Despite anger from Democratic lawmakers at language that would restrict health care for transgender children of service members, the annual defense policy bill with a massive pay raise for junior enlisted troops was approved by the House on Wednesday.
The House voted 281-140 to approve the National Defense Authorization Act, or NDAA, sending it to the Senate, which is expected to approve the bill next week.
Under the bill, troops in the ranks of E-1 through E-4 will see a 14.5% raise next year, while all other service members will get a 4.5% pay bump.
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The significant raise for the military's most junior troops was one of several measures included in the final NDAA aimed at improving service member quality of life that had widespread bipartisan approval.
But despite supporting the quality-of-life provisions, House Democrats largely turned against the NDAA after Republicans successfully included a provision that could prevent troops' transgender children from getting some types of medical care.
Specifically, the bill would bar Tricare from covering "medical interventions for the treatment of gender dysphoria that could result in sterilization" for beneficiaries under 18.
The bill does not define exactly which treatments would be banned, but advocates have warned the language could mean military kids will lose access to hormone therapy and puberty-suppressant medications.
Tricare has covered nonsurgical gender-affirming health care, such as hormones and mental health counseling, for dependents since 2016. Gender-affirmation surgery is available only to service members.
It's unclear exactly how many military children are currently receiving treatment for gender dysphoria through Tricare. One study found that more than 2,500 children received some form of transgender-related care through Tricare from 2009 to 2017. Rep. Adam Smith, D-Wash., the ranking member of the House Armed Services Committee, estimated earlier this week that 6,000 to 7,000 children could be affected by the NDAA ban.
Democratic leadership did not direct their members to vote against the NDAA over the transgender provision, House Minority Leader Hakeem Jeffries, D-N.Y., told reporters Wednesday morning. But influential Democrats such as Smith railed against its inclusion in the compromise bill.
"The inclusion of this harmful provision puts the lives of children at risk and may force thousands of service members to make the choice of continuing their military service or leaving to ensure their child can get the health care they need," Smith said in a statement Tuesday announcing he would oppose final passage of the bill he helped negotiate.
Ultimately, 81 Democrats supported the NDAA, compared to 124 who voted against it. Meanwhile, 16 Republicans voted against the bill.
Most GOP-supported provisions aimed at culture war issues that were in earlier drafts of this year's NDAA were taken out of the compromise bill, including one that would have also barred gender-affirming care for service members and another that would have reversed the Pentagon's policy of providing leave and travel reimbursement for troops seeking abortions and other reproductive care.
But Republicans touted the language targeting care for transgender minors as a major win.
"We banned Tricare from prescribing treatments that would ultimately sterilize our kids," House Speaker Mike Johnson, R-La., said at a news conference Tuesday while lauding the NDAA agreement. Tricare, as an insurance provider, doesn't advocate for specific medical treatments but rather pays for care.
Research on the long-term effects of puberty blockers on fertility is "currently limited and provides varied results," while hormone therapy may decrease fertility in certain circumstances, according to the American Academy of Pediatrics. Still, the organization, along with most other major medical associations, endorses the care.
Action on the NDAA now moves to the Senate, which is controlled by Democrats. Democratic Senate leaders have not publicly commented on the transgender provision, but similar language was included in the version of the NDAA that the Senate Armed Services Committee advanced in June.
President Joe Biden will also need to sign the bill before it becomes law. While the White House has previously criticized efforts to limit gender-affirming care for military children, the administration has not issued a statement on its position on the NDAA compromise.
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