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A MidWestern transgender woman trying to survive in the real life.

Tag: public administration

OPM Ends Gender-Affirming Care in 2026

By

On August 25, 2025

In LGBTQ+ rights

The recent announcement from the Office of Personnel Management (OPM) that gender-affirming health care will be excluded from the Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) programs beginning in 2026 represents a profound step backward in civil rights and health equity. Under this directive, chemical and surgical interventions for gender transition will no longer be covered, though counseling for gender dysphoria must remain available. Insurance carriers are required to develop exceptions processes for individuals currently undergoing such care, yet the parameters of those processes remain undefined. Providers of gender-affirming care are also barred from being listed in plan directories, effectively discouraging access (Office of Personnel Management, 2025; Moss, 2025).

To understand the gravity of this reversal, it is necessary to recall how hard-fought the gains for transgender health care under FEHB were. In 2014, OPM lifted the longstanding blanket exclusion of gender-affirming procedures, and by 2016 carriers were instructed not to categorically deny such care. This change aligned federal benefits with emerging medical consensus that gender-affirming treatments are not elective but medically necessary. The World Professional Association for Transgender Health (WPATH) and the Endocrine Society have long affirmed that access to hormone therapy and surgeries significantly reduces psychological distress, improves quality of life, and prevents serious health complications (Hembree et al., 2017; Coleman et al., 2022). For nearly a decade, transgender federal employees and retirees could rely on this coverage as a matter of equity and recognition of their humanity.

As a transgender woman who has been receiving gender-affirming health care for more than eleven years, this policy shift strikes me not just as a bureaucratic adjustment but as a direct threat to my life and well-being. Having undergone an orchiectomy, I rely on estradiol not simply as an affirming treatment, but as essential hormone replacement. Without it, my bones, cardiovascular health, cognition, and emotional stability would be at severe risk. Estradiol for me is no different than thyroid medication for someone with hypothyroidism—it is medically necessary, lifelong care. To see it lumped under a politically charged category of “optional” transition services is both scientifically inaccurate and deeply insulting.

What unsettles me most is the uncertainty this policy creates. OPM’s promise of an “exceptions process” offers little clarity. Will it protect those of us with medical histories spanning over a decade of consistent care? Or will it force us into endless appeals and denials, treating every prescription refill as a battle? This ambiguity is destabilizing, and I cannot help but feel that it is intentional—designed to make care harder to access and to discourage providers from stepping forward.

As a federal retiree, I gave years of service under the assumption that the benefits I earned would protect me equitably. Now, I feel as though my identity has made me a target within the very system I trusted. The estimated 14,000 transgender federal employees and retirees who will be affected are not faceless statistics; we are people who dedicated our careers to serving this country, only to be told that our health care needs are unworthy of recognition (Lambda Legal, 2025; them.us, 2025). The exclusion also signals a dangerous precedent: that essential medical care can be stripped away not because of evidence or cost, but because of politics.

This change must be understood in its broader social context. Over the past decade, transgender Americans have seen both progress and backlash. The Affordable Care Act’s Section 1557 extended nondiscrimination protections in health care, and the Supreme Court’s ruling in Bostock v. Clayton County (2020) affirmed that gender identity is protected under Title VII. Yet, simultaneously, states across the country have passed laws restricting access to gender-affirming care, particularly for youth, framing these measures as cultural wedge issues. The OPM directive extends that wave of exclusion into the federal system, embedding discrimination into the nation’s largest employer-based insurance program.

For me personally, this is not an abstract policy debate. It is about whether I will be able to continue accessing the medication that keeps me healthy and alive. It is about whether the years of progress we celebrated were only temporary reprieves. And it is about what message this sends to younger transgender people entering federal service today: that their health and dignity can be used as bargaining chips in political battles.

I cannot help but feel anxious about what the future holds, but I also feel resolved. This rollback will not go unchallenged. Advocacy groups such as Lambda Legal, the National Center for Transgender Equality, and others have already condemned it as unlawful and are preparing legal strategies (Lambda Legal, 2025). As a transgender woman and a retiree, I plan to add my voice to that chorus, because silence is what allows discrimination to endure. We have fought too hard, and for too long, to let the ground be taken out from under us without resistance.

