As we continue to consider the Medicaid provisions in the One Big Beautiful Bill Act, today we’ll tackle one that’s really ruffling some feathers on the far left: the provision that prohibits Medicaid and CHIP from covering gender-affirming treatments for individuals of all ages. This sweeping ban, tucked into what’s now being affectionately dubbed the Crenshaw Amendment, has folks from Berkeley to Brooklyn losing their collective minds. But let’s take a calm, clear-eyed look at what this really means, and why it matters.

What’s in the Bill?

This provision is essentially a categorical ban on using federal Medicaid and CHIP funds for gender transition procedures. This means that taxpayer dollars can no longer be used to cover hormone therapies, gender reassignment surgeries, puberty blockers, or any other medical interventions intended to change or affirm a person’s gender identity when it conflicts with their biological sex. In other words, if it’s part of a gender transition plan, it’s no longer eligible for federal reimbursement.

This isn’t just a tweak around the edges. It’s a full-scale application of the principle laid out in President Trump’s Executive Order 14187, which already barred federal funds for gender-related medical treatments for minors under the age of 19. What this new legislation does is expand that restriction to adults as well, making it a uniform national policy. All ages. All states. One federal standard.

This particular provision was introduced by Representative Dan Crenshaw of Texas, who’s been outspoken about the need to protect vulnerable individuals from what he describes as “experimental, irreversible, and ideologically driven procedures.” Crenshaw’s stance is that these treatments, especially when subsidized by public funds, not only lack a sound medical basis for many patients but also represent a dangerous entanglement between government and radical social ideologies.

In practice, this amendment rewrites Section 1903(i) of the Social Security Act to ensure that Medicaid — which already eats up a huge chunk of the federal budget — isn’t being used to bankroll procedures that many Americans find morally objectionable and medically questionable.

So, what you’ve got here is a clear message from Washington: federal healthcare programs are going back to the basics: treating actual diseases, not funding controversial identity experiments.

The Arguments for the Provision

Protecting Children and Upholding Sanity in Medicine

First and foremost, this is about protecting our children — body, mind, and soul. We live in a world where a 13-year-old can’t legally get a tattoo, can’t drive a car, can’t vote, and can’t buy cough syrup without a parent. But in some places, that same 13-year-old can be put on hormone blockers that halt natural puberty, or even pushed toward surgeries with permanent, irreversible consequences. That’s not just medical malpractice, that’s madness masquerading as compassion.

Christian conservatives, and frankly many common-sense Americans, are sounding the alarm here not out of hatred or fear, but out of deep concern for the well-being of children. The Bible says plainly, “So God created man in his own image… male and female created he them” (Genesis 1:27). That’s not up for revision. It’s not a suggestion. It’s a fundamental truth that shapes how we understand ourselves, our purpose, and our design.

Treating puberty like it’s a disease — something to be blocked, delayed, or corrected — is a dangerous distortion. Puberty is a natural, God-given process of growing into maturity. It’s not a problem to solve. It’s not an illness to treat. When medical professionals start administering hormone treatments or recommending surgeries to children who can’t fully grasp long-term consequences, they cross a line. Kids are not test subjects for social experiments. They deserve protection, not ideological experimentation.

And let’s be honest: children are highly impressionable. They’re still figuring out who they are. Yet some adults are encouraging them to make life-altering decisions based on fleeting feelings, social pressures, or TikTok trends and calling it healthcare.

This provision reestablishes the boundary between genuine care and dangerous overreach. It says clearly: if you’re under the care of a government-funded health program, you shouldn’t be subjected to treatments that are irreversible, controversial, and deeply contested among medical professionals and moral leaders alike.

We don’t let kids sign up for a mortgage or enlist in the military because we understand they’re not ready. So why on earth would we let them permanently alter their bodies based on feelings they may not even hold a few years down the road?

Protecting children isn’t just a political stance, it’s a moral duty. And this provision is a long-overdue stand for medical sanity and moral clarity in a world that’s been drifting too far, too fast.

Fiscal Responsibility: Priorities Matter

Let’s talk brass tacks. Medicaid and CHIP weren’t designed to bankroll controversial medical experiments, they were created to help those in genuine need: low-income families, elderly Americans living on fixed incomes, children born with disabilities, and folks dealing with serious, life-threatening conditions. In short, these programs are a lifeline for the vulnerable, not a blank check for ideology-driven procedures.

Now, take a look at our national debt. It’s rising faster than a thermometer in a Texas July and we’re mortgaging our grandkids’ future. Every dollar we spend needs to be justified, prioritized, and stewarded with care. And yet, here come demands for taxpayer-funded gender surgeries and hormone treatments that are, by all reasonable standards, elective. Not lifesaving. Not urgent. Elective.

We’re not talking about emergency heart surgery or cancer treatment. We’re talking about procedures that attempt to change someone’s biological sex, something no amount of drugs or scalpels can truly achieve. It’s one thing for an adult to pursue these procedures on their own dime. It’s another thing entirely to expect the American taxpayer — many of whom hold deep moral objections — to foot the bill.

