Guest Essay: The NDAA’s Attack on Family Healthcare: A Threat to Military Families and Readiness

By Trish King

Military families are often seen as the backbone of America’s national security. They endure frequent relocations, long separations, and the unique stress of serving a country where duty often supersedes personal needs. 

But what happens when the military turns its back on these families? The National Defense Authorization Act (NDAA) for FY 2025, passed by the House and Senate, answers that question with alarming clarity. Included in the $895 billion bill is a provision banning TRICARE from covering medically necessary healthcare for transgender minors, a move that threatens the stability, morale, and readiness of the very force it claims to support.

This amendment passed in the House with bipartisan support, including 81 Democrats. It passed the Senate with even more support; only 14 Senators voted against final passage. The amendment introduced by Senator Baldwin — with 21 co-sponsors — that would have removed the healthcare provision was not allowed to go to a vote. 

Now we wait to see if President Biden will sign or veto the bill. This provision strikes at the heart of military families with transgender children. It denies essential, evidence-based care endorsed by leading medical organizations, such as the American Academy of Pediatrics and the American Medical Association. 

For families stationed in states like Texas or Florida, where access to medically necessary healthcare is already banned, the consequences are doubly dire. Nearly 47% of active-duty service members in the United States are stationed in states with these healthcare bans, creating widespread challenges for military families. 

As Alex Sheldon, Executive Director (ED) of GLMA, explained in an interview, families in these situations are often forced to separate, with one parent and child relocating to access care while the other remains behind to fulfill their service obligations. This fracturing of families is a direct result of policies that weaponize healthcare as a tool of discrimination.

A Weaponization of Healthcare

The language of the NDAA amendment is vague, barring coverage of care that “could result in sterilization.” It echoes state bans already in place in 26 states, where care is blocked not because of medical evidence but to appease ideological agendas. Critics argue that this provision creates a double standard, as treatments like puberty blockers and hormones remain available under TRICARE for cisgender youth. As Sheldon notes, “The only young people targeted are trans and nonbinary children. This isn’t about medicine — it’s about [targeting a specific] population.”

For Lucy, a Navy spouse and mother of a 13-year-old nonbinary child, the stakes are clear: “All of my kid’s medical care is gender-affirming care because it helps them live as themselves. This ban creates a barrier to care, and every new restriction feels like another fight we shouldn’t have to have.”

Rebecca, a military spouse and mother of a 17-year-old transgender son, echoes the challenge of navigating disrupted care: “We couldn’t get care set up in time when we moved to Virginia, so we flew him back to California for his shot. These delays are devastating for kids and families — it shouldn’t be this hard to get essential care.”

Families like Lucy’s and Rebecca’s rely on TRICARE to ensure their children’s health and well-being. But the amendment shifts the burden of care onto these families, forcing them to navigate civilian healthcare markets at enormous personal expense. For service members stationed in states with healthcare bans, options become even bleaker. The military’s own policies, meant to serve as recruitment and retention tools, are becoming sources of profound disillusionment.

Readiness and Retention in Jeopardy

The military’s reliance on retention to offset recruitment shortfalls has been increasingly evident in recent years. Yet discriminatory policies like this one risk undermining the delicate balance between recruitment, retention, and readiness. By politicizing healthcare access and targeting specific groups, the amendment destabilizes the military’s core mission of maintaining a ready and cohesive force. Service members with transgender children already face immense stress, and this amendment adds a heavy new weight.

For families like Lucy’s, policies like these force hard decisions. “We’ve stayed in because the military offered stability, housing, and healthcare,” Lucy explains. “But if I have to fight for my kid’s care, why stay?”

Rebecca shares the same sentiment: “If we can’t take care of our kids through the job we have, we’ll have to find another job. My husband served for 21 years, but this kind of policy would have made us think twice.”

Retention, often taken for granted in the military, depends on ensuring service members can focus on their duties without the distraction of unresolved family needs. As Lucy points out, “If you’re constantly worried about your child’s healthcare, how can you focus on the job?”

Research shows that denying medically necessary healthcare significantly increases anxiety, depression, and suicidal ideation among transgender youth. This mental health toll destabilizes families, leaving service members distracted, overburdened, and potentially considering leaving the military altogether.

The implications are particularly stark in technical fields. Lucy’s spouse, a highly trained subject-matter expert, has spent years developing skills the Navy can’t easily replace. “My wife is competitive in the civilian market,” Lucy says. “Her training cost thousands of dollars, and the Navy depends on her expertise. If she leaves, the military loses too.” This is a stark reality across the force: experienced service members weighing their families’ needs against the increasing hostility of discriminatory policies.

The Recruitment Crisis

The strain on retention comes as the military faces its worst recruitment crisis in decades. In 2023, the Army met only 76.6% of its recruitment goal, and the Navy and Air Force struggled similarly. The Department of Defense has described these shortfalls as the greatest challenge to the all-volunteer force since its inception. Policies like the NDAA amendment, which explicitly discriminate against LGBTQ+ families, will only make matters worse.

Rebecca highlights the long-term impact: “If you take TRICARE away from families like ours, there’s no reason for us to stay. And if we leave, why would anyone else sign up knowing their kids won’t be taken care of?”

The False Premise of “Insufficient Evidence”

Leading medical organizations overwhelmingly support such care, citing robust evidence of its safety and effectiveness. Treatments like puberty blockers, in use since the 1980s, are reversible and have been shown to significantly improve mental health outcomes. According to a 2022 study published in JAMA Network Open, access to puberty blockers and hormone therapy is associated with a 73% reduction in suicidality among transgender youth.

Sheldon, GLMA’s ED, underscores the hypocrisy of this argument: “Puberty blockers and hormone therapy for cisgender youth are still covered because they’re safe and effective. The only people denied this care are trans youth. It’s not about medicine — it’s about discrimination.”

The long-standing military principle of “taking care of your own” is eroding under policies like this. As Lucy reflects, “We shouldn’t have to fight this hard for care. Military families already sacrifice so much.”

A Fight for Bodily Autonomy

The ban on medically necessary healthcare echoes broader attacks on bodily autonomy, such as restrictions on reproductive healthcare. Both are part of a larger political strategy targeting vulnerable groups under the guise of protecting children. In reality, these policies strip away the freedom to make deeply personal medical decisions, replacing evidence-based care with political agendas.

As Rebecca puts it, “We’re supposed to be fighting for values like equality and inclusion. How can we do that when those values are being stripped away from our own families?”

A Call to Action

The NDAA amendment banning healthcare for transgender minors is more than a policy — it’s a betrayal of the trust between service members and the institution they serve. It endangers the health and well-being of military families, undermines morale, and risks the military’s ability to retain its most valuable asset: its people.

If lawmakers truly value readiness and retention, they must reject policies that alienate and harm the families who serve. Military families like Lucy’s and Rebecca’s shouldn’t have to choose between their children’s health and their service. It’s time to uphold the values we claim to defend, ensuring that all military families receive the support their service has earned.

About the author: Trish King is a retired U.S. Army infantry NCO and the first openly transgender service member in her field. She writes about military life, family, and LGBTQ+ rights, drawing from her decades of service and personal experience.