Just 22% of Americans believe that health insurance companies should be required to cover medical care for ‘gender transitions’ according to a Pew Research Poll and yet left-wing politicians and their allies in the health insurance industry continue to seek ways to force citizens to pay for this controversial coverage.
The Affordable Care Act (ACA) Marketplace is at the center of the policy battle. With the Trump administration’s return to power, sweeping changes are coming that will reshape who pays for these procedures—and who can opt out.
And Americans will soon face a stark choice: do they want to participate in funding these interventions or will they choose alternatives more in line with their values?
The supportive sounding but essentially deceitful phrase ‘gender-affirming care’, in reality refers to ‘sex change’ medical interventions which aim to change males to females and females to males.
In an executive order issued in January, President Trump outlined the administration’s position: ”It is the policy of the United States that it will not fund, sponsor, promote, assist, or support the so-called “transition” of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures,” the order stated.
As Jennifer Baurwens, Director of the Center for Family Studies at the Family Research Council put it: “Gender-affirming care creates an illusion that there is only one choice for children and their families to experience relief from their distress, and that is to become someone else”.
While the focus of the administration and lawmakers has been mainly on the impact on minors, when it comes to health insurance costs, the issue is by no means limited to children.
Yet despite concerns from within the medical profession and broader ethical and moral objections, for years, ACA Marketplace insurance plans have been quietly expanding coverage for gender-affirming care, including hormone therapies and surgeries. These procedures are not only medically and ethically contentious, but also expensive. Hormone therapy can cost thousands of dollars per year, and surgeries can run into the tens of thousands per patient.
While trans activists and their supporters in the medical and health insurance industries, claim these costs are negligible when spread across the insurance pool, the reality is that every new mandate—no matter how small—drives up premiums for everyone. In fact, insurers are proposing an 18% median premium increase for 2026, the largest since 2018, with coverage mandates cited as a key driver.
The insurance industry, ever eager to pass costs on to consumers, has been all too willing to comply with these mandates, knowing they can simply raise rates or reduce benefits elsewhere. Meanwhile, those who object to footing the bill for controversial procedures have had little recourse—until now.
The Trump administration’s new rules, finalized in June 2025, will prohibit ACA Marketplace plans from covering gender-affirming care as an Essential Health Benefit (EHB) starting in 2026. This means insurers will no longer be required to include these services in their standard plans, and any coverage that remains will be stripped of key consumer protections—such as out-of-pocket maximums and annual/lifetime limit bans.
The administration’s rationale is simple: most employer plans don’t cover these procedures, so why should taxpayers and policyholders be forced to subsidize them on the individual market?
This is a welcome change for those who believe that insurance should cover genuine medical necessities, not elective or experimental procedures with dubious long-term benefits. Critics of gender-affirming care point to the lack of rigorous, long-term studies on outcomes, especially for minors, and question whether these interventions should be foisted on the public through insurance mandates.
Of course, the insurance industry and progressive states are not giving up without a fight. At least 16 states and the District of Columbia have enacted “shield” laws and expanded insurance mandates to protect gender-affirming care, vowing to continue coverage regardless of federal policy.
Some states, like California and Washington, explicitly mandate coverage through state laws or insurance regulations. Others achieve this through broader nondiscrimination laws or by including gender-affirming care in their essential health benefits benchmark plan
But under the new rules, states that want to keep these mandates will have to pay for them out of their own budgets, rather than passing the costs onto the federal government or the broader insurance pool. This could mean higher state taxes or cuts to other services—hardly a win for fiscal responsibility and a particular insult to those living in such states who object to the practice.
The good news is that for those who are tired of being forced to subsidize controversial care, health care sharing ministries (HCSMs) offer a compelling alternative. These faith-based organizations are not insurance, but rather cost-sharing arrangements among like-minded individuals.
Crucially, HCSMs are legally exempt from ACA mandates and are free to exclude coverage for gender-affirming care and other services that conflict with their values. Members can rest assured that their contributions won’t be used to pay for procedures they find objectionable.
If you don’t want to pick up the tab for gender-affirming care, it’s time to look beyond the insurance industry. Healthshare ministries may not be for everyone, but for those who value both conscience and cost, they’re an option well worth considering.