Children supporting transgenders rights protest during a rally outside of the Supreme Court in Washington.

Transgender children of service members could lose access to gender-affirming health care through the military health system under the annual defense bill Congress is expected to approve this month.

This year's version of the National Defense Authorization Act, or NDAA, that was negotiated by the House and Senate would prohibit Tricare[1] from covering "medical interventions for the treatment of gender dysphoria that could result in sterilization" for beneficiaries under 18. The bill is considered a must-pass piece of legislation since it authorizes special pay[2] and bonuses for troops that would expire at the end of the year if not renewed.

The restriction, which does not specify exactly which treatments would be banned, is somewhat less stringent than an earlier version of the bill that specifically banned Tricare from covering hormone therapy and puberty blockers for minors. But advocates are still warning the final language will harm military families.

Read Next: Compromise Defense Bill Would Give Junior Troops 14.5% Pay Raise in 2025[3]

"Lawmakers are playing politics with the military families' health care. This is a betrayal of our service members and a threat to national security," Rachel Branaman, executive director of the Modern Military Association of America, which advocates for LGBTQ+ troops and military families, said in a written statement.

"By forcing families to choose between their military careers and their children's health care, this bill would lead to decreased military readiness and retention," Branaman added. "Families have made it clear that they will choose health care for their loved ones over their careers if this provision is passed."

It's unclear exactly how many military children would be affected by a ban in Tricare coverage of gender-affirming care for minors. A 2019 study published in JAMA Pediatrics found that more than 2,500 children[4] received some form of transgender-related care through Tricare from 2009 to 2017, including 332 prescriptions for hormones in 2017.

Military.com asked the Defense Health Agency on Monday for current numbers on transgender kids receiving treatment through Tricare, but the agency did not provide them by publication time.

The impending ban on gender-affirming care for military children adds to a fraught time for LGBTQ+ service members and their families as they brace for the incoming Trump administration. President-elect Donald Trump is widely expected to reimpose a ban[5] on transgender troops serving openly.

The NDAA provision also follows a trend of conservative legislators across the country specifically targeting gender-affirming care for transgender children. At least 79 bills were proposed in state legislatures this year to restrict gender-affirming care by age, according to a tracker maintained by the American Civil Liberties Union[6]. Last week, the Supreme Court heard oral arguments in a lawsuit against Tennessee's ban on hormone therapy[7] for transgender youth.

While medical professionals maintain gender-affirming care for children is safe and necessary, right-wing politicians argue that research is limited and children aren't mature enough to make decisions about their health care that could have lasting effects.

House Speaker Mike Johnson, R-La., touted the NDAA provision as a major win to "end the radical woke ideology being imposed on our military by permanently banning transgender medical treatment for minors."

The American Academy of Pediatrics acknowledges that research into long-term risks of puberty blockers on fertility is "currently limited and provides varied results." Still, the association recommends that transgender youth[8] have access to "comprehensive, gender-affirming and developmentally appropriate health care that is provided in a safe and inclusive clinical space." The group also recommends that insurance plans "offer coverage for health care that is specific to the needs of youth who identify as [transgender], including coverage for medical, psychological and, when indicated, surgical gender-affirming interventions."

Transgender service members and military families have faced whiplashing policies for nearly a decade. In 2016, then-President Barack Obama lifted a ban on transgender service members. Also that year, Tricare started covering nonsurgical gender-affirmation[9] care for dependents, though patients could request a waiver for treatment before then.

Then, in 2017 during Trump's first term, he announced on social media he was reimposing the ban on transgender troops. Trump's ban took effect in 2019 after some court battles.

When President Joe Biden took office in January 2021, he lifted Trump's ban as one of his first acts in office. Now, transgender troops are facing down the likelihood of Trump again banning them when he returns to office in January.

Meanwhile, Republicans in Congress have also tried unsuccessfully for years to restrict transgender military service. The original versions of the House and Senate's NDAAs this year also included language that would have banned[10] gender-affirming care for service members.

While the provisions targeting transgender troops were taken out of the compromise NDAA released this weekend, the restriction on health care for transgender military kids is on track to become the first anti-LGBTQ+ law enacted by Congress since the 1990s, according to the ACLU. In that decade, Congress passed the "Don't Ask, Don't Tell" policy that banned gay service members and the Defense of Marriage Act that barred the federal government from recognizing same-sex marriages.

While the bill released this weekend was the result of bicameral, bipartisan negotiations, Democrats are fuming at the outcome.

"Blanketly denying health care to people who clearly need it, just because of a biased notion against transgender people, is wrong," Rep. Adam Smith, D-Wash., the ranking member of the House Armed Services Committee, said in a statement Sunday. "I urge the speaker to abandon this current effort and let the House bring forward a bill -- reflective of the traditional bipartisan process -- that supports our troops and their families, invests in innovation and modernization, and doesn't attack the transgender community."

The House is scheduled to vote on the bill later this week. The Senate is expected to approve it before the end of the month, after which President Joe Biden would need to sign it into law. The White House has previously blasted efforts to restrict transgender health care in the military, but has not yet publicly commented on the compromise NDAA.

Related: Restrictions on Transgender Health Care Slipped into Senate's Must-Pass Defense Bill[11]

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President Joe Biden speaks about the collapse of the Syrian government under Bashar Assad.

WASHINGTON (AP) — President Joe Biden said Sunday that the sudden collapse of the Syrian government under Bashar Assad[1] is a “fundamental act of justice” after decades of repression, but it was “a moment of risk and uncertainty” for the Middle East.

