Published April 11, 2025
On Friday, April 11, 2025, EPPC scholars Eric Kniffin, Rachel N. Morrison, Mary Rice Hasson, and Jamie Bryan Hall submitted a public comment supporting the Department of Health and Human Services’ (HHS) Centers for Medicare & Medicaid Services’ proposal to prohibit coverage of “sex-trait modification” as an Essential Health Benefit (EHB) in health insurance plans beginning in plan year 2026.
The scholars’ supported the proposal, recommended HHS use the more accurate and less problematic term “sex-rejecting procedures” instead of “sex-trait modification,” and proposed a definition for whichever term HHS adopts.
As the scholars explain in their comment:
The most important reason why Secretary Kennedy should exclude sex-rejecting procedures from the definition of EHB is because it is clear that a “typical employer plan” does not cover these dangerous and scientifically unproven procedures. Congress has entrusted the Secretary of HHS with the job of “ensur[ing] that the scope of essential health benefits … is equal to the scope of benefits provided under a typical employer plan.” Thus, the Affordable Care Act requires Secretary Kennedy to ensure that neither the federal government nor states in their benchmark plans designate as an EHB procedures that are not covered by the typical employer plan.
HHS is also right to be concerned about the scientific integrity of claims made in favor of sex-rejecting procedures. Here in America and across the globe, gender specialists, clinicians, and whistleblowers have raised alarm over the scant evidence supporting gender-affirming protocols, amid growing evidence that gender affirmation seriously harms vulnerable children.
… This proposal would advance HHS’s stated goal in the Proposed Rule to give Americans “relief from rising health care costs.” HHS should also act to honor the 66% of Americans who believe that federal tax dollars should not go toward sex-rejecting procedures.
There is also no legal impediment to HHS finalizing this proposal. Excluding sex-rejecting procedures as an EHB would not violate the Fourteenth Amendment or federal nondiscrimination laws. Moreover, nothing in law prohibits HHS from rejecting gender ideology’s radical anthropology, which claims that gender identity is immutable, but sex is not.
For all these reasons, we strongly encourage HHS to finalize the [proposal] and encourage Secretary Kennedy to recognize that sex-rejecting procedures are not “essential health benefits” as Congress has defined that term.
Other organizations submitting comments on the proposed rule include:
- Advancing American Freedom
- Alliance Defending Freedom
- National Catholic Bioethics Center, Catholic Medical Association, National Catholic Partnership on Disability, and the National Association of Catholic Nurses
Eric Kniffin is a fellow at the Ethics and Public Policy Center, where he works on a range of initiatives to protect and strengthen religious liberty as part of EPPC’s Administrative State Accountability Project.