Fiscal responsibility means making hard choices. And in a time of economic uncertainty, high inflation, and rising healthcare costs, we can’t afford to be careless. Every dollar funneled into gender transition procedures is a dollar not spent on prenatal care, cancer screenings, mental health services, or helping elderly patients get their prescriptions filled. That’s not compassion, that’s mismanagement.

Furthermore, when government-funded health programs start covering politically charged and medically controversial procedures, it sets a dangerous precedent. It politicizes medicine and burdens taxpayers with the cost of trends driven more by activism than sound science.

This isn’t about cruelty or exclusion. It’s about saying, “Let’s get our priorities straight.” We owe it to the truly needy — and to future generations — to keep Medicaid and CHIP focused on their original mission: healing the sick, caring for the poor, and preserving human life. That’s real compassion, grounded in truth and guided by wisdom.

Moral and Cultural Integrity

Just a little good ol’ fashioned common sense tells us that male and female are not just social constructs, they are God-given, biologically rooted, and deeply meaningful distinctions.

When the government starts using taxpayer dollars to fund gender transition procedures, it’s not just making a budgetary choice, it’s making a moral statement. It’s taking sides in a deep cultural and spiritual conflict. It’s saying, in essence, that biology is optional, truth is flexible, and that the Creator’s design can be edited like a Wikipedia page.

For millions of Americans, this isn’t just about policy. This is a spiritual battle over truth, identity, and the very nature of human dignity. It cuts to the core of what we believe about God, creation, and the value of every individual as made in His image.

Funding gender transitions isn’t morally neutral; it’s an endorsement of a worldview that denies the reality God wrote into our DNA. It’s a culture-wide attempt to replace divine order with human confusion, and it’s being done with our own tax dollars. That should concern every believer, every parent, and every citizen who still thinks truth matters.

This isn’t about hating anyone. Quite the opposite, it’s about loving people enough to stand firm on what’s right. Love doesn’t always mean affirmation. Sometimes it means having the courage to say, “This far, and no further.” True compassion walks hand-in-hand with truth. And when it comes to public policy, cultural sanity, and moral clarity, this provision is a long-overdue course correction.

In a nation drifting further into confusion, drawing a line in defense of biological reality and biblical truth isn’t just the right thing, it’s the righteous thing.

The Arguments Against the Provision

Medical Support for Gender-Affirming Care

Proponents of gender-affirming treatments often lean on the backing of major medical organizations like the American Medical Association, the American Academy of Pediatrics, and others. They argue that these interventions — including hormone therapy, puberty blockers, and surgeries — can help reduce depression, anxiety, and suicidal ideation among individuals who identify as transgender. According to this view, denying access to these treatments is seen not just as a policy failure, but as a threat to mental health and personal well-being.

Now let’s be clear: the claim that people are hurting and in need of help should always be taken seriously. No one should mock or minimize the pain of someone struggling with identity, confusion, or despair. As Christians, we’re called to weep with those who weep and bear one another’s burdens (Romans 12:15, Galatians 6:2). But compassion doesn’t mean abandoning discernment.

Just because a treatment is endorsed by some within the medical establishment doesn’t make it morally right, scientifically sound, or universally effective. The history of medicine is filled with examples of “expert consensus” turning out to be disastrously wrong: lobotomies for mental illness, thalidomide for morning sickness, and yes, doctors promoting cigarettes for stress relief. So, when a radical new protocol emerges that flies in the face of biology, long-standing ethics, and religious conviction, we have every right — and responsibility — to say, “Hold on a minute.”

Medical institutions are not immune to political pressure, cultural trends, or ideological capture. In fact, we’ve seen just how quickly medicine can be swayed when activism replaces objectivity and debate is silenced in the name of “progress.” The science surrounding gender-affirming care is far from settled. Long-term studies are limited, many treatments are experimental, and there are growing numbers of detransitioners speaking out about regret and the harm done in the name of affirmation.

So yes, mental health matters. But treating emotional pain with radical medical interventions — especially those that sterilize, mutilate, or irreversibly alter the body — is not compassion. It’s malpractice dressed in political correctness. We should invest in counseling, family support, trauma-informed care, and time-tested therapies that help people reconcile with reality, not flee from it.

In short, trust may be earned, but in this case, it must be verified. And so far, the evidence doesn’t justify the risk, the cost, or the moral compromise.

Discrimination Concerns

One of the most common objections to the Crenshaw Amendment is that it constitutes discrimination against transgender individuals. Critics argue that by refusing to fund gender-affirming treatments through Medicaid and CHIP, the government is effectively denying care based on gender identity, and they say that’s unfair, unjust, and even unconstitutional.

But let’s clear up a major misconception: denying public funding for a medical procedure is not the same thing as denying access to care. There’s a world of difference between saying, “You can’t have this treatment,” and saying, “You’re welcome to pursue this treatment, but the taxpayers shouldn’t have to pay for it.”