References

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., … Winter, S. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644

Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., … T’Sjoen, G. G. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869–3903. https://doi.org/10.1210/jc.2017-01658

Lambda Legal. (2025, August 19). Lambda Legal condemns Trump administration’s illegal exclusion of gender-affirming care from employee health benefits. Retrieved August 22, 2025, from https://lambdalegal.org/newsroom

Moss, K. (2025, August 20). Coverage for gender-affirming care will be eliminated from FEHB plans in 2026. Government Executive. Retrieved August 22, 2025, from https://www.govexec.com

Office of Personnel Management. (2025). Carrier Letter 2025-01b: Chemical and surgical sex-trait modification exclusion. Retrieved August 22, 2025, from https://opm.gov

them.us. (2025, August 20). Trump Admin to end coverage of gender-affirming care for federal workers. them. Retrieved August 22, 2025, from https://www.them

The Hidden Costs of Trump’s Big Beautiful Bill

By

On May 29, 2025

In Donald Trump

WASHINGTON, DC – MAY 22: U.S. Speaker of the House Mike Johnson (R-LA) speaks to the media after the House narrowly passed a bill forwarding President Donald Trump’s agenda at the U.S. Capitol on May 22, 2025 in Washington, DC. The tax and spending legislation, called the “One, Big, Beautiful Bill” Act, redirects money to the military and border security and includes cuts to Medicaid, education and other domestic programs. Johnson was flanked by House Committee Chairmen who helped craft the legislation. (Photo by Kevin Dietsch/Getty Images)

As a former Senior Program Specialist with the Supplemental Nutrition Assistance Program (SNAP) at the USDA’s Food and Nutrition Service, I am deeply concerned about the ramifications of President Donald Trump’s recently passed “One Big Beautiful Bill Act” (OBBB). While touted as a transformative economic package, this legislation poses significant threats to both the national economy and the well-being of millions of Americans, particularly through its drastic cuts to SNAP.

The OBBB extends the 2017 tax cuts and introduces additional reductions, primarily benefiting corporations and high-income individuals. Proponents argue that these measures will spur economic growth. However, the Congressional Budget Office projects that the bill will add approximately $3.8 trillion to the national deficit over the next decade (Vanity Fair, 2025). This increase in debt raises concerns about long-term fiscal sustainability and the potential for higher interest rates, which could stifle economic growth rather than promote it.

One of the most alarming aspects of the OBBB is the proposed $300 billion cut to SNAP over the next ten years (Kiplinger, 2025). These cuts would tighten eligibility requirements, shift program costs to states, and limit future benefit increases (Newsweek, 2025). Such changes threaten to increase food insecurity among low-income families, children, the elderly, and individuals with disabilities.

In Wisconsin, for instance, the state could lose over $300 million in food assistance, potentially affecting more than 700,000 residents (Economic Times, 2025). These reductions not only jeopardize the health and well-being of vulnerable populations but also place additional financial burdens on state governments and local communities.

SNAP benefits are not just a lifeline for recipients; they also play a crucial role in supporting local economies. Every dollar spent on SNAP generates approximately $1.50 to $1.80 in economic activity (KCRG, 2025). Cuts to the program could therefore have a cascading effect, reducing revenue for grocery stores, farmers, and food producers. In Iowa, the president of the Iowa Farmers Union expressed concern that reduced SNAP benefits would hurt farmers by decreasing demand for their products (KCRG, 2025).

The OBBB’s approach to shifting SNAP administrative costs to states—up to 75%—represents an unfunded mandate that could strain state budgets (Newsweek, 2025). States would be forced to make difficult decisions, potentially cutting other essential services or increasing taxes to cover the shortfall. This shift undermines the federal-state partnership that has been fundamental to the success of SNAP.

The “One Big Beautiful Bill Act” presents a facade of economic progress while undermining the very foundations of food security and fiscal responsibility. As someone who has dedicated a career to ensuring access to nutrition assistance, I find the proposed cuts to SNAP not only detrimental to individual well-being but also harmful to the broader economy. Policymakers must reconsider these provisions to protect vulnerable populations and maintain the integrity of programs that have long served as a safety net for millions of Americans.

References:

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