In a significant development on Tuesday, the House took a party-line vote that advanced a provision within the annual defense spending bill. This provision specifically targets health care for transgender youth on military health insurance. It was tacked onto the National Defense Authorization Act (NDAA) at the last moment, marking the first time in decades that explicitly anti-LGBTQ+ policy is being codified into federal law. The controversial language, pushed by Republican leadership and adopted into a bipartisan compromise bill, would prohibit "medical interventions for the treatment of gender dysphoria that could result in sterilization." This effectively bars access to gender-affirming care for minors with active-duty family members in the military.

Implications and Concerns

Civil liberties groups had predicted that the Tuesday vote would be close and urged House Democrats to vote against moving the current version of the bill forward. Advocates are deeply concerned about the potential deadly consequences this bill could have for trans youth on military insurance. It is seen as a serious rollback in rights for LGBTQ+ people in the United States. Ian Thompson, senior legislative advocate at the American Civil Liberties Union, emphasized the significance of this vote. He stated that not only would it be devastating for the lives, health, and well-being of these children and military families, but it would also be the first time in nearly three decades that explicit anti-LGBTQ+ policy has been adopted into federal statute. The Defense of Marriage Act of 1996, which prohibited same-sex marriages, serves as a recent example. Thompson stressed the need to highlight the gravity of this attack on human rights and the freedom of transgender people.

While the exact number of transgender youth receiving health care through the military's insurer, TRICARE, is unclear, a 2022 analysis published in the American Journal of Public Health found that approximately 2,500 minors sought care for experiencing gender dysphoria through the insurance program that year. This highlights the importance of providing appropriate and inclusive health care for this vulnerable population.

Reactions from Congress

Rep. Delia Ramirez, D-Ill., criticized her Republican colleagues for "targeting trans people" instead of focusing on legislative work. She emphasized that this is not only an unprecedented discriminatory rider but will cause real and irreversible harm. Young trans people deserve the care they need to thrive, and all members of society deserve the opportunity to debate and shape significant legislation that impacts their communities.

Ranking Member of the House Armed Services Committee, Rep. Adam Smith, D-Wash., called on Republicans to remove the anti-trans provision on Sunday. He firmly stated that blanketly denying health care to those who clearly need it due to a biased notion against transgender people is wrong. Smith pointed out that Speaker Johnson is pandering to the most extreme elements of his party to maintain his speakership, which has upended the bipartisan process. After the vote, in a written statement, Smith said he would vote against the final version of the bill when it comes to the floor. He emphasized that the inclusion of this harmful provision puts the lives of children at risk and may force thousands of service members to make difficult choices.

Opposition and Hopes

Groups opposed to the provision are hopeful that the Biden administration will take a stand and support trans youth. The Human Rights Campaign pointed out that President Joe Biden has repeatedly promised to veto any legislation that enshrines discrimination against transgender people into law.

Thompson of the ACLU noted that although the White House generally releases a statement of administrative policy on important legislation like the NDAA, which is considered a "must pass" bill, it has not yet done so. The White House faced criticism from trans rights groups after initially stating that it opposed gender-affirming surgeries for transgender youth but later changed its position to oppose limits on health care for transgender individuals.

Ahead of the vote, Thompson expressed hope that the rule would fail and that only a version of the legislation without the health care ban would move forward. However, if the rule is adopted and a vote on the underlying bill takes place, pro-equality members of Congress are expected to oppose the defense bill due to the inclusion of this health care ban.

Update: December 10, 2024, 4:09 p.m. ETThis article was updated to include the results of the vote and a statement from Rep. Adam Smith, D-Wash.

Open enrollment for healthcare often presents a complex and overwhelming landscape. However, there are innovative healthcare companies striving to make this process more manageable. Let's explore how they are doing it.

Empowering Healthcare Choices During Open Enrollment

Understanding the Challenges of Open Enrollment

During open-enrollment season, as Business Insider reports, Reddit users flood the platform's health insurance and personal finance forums daily. They seek guidance on choosing the best health-insurance plans. For instance, a recently unemployed married woman in Texas wondered whether to enroll with her husband's employer or stick to COBRA. Another married person needed advice on coverage during pregnancy in 2025. In California, employees navigated dental-plan options with costs ranging from $0 to nearly $440 annually. Open-enrollment season typically runs from October to December, with companies having their own periods. Employees must look back at past healthcare utilization and anticipate future events while dealing with changing insurance options and family situations. This process can be extremely confusing, as Dan Beck, president and chief product officer of SAP SuccessFactors, explains.

Employees are tasked with reflecting on whether they maximized their benefits in the past year based on healthcare system usage. Simultaneously, they need to anticipate health-related events such as having a child or major surgery. The complexity is further compounded by life changes like moving to a new state or employer or a company changing insurance providers. Keeping track of life events that could change coverage, including moving, having a baby, or adopting a child, is also crucial. There is a special enrollment period outside of open enrollment, but it has a limited time for making changes and retaining coverage.

Employer Initiatives to Simplify Enrollment

Increasingly, employers are encouraged by their employees and HR-benefits companies to share more digestible benefits information. Karen Frost, a senior vice president at Alight, a cloud-based employee-benefits vendor, told BI that employees need help during enrollment. Some employers are partnering with third-party companies to handle payroll and health benefits and build software with clear step-by-step prompts. This helps workers make confident healthcare elections.

For example, in Alight's 2024 annual survey of 2,500 employees in the US, UK, France, Germany, and the Netherlands, 63% felt confident about their most recent health-plan election. However, there are generational splits, with 70% of Gen Z and 72% of millennial workers wanting personalized support compared to just 46% of baby boomers. Despite the decline in paper-packet methods, the enrollment process remains overwhelming due to life changes.

Mobile Apps and Generative-AI in Open Enrollment

To assist employees during open enrollment, some healthcare startups are leveraging mobile apps and generative-AI chatbots. Alight aims to learn about employee preferences and family needs through Q&A and make recommendations. It provides clear definitions of complex benefits like health savings accounts. For instance, if an employee picks a high-deductible health plan, Alight guides them to an HSA and explains its benefits.

SAP SuccessFactors, with customers like McDonald's, L'Oréal, and Delta Air Lines, is focusing on developing its mobile app targeted at workers under 40 and frontline workers. It uses generative-AI chatbots to answer policy questions and improve the user experience. In the future, the company plans to automate some open-enrollment processes. To enhance its capabilities, SAP bought WalkMe earlier this year for $1.5 billion to provide real-time website navigation for healthcare and other tasks.AI-based virtual assistants are also gaining popularity. Alight has Ask Lisa, SAP SuccessFactors uses Joule, and Workday uses Wex. These tools allow employees to get automatically generated responses to their benefits questions. Workday's senior vice president, Ben Carter, emphasizes catering to all generations. AI-enabled tools like Workday Wellness integrate with insurance providers and help employers understand which wellness benefits are used and which ones need more investment.

"It brings a nice story," Carter said. "If I'm going to invest another $20 million in my benefits programs next year, I know where to go or where to double down."