WASHINGTON, D.C. (Bloomberg Law) — President Donald Trump’s rescission of executive orders protecting LGBTQ+ individuals in the federal workforce jeopardizes future coverage of gender-affirming care in federal health plans, though advocates say denying care would violate anti-discrimination laws.
Trump revoked a series of former President Joe Biden’s executive orders on his first day in office, including two 2021 directives that led the Office of Personnel Management to expand gender-affirming care in the Federal Employees Health Benefits Program. A separate order Trump signed effectively erases the recognition of transgender individuals at the federal level, saying the administration will only acknowledge the existence of two sexes.
Trump signed another order Jan.28 directing OPM to remove “pediatric transgender surgeries or hormone treatments” from FEHB plans next year.
The moves don’t immediately impact adults’ coverage under federal health plans, but the administration’s position on transgender people—coupled with promises to slash trillions in government spending—signals that more is likely on the horizon. Attempts to curtail gender-affirming care for adults would likely trigger another legal battle over Title VII of the 1964 Civil Rights Act, which the US Supreme Court’s 2020 decision in Bostock v. Clayton County said encompasses gender identity protections. The ruling’s scope, however, has been debated.
“It really is because of executive order that the health insurance carriers have been covering these types of care,” said Debra D’Agostino, a partner with Federal Practice Group LLP. “Taking these executive orders away—and obviously issuing an affirmative one saying that sex does not encompass gender identity—is certainly going to likely mean a change in health insurance coverage.”
An OPM spokesperson referred Bloomberg Law to the White House, which did not respond to a request for comment.
The FEHB program is the nation’s largest employer-sponsored health insurance program, covering an estimated 8.3 million federal civil service employees and their families through 180 plans. In 2023, 72% of enrollees and dependents who sought gender-affirming care could access it, according to the Federal Employee Benefits Survey.
House Republicans are floating a proposal to convert the FEHB Program to a voucher system, which a leaked policy document estimates could reduce spending between $16 billion and $18 billion over 10 years.
Trump’s ‘two sexes’ order doesn’t reference the FEHB Program, but the broader intentions are there, said Michael Fallings, a partner with Tully Rinckey PLLC.
“From how I read it, it’s really directing all federal agencies to end any benefit or expansion,” he said.
“OPM would rely on this executive order as far as instituting new rules and procedures,” he added.
The order does explicitly target care in federal prisons, and on Jan. 27 Trump signed another order aimed at ousting transgender troops from the military.
