The provisions would immediately strip Medicaid and Medicare coverage for gender-affirming care if passed by both chambers of Congress and signed into law. But their impact could stretch far beyond that narrow reading. President Trump, who has repeatedly shown a willingness to expand executive authority, could wield the language as yet another weapon in his ongoing campaign of federal funding threats. Armed with this budgetary provision, his administration could pressure hospitals and clinics—just as it has already done with youth gender care providers—by threatening to pull federal dollars unless they comply with sweeping anti-trans policies.

Importantly, the funding ban would cover all forms of gender-affirming care, including “social” or “psychological” interventions. That language sweeps far beyond medical treatment and could place adult psychological support, therapy, and counseling directly in the crosshairs, along with any federally funded effort deemed “social” in nature. In practice, “social” care often refers to basic steps like updating names in official systems, changing gender markers, or affirming identity in institutional settings. Under this provision, the Trump administration could interpret even those routine measures as violations, weaponizing the ban to choke off critical funding for any entity deemed out of compliance.

These are not the only provisions in the appropriations bill targeting transgender people. Another section stipulates that any educational institution receiving federal funding could lose that funding if it allows transgender female students to participate in “athletic programs or activities designated for women or girls.” Such language would function as a de facto national transgender sports ban, forcing schools and universities into compliance. Even more troubling, the vague use of the word “activity” could give the administration sweeping latitude to strong-arm schools into broader restrictions—potentially extending to bathrooms, dorms, and virtually any gendered program or event, even if it may not be fully supported by some readings of the text.