We draw these lines all the time. Medicaid doesn’t cover elective cosmetic surgery like nose jobs or liposuction. It doesn’t pay for hair transplants, tattoo removals, or boutique spa treatments, not because the government is discriminating against people who want those things, but because those procedures aren’t considered medically necessary. The same logic applies here. Just because a treatment is desired doesn’t mean it qualifies as an essential public expense.

Furthermore, religious and ethical objections matter in a free society. Forcing taxpayers — many of whom hold deep convictions about the immutability of sex and the sacredness of the human body — to subsidize procedures that violate their conscience is a serious moral breach. Religious liberty isn’t just about what you believe in private; it’s about not being compelled to fund or support actions that contradict your faith.

So no, this isn’t discrimination. It’s discernment. It’s drawing a clear boundary between personal autonomy and public responsibility. If an adult chooses to undergo gender transition treatments, that’s their legal right. But they should do so with their own resources, not the collective wallet of the American people.

In a nation built on freedom and responsibility, it’s entirely reasonable — and morally sound — to say: your choices, your cost.

Cost of Mental Health Crises

Opponents also often raise a practical concern: if Medicaid and CHIP don’t cover gender-affirming treatments, we could see an uptick in untreated mental health issues, which might ultimately cost the healthcare system more. The argument goes something like this: if people experiencing gender dysphoria don’t receive transition-related care, they’ll suffer higher rates of depression, anxiety, or even suicidal ideation, leading to increased emergency room visits, hospitalizations, and long-term psychological care. On the surface, that’s a serious and seemingly compassionate concern.

But here’s the rub: the idea that radical medical procedures are the only or best way to address mental health struggles is both unproven and dangerously narrow. Just because there’s emotional pain doesn’t mean the solution is surgery. You don’t treat body dysmorphia with liposuction, and you don’t cure anorexia with diet pills. In any other context, we understand that mental health issues deserve psychological and spiritual support, not physical alterations that could cause more harm than healing.

If the goal is truly to address mental health, then let’s invest in what works: counseling, trauma-informed care, faith-based recovery programs, family therapy, and community-based support. These approaches don’t just manage symptoms; they aim to heal the underlying wounds. They respect the complexity of the human person and offer a path to peace that doesn’t involve permanent, irreversible bodily harm.

Moreover, the “higher costs later” argument assumes that gender transition procedures actually solve the mental health crisis, and that’s far from settled science. In fact, a growing body of research and testimony from detransitioners suggests that these interventions often don’t deliver the promised relief and can, in many cases, lead to deeper regret, physical complications, and a second wave of psychological trauma. That’s not just costly in dollars, that’s costly in human lives.

If we truly care about the mental health of those struggling with gender identity, then we must prioritize compassionate, evidence-based, and non-invasive care. The answer to inner confusion isn’t to alter the body to match the mind, it’s to bring the mind back into harmony with truth. That takes time, care, and patience, not a fast-track to the operating room.

In the long run, standing firm on biological truth and investing in holistic, ethical mental health care isn’t just morally right, it’s fiscally wise. It’s the kind of approach that strengthens individuals, families, and the nation as a whole.

Drawing the Line: Truth, Compassion, and the Role of Government

The Crenshaw Amendment isn’t just a good policy; it’s a critical course correction. In a society increasingly allergic to reality, this provision stands as a bold declaration that truth still matters, that compassion must be tethered to conviction, and that public policy must serve the good, not indulge the confused.

Yes, we’re called to love our neighbors. That’s not up for debate. But biblical love isn’t the squishy, spineless sentimentality the culture often peddles. It doesn’t mean nodding along to lies or going silent when someone’s racing toward harm. The love Jesus showed was fierce, firm, and grounded in truth. He never affirmed sin, but He never stopped reaching out either.

So yes, we care deeply about those struggling with gender dysphoria. But real care doesn’t mean throwing taxpayer money at radical medical interventions that violate God’s design and often leave people more broken than before. It means offering truth with tenderness, compassion without compromise, and help that heals instead of harms.

This provision says clearly: no, we’re not going to let public health dollars be used to undermine the biological and biblical reality that male and female are distinct, purposeful, and sacred. We’re not going to let activist medicine dictate national policy. And we’re certainly not going to force millions of Americans to subsidize procedures that conflict with their deepest convictions.

It also reinforces something our country desperately needs to relearn: the proper role of government. Washington is supposed to protect rights, not rewrite reality. It’s meant to uphold the common good, not chase the latest social fad. By drawing a firm line against taxpayer-funded gender ideology, this legislation respects the conscience of the nation, restores medical integrity, and renews a cultural commitment to objective truth.

If that sends the usual suspects into a frenzy, well, maybe that’s the sound of the culture finally stirring from its slumber. Maybe, just maybe, it’s the first rumblings of a society remembering that there is such a thing as right and wrong, male and female, and truth worth standing for.

Because in the end, policy matters. But what matters more is the message it sends: that this nation still has a backbone, a conscience, and a compass, and by God’s grace, we’re not afraid to use them.