Talking about Funding for Transgender Health Care

Approximately six years ago, the right wing decided that they had lost the cultural battle on marriage equality and went scoping for a new target. As they’ve said on the record in the press, they threw spaghetti against the wall to see what stuck, and they discovered that they could weaponize issues around transgender young people to divide Americans and claw back political ground. This effort was supersized in 2024 when Trump and his allies spent hundreds of millions on ads attacking Harris on the issue. And in the first 100 days of Trump 2.0, they’ve made it their obsession to undermine the rights and mere existence of transgender people in America.

As part of a multi-year research project, Third Way and Impact Research recently dug into one of the emerging issues in this battlefield: taxpayer funding of health care for transgender people. Our aim with these three rounds of qualitative and quantitative research was to help equip those who want transgender Americans to thrive to deploy the most persuasive messages to build support among voters.¹

The Landscape on Transgender Issues

To start, issues around transgender people continue to be high visibility for most voters: 78% say they’ve heard a lot or some about those topics recently. Voters say they trust Democrats more to handle transgender issues by five points (46/41), and that advantage grows to 14 points with Independents.

When asked which party is more extreme on these issues, a solid 54% name Republicans, while only 36% say Democrats are more extreme. That’s an 18-point spread—likely due to Trump’s overreach in his first 100 days.

Views on Health Care and Government Funding

Voters solidly support access to health care for transgender adults. When asked about “prohibiting medical providers from providing gender-affirming health care to anyone of any age, including adults,” voters oppose it by 13 points. They express more concerns when it comes to health care for transgender young people.

Even on the topics where voters voice the most trepidation, they are split on the impact those issues would have on their candidate choice. When asked about an elected official that supported prohibiting access to transgender health care in federally funded programs like Medicaid, Medicare, and TRICARE for patients under the age of 19, 39% say that stance would make them more likely to support that candidate, 37% say it would make them less likely to support them, and 15% say it would have no impact. Independents are four points more likely to say it would turn them off of a candidate (35%) rather than increase their support (31%), with 21% saying that stance would have no impact on their vote choice.

When it comes to covering health care for transgender young people in federally-funded insurance programs, voters’ views are also complex. They are split, within the margin of error, on the following binary choices:

Politicians should not get to decide the medical care that insurance programs can and cannot cover. They should be focused on bringing down costs instead of getting in the way of doctors who know what’s best for their patients.

OR

Taxpayer-funded insurance programs like Medicare, Medicaid, and TRICARE should only be used to pay for essential health care, which does not include things like gender transition.

But when asked a more nuanced question with three options, a sizable segment of voters express both personal concerns and also opposition to a ban on this kind of care in these programs.

• A base of 31% say, “I personally support transgender health care for patients under the age of 19 and do not believe that the government should block federally-funded insurance programs from providing coverage for that care.”
• Another 18% say, “I do not personally support transgender health care for patients under the age of 19 but do not believe that the government should block federally-funded insurance programs from providing coverage for that care.”
• And 42% say, “I do not personally support transgender health care for patients under the age of 19 and believe that the government should block federally-funded insurance programs from providing coverage for that care.”

Added together, that means 49% oppose a ban compared to only 42% who support it, when voters are given space to express their personal reservations while also opposing a ban. And when asked a similarly-constructed question about banning all insurance programs from covering this care for young people, the combination of options one and two adds up to 54% opposition to a ban, with only 39% expressing support.

Talking about Funding for Transgender Health Care

These issues are very new to voters, so while they express real reservations at first blush, engaging in these conversations moves them and significantly changes their views. When talking about proposed bans on health care for transgender young people in federally-funded insurance programs, a three-pronged message was most effective to persuade voters to oppose it. 

• Regardless of how we feel personally about the issue, parents of transgender young people should have the right to make personal medical decisions with their families and their doctors just like every other parent—without government interference or fear of losing insurance coverage.
• Our country is facing major challenges. The economy is struggling, and costs are out of control. Politicians should be focused on getting things in this country back on track, not messing with Medicare and Medicaid.
• America was founded on the basic principle of freedom, and that freedom should be for everyone. Transgender people deserve the same basic protections as everyone else—to live their lives with safety, privacy, and dignity, and that includes having access to the medical care they need.

Messages focused on the rights of people on federally-funded programs or concerns that these kinds of bans on coverage would push folks to seek treatment in unsafe, underground ways were far less persuasive. But the combination of the three most effective messages moved voters away from a ban: after hearing these arguments, 47% oppose banning federally-funded insurance programs like Medicare, Medicaid, or TRICARE from providing care to transgender young people, while only 45% support such a funding ban.

Talking about Coercion of Health Insurers and Providers

Although they started with federal insurance programs, Trump and his allies have made it clear they do not intend to end there. In fact, he has already issued an executive order attempting to ban private insurance companies from covering this care and punishing any medical institution or system who provides it by making them ineligible for all federal health care funding. This overreach, attempting to use federal health care funding for research and other activities completely unrelated to transgender health care to coerce private actors, also necessitates further conversation with voters who are encountering it for the first time. The following points resonate most clearly to explain to Americans why this coercion is inappropriate.

• The government should not get to decide what kind of care medical professionals need to provide to patients. These decisions are best left to families and doctors, who should be able to provide safe, effective, and medically necessary care without fear of being shut down by the federal government.
• Health care providers rely on federal funding to provide care to many patients—not just transgender young people. If health care providers lose their federal funding, they would be forced to reduce services, cut staff, and increase costs, which would hurt all patients.
• This policy is a massive government overreach. Politicians are trying to use their funding power to coerce doctors and control what they provide to patients even when that care is paid for with private funds.

After hearing these arguments, voters oppose these coercive policies 47% to 45%. And those numbers improve even further when this question is framed up side-by-side. We asked respondents which of the following best captured their viewpoint on a policy that blocks all federal dollars from flowing to any hospital or hospital system that offers any transgender health care to patients under the age of 19:

Politicians should be focused on issues that affect all Americans, like fixing the economy and addressing inflation instead of cutting federal funding for health care providers and raising health care costs for all patients;

OR

These federal funding cuts are necessary in order to bring down government spending and prevent taxpayer dollars from being used in elective procedures that young people may come to regret.

When the choice is framed in those terms, the first statement wins by 14 points (51% to 37%), and by 18 points among Independents.

Conclusion

There is no doubt that although a majority of Americans support comprehensive health care access for transgender adults, they have complex feelings about health care for transgender young people. But these conversations are new to most voters, and they benefit from further discussion and explication. While leaving room for voters to have personal reservations about the issue, policymakers and advocates who oppose funding bans and other restrictions on care should engage and persuade—because when they do, using the messages above, they can gain significant ground and, ultimately, win voters over.