The “Big, Beautiful Bill” heads to President Donald Trump’s desk following the vote by the Republican majority in the U.S. House of Representatives Thursday, which saw two nays from GOP members and unified opposition from the entire Democratic caucus.

To partially offset the cost of tax breaks that disproportionately favor the wealthy, the bill contains massive cuts to Medicaid and social safety net programs like food assistance for the poor while adding a projected $3.3 billion to the deficit.

Policy wise, the signature legislation of Trump’s second term rolls back clean energy tax credits passed under the Biden-Harris administration while beefing up funding for defense and border security.

Roughly 13 percent of LGBTQ adults in the U.S., about 1.8 million people, rely on Medicaid as their primary health insurer, compared to seven percent of non-LGBTQ adults, according to the UCLA School of Law’s Williams Institute think tank on sexual orientation and gender identities.

In total, the Congressional Budget Office estimates the cuts will cause more than 10 million Americans to lose their coverage under Medicaid and anywhere from three to five million to lose their care under Affordable Care Act marketplace plans.

A number of Republicans in the House and Senate opposed the bill reasoning that they might face political consequences for taking away access to healthcare for, particularly, low-income Americans who rely on Medicaid. Poorer voters flocked to Trump in last year’s presidential election, exit polls show.

A provision that would have blocked the use of federal funds to reimburse medical care for transgender youth was blocked by the Senate Parliamentarian and ultimately struck from the legislation — reportedly after the first trans member of Congress, U.S. Rep. Sarah McBride (D-Del.) and the first lesbian U.S. senator, Tammy Baldwin (D-Wis.), shored up unified opposition to the proposal among Congressional Democrats.

The U.S. Supreme Court on Thursday agreed to hear two cases involving transgender youth challenging bans prohibiting them from participating in school sports.

In Little v. Hecox, plaintiffs represented by the ACLU, Legal Voice, and the law firm Cooley are challenging Idaho’s 2020 ban, which requires sex testing to adjudicate questions of an athlete’s eligibility.

The 9th U.S. Circuit Court of Appeals described the process in a 2023 decision halting the policy’s enforcement pending an outcome in the litigation. The “sex dispute verification process, whereby any individual can ‘dispute’ the sex of any female student athlete in the state of Idaho,” the court wrote, would “require her to undergo intrusive medical procedures to verify her sex, including gynecological exams.”

In West Virginia v. B.P.J., Lambda Legal, the ACLU, the ACLU of West Virginia, and Cooley are representing a trans middle school student challenging the Mountain State’s 2021 ban on trans athletes.

The plaintiff was participating in cross country when the law was passed, taking puberty blockers that would have significantly reduced the chances that she could have a physiological advantage over cisgender peers.

“Like any other educational program, school athletic programs should be accessible for everyone regardless of their sex or transgender status,” said Joshua Block, senior counsel for the ACLU’s LGBTQ and HIV Project. “Trans kids play sports for the same reasons their peers do — to learn perseverance, dedication, teamwork, and to simply have fun with their friends,” Block said.

He added, “Categorically excluding kids from school sports just because they are transgender will only make our schools less safe and more hurtful places for all youth. We believe the lower courts were right to block these discriminatory laws, and we will continue to defend the freedom of all kids to play.”

“Our client just wants to play sports with her friends and peers,” said Lambda Legal Senior Counsel Tara Borelli. “Everyone understands the value of participating in team athletics, for fitness, leadership, socialization, and myriad other benefits.”

Borelli continued, “The U.S. Court of Appeals for the Fourth Circuit last April issued a thoughtful and thorough ruling allowing B.P.J. to continue participating in track events. That well-reasoned decision should stand the test of time, and we stand ready to defend it.”

Shortly after taking control of both legislative chambers, Republican members of Congress tried — unsuccessfully — to pass a national ban like those now enforced in 27 states since 2020.

In 2020, the state of Virginia had banned the practice of conversion therapy, but on Monday, a county judge ruled the ban violates the Virginia Constitution and Religious Freedom Restoration Act, allowing the therapy to start once more.

The conversion therapy ban, which can be seen in Va. Code § 54.1-2409.5 and 18VAC115-20-130.14, was overturned on June 30 as a result of two Christian counselors who argued that their — and all Virginia parents’ — constitutional right to freedom of religion had been encroached upon when the state legislature passed the ban.

A Henrico County Circuit Court judge sided with John and Janet Raymond, two Christian counselors represented by the Founding Freedoms Law Center, a conservative organization founded in 2020 following Virginia’s conversion therapy ban. Virginia’s Office of the Attorney General entered a consent decree with FFLC, saying state officials will not discipline counselors who engage in talk conversion therapy.

Conversion therapy, as the legislation described it, is considered to be “any practice or treatment that seeks to change an individual’s sexual orientation or gender identity, including efforts to change behaviors or gender expressions or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender.” The ban’s reversal will now allow parents to subject their children to these practices to make them align better with their religion.

This decision comes despite advice and concern from many medical and pediatric organizations — including the American Psychiatric Association, American Psychological Association, American Association for Marriage and Family Therapy, and the American Counseling Association, to name a few — all of which denounce conversion therapy as dangerous and harmful to those subjected to it.

The American Medical Association, the largest and only national association that convenes more than 190 state and specialty medical societies, says that “these techniques are the assumption that any non-heterosexual, non-cisgender identities are mental disorders, and that sexual orientation and gender identity can and should be changed. This assumption is not based on medical and scientific evidence,” with attached data indicating people subjected to conversion therapy are more likely to develop “significant long-term harm” as a result of the therapy.

The AMA goes as far as to say that they outright “oppose the use of reparative or conversion therapy for sexual orientation or gender identity.”

FFLC has a clear goal of promoting — if not requiring — conservative ideology under the guise of religious freedom in the Virginia General Assembly. On their website, the FFLC argues that some progressive policies passed by the Assembly, like that of freedom from conversion therapy, are a violation of some Virginians’ “God-given foundational freedoms.”

The FFLC has argued that when conservative notions are not abided by in state law — especially when it involves “God’s design for male and female, the nuclear family, and parental rights” — that the law violates Virginians’ religious freedom.

A statement on the FFLC’s website calls gender dysphoria among children a “contagion” and upholds “faith-based insights” from counselors as equal — in the eyes of the law — to those who use medical-based insights. This, once again, is despite overwhelming medical evidence that indicates conversion therapy is harmful.

One study showed that 77 percent of those who received “sexual orientation change efforts,” or conversion therapy, experienced “significant harm.” This harm includes depression, anxiety, lowered self-esteem, and internalized homophobia. In addition, the study found that young LGBTQ adults with high levels of parental or caregiver rejection are “8.4 times more likely to report having attempted suicide,” with another study finding that “nearly 30 percent of individuals who underwent SOCE reported suicidal attempts.”

Virginia Senate Majority Leader Scott Surovell, a Democrat representing Fairfax, said that the overturning of the ban on religious merit disregards the entire concept of having professionally licensed counselors.

“I have no problem if somebody wants to go look at religious counseling from their priest or their minister, their rabbi, their imam — that’s perfectly fine,” Surovell told the Virginia Mercury. “When somebody goes to get therapy from somebody licensed by the commonwealth of Virginia, there’s a different set of rules applied. You can’t just say whatever you want because you have a license. That’s why we have professional standards, that’s why we have statutes.”