Biden spoke at the White House hours after after rebel groups completed a takeover of the country following more than a dozen years of violent civil war and decades of leadership by Assad and his family[2]. Biden said the United States was monitoring reports of the whereabouts of Assad, with Russian state media saying he had fled to Moscow and received asylum from his longtime ally.

The outgoing Biden administration and President-elect Donald Trump were working to make sense of new threats and opportunities across the Middle East.

Biden credited action by the U.S. and its allies for weakening Syria's backers — Russia, Iran and Hezbollah. He said “for the first time” that they could no longer defend Assad's grip on power.

“Our approach has shifted the balance of power in the Middle East," Biden said, after a meeting with his national security team.

Trump said Sunday that Assad had fled because close ally Vladimir Putin,[3] the Russian president, “was not interested in protecting him any longer.”

Those comments on Trump's social media platform came a day after he used another post to decry the possibility of the U.S. intervening militarily[4] in Syria to aid the rebels, declaring, “THIS IS NOT OUR FIGHT." The Biden administration said it had no intention of intervening.

The U.S has about 900 troops in Syria, including forces working with Kurdish allies in the opposition-held northeast to prevent any resurgence of the Islamic State group. Biden said he intended for those troops to remain, adding that U.S. forces on Sunday conducted “precision air strikes" on IS camps and operations in Syria.

U.S. Central Command said the operation hit more than 75 targets.

“We’re clear-eyed about the fact that ISIS will try and take advantage of any vacuum to reestablish its credibility, and create a safe haven," Biden said, using a different acronym for the group. "We will not let that happen.”

The Syrian opposition that brought down Assad is led by Hayat Tahrir al-Sham[5], which the U.S. says is a terrorist organization with links to al-Qaida, although the group says it has since broken ties with al-Qaida.

“We will remain vigilant,” Biden said. “Make no mistake, some of the rebel groups that took down Assad have their own grim record of terrorism and human rights abuses.” He added that the groups are “saying the right things now.”

“But as they take on greater responsibility, we will assess not just their words, but their actions,” Biden said.

A senior Biden administration official, when asked about contact with Hayat Tahrir al-Sham leaders after Assad's departure, said Washington was in contact with Syrian groups of all kinds. The official, who was not authorized to publicly discuss the situation and spoke on condition of anonymity, also said the U.S. has focused over the past several days on chemical weapons that had been controlled by the Assad government, aiming to ensure they were secured.

Still, Assad's fall[6] adds to an already tense situation throughout much of region on many fronts — including Israel's war with Hamas in Gaza[7] and its fragile cease-fire with Hezbollah[8] in Lebanon.

Like Biden, Trump, who takes office in five-plus weeks, made a connection between the upheaval in Syria and Russia's war in Ukraine[9], noting that Assad's allies in Moscow, as well as in Iran, the main sponsor of Hamas and Hezbollah, “are in a weakened state right now.”

Vice President-elect JD Vance[10], a veteran of the U.S.-led war in Iraq, wrote on own social media Sunday to express skepticism about the insurgents.

“Many of ‘the rebels’ are a literal offshoot of ISIS. One can hope they’ve moderated. Time will tell,” he said, using another acronym for the group.

Trump has suggested that Assad's ouster can advance the prospects for an end to fighting in Ukraine, which was invaded by Russia in February 2022.

The president-elect wrote that Putin's government “lost all interest in Syria because of Ukraine” and the Republican called for an immediate cease-fire, a day after meeting in Paris with the French and Ukrainian leaders[11].

Daniel B. Shapiro, a deputy assistant secretary of defense for the Middle East, said the American military presence will continue in eastern Syria but was “solely to ensure the enduring defeat of ISIS and has nothing to do with other aspects of this conflict.”

“We call on all parties in Syria to protect civilians, particularly those from Syria’s minority communities to respect international military norms and to work to achieve a resolution to include the political settlement,” Shapiro said.

“Multiple actors in this conflict have a terrible track record to include Assad’s horrific crimes, Russia’s indiscriminate aerial bomb bombardment, Iranian-back militia involvement and the atrocities of ISIS," he added.

Shapiro, however, was careful not to directly say Assad had been deposed by the insurgents.

“If confirmed, no one should shed any tears over the Assad regime,” he said.

As they pushed toward the Syrian capital of Damascus, the opposition freed political detainees from government prisons. The family of missing U.S. journalist Austin Tice[12] renewed calls to find him.

“To everyone in Syria that hears this, please remind people that we’re waiting for Austin,” Tice’s mother, Debra, said in comments that hostage advocacy groups spread on social media. "We know that when he comes out, he’s going to be fairly dazed & he’s going to need lots of care & direction. Direct him to his family please!”

Tice disappeared in 2012 outside Damascus, amid intensification of what became a civil war stretching more than a decade.

"We’ve remained committed to returning him to his family,” Biden said at the White House. "We believe he’s alive, we think we can get him back but we have no direct evidence to that yet. And Assad should be held accountable.”

The president added: “We have to identify where he is."

The U.S. has no new evidence that Tice is alive but continues to operate under the assumption that he is, according to a U.S. official. The official, who was not authorized to comment publicly, added that the U.S. will continue to work to identify Tice's whereabouts and to try to bring him home .

___

Associated Press writers Jon Gambrell in Manama, Bahrain, and Aamer Madhani and AP White House Correspondent Zeke Miller contributed to this report.

© Copyright 2024 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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