The U.S. Senate has narrowly passed its version of the One Big Beautiful Bill Act (OBBB), omitting anti-transgender health care provisions that had previously sparked widespread concern.
The bill passed with 50 Republican votes, and Vice President J.D. Vance casting the tie-breaking vote. Senate Democrats unanimously opposed the bill, joined by Republican Senators Rand Paul (KY), Thom Tillis (NC), and Susan Collins (ME). With this version excluding the House’s proposed restrictions on gender-affirming care, the legislation may now proceed without further targeting transgender individuals’ access to vital healthcare.
The House-passed version included sweeping bans on Medicaid, CHIP, and Affordable Care Act plans covering gender-affirming care, measures that LGBTQ+ advocates warned would severely impact transgender people reliant on these programs. The original Senate bill mirrored these provisions, but they were ultimately dropped to enable passage through the reconciliation process, which requires only a simple majority and is limited to budget-related legislation.
Last week, the Senate parliamentarian ruled that the anti-trans clauses were not budgetary, meaning their inclusion would have necessitated 60 votes. To keep the bill viable, Senate Republicans removed the provisions without seeking a floor vote.
Independent journalist Erin Reed and analysts at Transitics confirmed that the final bill text lacked any language about banning gender-affirming care, following scrutiny of the language.
While the removal of the anti-trans measures has been welcomed by LGBTQ+ rights advocates, the broader bill remains highly contentious. According to the Congressional Budget Office, it will add $3.3 trillion to the national debt over the next decade, primarily due to tax cuts. It is also projected to remove 12 million Americans from Medicaid, a key healthcare program for low-income individuals.
Democratic Senator Tammy Baldwin (WI), one of the chamber’s few openly LGBTQ+ members, fiercely criticised the bill. “Instead of standing up for these working families, my Republican colleagues jammed through a bill that guts Medicaid, kicks 17 million Americans off their health insurance, shutters rural hospitals, and takes food from families in need,” she said.
Baldwin vowed continued resistance: “This fight isn’t over, and together, we can still beat this thing.”
