefits. Making it harder for people to get health care means that people will lose insurance coverage for some kinds of health care. You can tell your legislators that you do not want people to lose coverage. You can tell your legislators that you do not want people to get fewer health care benefits. You can tell your legislators that you do not want any cuts to Medicaid.
ASAN made a plain language guide to help people talk to their legislators about Medicaid. The guide shows you how to find contact information for your legislators. The guide has scripts you can use when you call or email your legislators. You can read the guide here.