Key Takeaways
- Gender-based health care discrimination disproportionately affects transgender, nonbinary, and intersex individuals.
- The Veterans Healthcare Equality Act of 2025 aims to amend Title 38 of the U.S. Code, which would prohibit gender-based discrimination in health care services provided by the Department of Veterans Affairs, establish protections for veterans’ autonomy, and increase access to gender-affirming healthcare services.
- Executive Orders 14168 and 14183 create a more restrictive environment for those who experience gender dysphoria and/or are transgender, which the Veterans Healthcare Equality Act seeks to remedy.
What is the Veterans Healthcare Equality Act of 2025 (H.R. 5635)?
The Veterans Healthcare Equality Act of 2025 (H.R. 5635) is a bill that would prohibit gender-based discrimination for veterans seeking health care from the Department of Veterans Affairs (VA). This bill was introduced in the House of Representatives in September 2025 by Representative Timothy M. Kennedy (D-NY) as an amendment to the Title 38 United States Code, which governs veterans’ benefits.
Goals of H.R. 5635
According to Advocates for Trans Equality, nearly one in five transgender individuals are active military service members. Unfortunately, research has demonstrated the complex barriers that transgender veterans face in receiving healthcare. One study found more than one in five transgender veterans who sought or received care from the VA reported discriminatory treatment before 2011.
The purpose of this bill is to protect the vulnerability of transgender veterans and ensure their access to health care. This bill would address concerns about intentional misgendering and discrimination in Veterans Health Administration (VHA) facilities, and uphold the provisions of the Affordable Care Act (ACA). Section 1557 of the ACA protects all Americans from gender and sex discrimination in health programs receiving funding from the U.S. Department of Health and Human Services (HHS). To achieve this goal, the Veterans Healthcare Equality Act of 2025 calls for explicit protections for transgender veterans and for the VA to fulfill its obligation in offering medically necessary care, including non-surgical gender-affirming care.
Past Regulations on Gender-Based Discrimination in Veterans Affairs
In 2018, VHA Directive 1341, “Providing Health Care for Transgender and Intersex Veterans,” established guidelines for providing respectful and clinically-appropriate health care to transgender and intersex veterans in the VA healthcare system. While these guidelines and pre-existing VA regulations excluded gender-affirming surgeries from medical benefits, this policy mandated that comprehensive and dignifying care be offered to veterans receiving other gender-related medical services in VA facilities. Furthermore, it ensured that in clinical encounters, veterans were being addressed by their preferred names and pronouns, without tolerance for discrimination or harassment.
However, in March 2025, VHA Directive 1341 was rescinded under compliance with Executive Order 14168. While the provision of health care for transgender and intersex veterans has not been legally changed, VHA facilities updated assignments for restrooms and changing facilities. As a result, there was a rise in concern and fear, especially amongst transgender veterans, about whether they can trust VHA medical providers. The Veterans Healthcare Equality Act of 2025 was introduced following this rescission, with the bill sponsors citing the negative impacts of Executive Order 14168 as a contributing factor.
Gender Dysphoria and Recent Policy Changes
According to the American Psychiatric Association, gender dysphoria refers to the psychological distress resulting from the discord between a person’s self-identified gender and biological sex. Although gender dysphoria is not a universal experience amongst transgender individuals, the diagnosis is experienced by many within the community. Gender dysphoria leads to severe psychological distress and unhealthy behaviors, including drug and alcohol abuse. Moreover, 40% of those who suffer from gender dysphoria have attempted suicide at least once, which is nine times higher than the prevalence of suicidality in the general population.
In January 2025, President Trump updated how federal agencies define sex. In accordance with Executive Order 14168, sex is considered to be a biological binary of male and female, is based on reproductive cell type, and is a fixed categorization. Within these new parameters, the nuanced spectrum of gender was also omitted, based on the idea that it is an internal, subjective concept that does not meaningfully contribute to identity. Following this, under Executive Order 14183, the President began the process of directing and permitting the Department of Defense to prohibit transgender, nonbinary, and gender-nonconforming people from serving in the military. These Orders remove the ability to describe certain discriminatory practices, including those related to health access, as being gender-based.
Taken together, both Executive Orders create a more restrictive environment for those who experience gender dysphoria and/or are transgender. Already, many critics emphasize the irreversibility of certain gender-affirming care options. Moreover, there is the assertion that gender dysphoria is a contentious issue that remains a subject of both public and political debate.
Although not as explicit, the Veterans Equality Act is impactful for not just transgender individuals, but for those experiencing gender dysphoria. While opinions opposing improved access to gender-affirming care focus on the potential for long-term challenges regarding the safety and efficacy of gender-affirming care, there is limited evidence to support this perspective. Instead, critics emphasize the utility of psychotherapy, which is a mental health service offered by the VHA that can be useful in identifying and addressing psychological challenges such as gender dysphoria.
Conclusion
The Veterans Healthcare Equality Act of 2025 (H.R. 5635) seeks to prohibit gender discrimination and maintain general autonomy and accessibility to health services. Supporters argue that access to gender-affirming care is medically necessary and that restrictions may impact mental health outcomes. Suicide rates and mental health risks are higher amongst transgender veterans than in the general veteran population, mirroring the elevated risks seen among transgender people nationwide. With the recent omission of intersex identity from federal agencies and their corresponding websites, there is an additional risk of a future where clinically appropriate care is not provided to intersex individuals.
Frequently Asked Questions
Is gender-affirming care considered medically necessary?
All major medical associations, including the American Medical Association, the American Psychological Association, and the World Health Organization, have stated that gender-affirming care is medically necessary, and an evidence-based system of care. Doctors have stated that both surgical and non-surgical treatments are important to the physical and mental health of both transgender and intersex people. However, there is ongoing debate about specific treatments and coverage policies.
Is gender-affirming care illegal in the U.S.?
Gender-affirming care is legal for adults; however, there are state-dependent restrictions and bans for minors in 27 states. There are also policies known as “shield laws” or “refuge laws” that protect people seeking this kind of healthcare and medical providers in instances where a person travels from a state with bans and receives care in another state. There also exists a growing number of federal restrictions on federal funding and insurance exclusions that will affect both veterans’ and civilians’ access to gender-affirming care.
Why is gender-affirming care a public health matter?
Gender-affirming care for veterans is a public health matter because it addresses mental health and suicide risk, as well as general health disparities. Twenty percent of the U.S. transgender population are veterans, and transgender individuals in particular are twice as likely to serve in the U.S. military compared to the general population. In this way, this bill is particularly important for protecting transgender individuals’ health and safety.