The Republican-led U.S. House of Representatives on Thursday voted 215-214 for passage of the “One Big Beautiful Bill Act” reconciliation package, which includes provisions that would prohibit the use of federal funds to support gender-affirming care.

But for an 11th hour revision of the bill late Wednesday night by conservative lawmakers, Medicaid and CHIP would have been restricted only from covering treatments and interventions administered to patients younger than 18.

The legislation would also drop requirements that some health insurers must cover gender-affirming care as an “essential health benefit” and force states that currently mandate such coverage to find it independently. Plans could still offer coverage for transgender care but without the EHB classification patients will likely pay higher out of pocket costs.

To offset the cost of extending tax cuts from 2017 that disproportionately benefited the wealthiest Americans, the reconciliation bill contains significant cuts to spending for federal programs like Medicaid and the Supplemental Nutrition Assistance Program.

The Human Rights Campaign criticized House Republicans in a press release and statement by the group’s president, Kelley Robinson:

“People in this country want policies and solutions that make life better and expand access to the American Dream. Instead, anti-equality lawmakers voted to give  handouts to billionaires built on the backs of hardworking people — with devastating consequences for the LGBTQ+ community.

“If the cuts to programs like Medicaid and SNAP or resources like Planned Parenthood clinics weren’t devastating enough, House Republicans added a last minute provision that expands its attacks on access to best practice health care to transgender adults.

“This cruel addition shows their priorities have never been about lowering costs or expanding health care access–but in targeting people simply for who they are. These lawmakers have abandoned their constituents, and as they head back to their districts, know this: they will hear from us.”

Senate Republicans are expected to pass the bill with the budget reconciliation process, which would allow them to bypass the filibuster and clear the spending package with a simple majority vote.

Changes are expected as the bill will be reviewed and amended by committees, particularly the Finance Committee, and then brought to the floor for debate — though modifications are expected to focus on Medicaid reductions and debate over state and local tax deductions.

Democratic U.S. Rep. Gerry Connolly of Virginia died on Wednesday, according to a statement from his family.

The 75-year-old lawmaker, who served in Congress since 2009, announced last month that he will not seek reelection and would step down from his role as the top Democrat on the powerful U.S. House Oversight Committee because his esophageal cancer had returned.

“We were fortunate to share Gerry with Northern Virginia for nearly 40 years because that was his joy, his purpose, and his passion,” his family said in their statement. “His absence will leave a hole in our hearts, but we are proud that his life’s work will endure for future generations.”

“He looked out for the disadvantaged and voiceless. He always stood up for what is right and just,” they said.

Connolly was memorialized in statements from colleagues and friends including House Democratic Leader Hakeem Jeffries (N.Y.), Republican House Speaker Mike Johnson (La.), former President Joe Biden, and U.S. Rep. Jamie Raskin (D-Md.).

Several highlighted Connolly’s fierce advocacy on behalf of federal workers, who are well represented in his northern Virginia congressional district.

The congressman also supported LGBTQ rights throughout his life and career.

When running for the Fairfax County Board of Supervisors in 1994, he fought the removal of Washington Blade newspapers from libraries. When running in 2008 for the U.S. house seat vacated by Tom Davis, a Republican, Connolly campaigned against the amendment to Virginia’s constitution banning same-sex marriage and civil unions in the state.

In Congress, he supported the repeal of “Don’t Ask, Don’t Tell,” the U.S. Supreme Court’s ruling on marriage equality, the Biden-Harris administration’s rescission of the anti-trans military ban, and the designation within the State Department of a special LGBTQ rights envoy. The congressman also was an original cosponsor of the Equality Act and co-sponsored legislation to repeal parts of the Defense of Marriage Act.

U.S. Rep. Marjorie Taylor Greene (R-Ga.)’s “Protect Children’s Innocence Act,” which would criminalize guideline-directed gender affirming health care for minors, will advance to markup in the House Judiciary Committee on Wednesday morning.

Doctors and providers who administer medical treatments for gender dysphoria to patients younger than 18, including hormones and puberty blockers, would be subject to Class 3 felony charges punishable by up to 10 years in prison if the legislation is enacted.

LGBTQ advocates warn conservative lawmakers want to go after families who travel out of state to obtain medical care for their transgender kids that is banned or restricted in the places where they reside, using legislation like Greene’s to expand federal jurisdiction over these decisions. They also point to the medically inaccurate way in which the bill characterizes evidence-based interventions delineated in standards of care for trans and gender diverse youth as “mutilation” or “chemical castration.”

Days into his second term, President Donald Trump signed “Protecting Children from Chemical and Surgical Mutilation,” an executive order declaring that the U.S. would not “fund, sponsor, promote, assist, or support the so-called ‘transition’ of a child from one sex to another, and it will rigorously enforce all laws that prohibit or limit” medical treatments and interventions intended for this purpose.

Greene, who has introduced the bill in years past, noted the president’s endorsement of her bill during his address to the joint session of Congress in March when he said “I want Congress to pass a bill permanently banning and criminalizing sex changes on children and forever ending the lie that any child is trapped in the wrong body.”