On December 18, 2025, the U.S. House of Representatives took a decisive step in the ongoing culture wars over healthcare and personal autonomy, passing the Do No Harm in Medicaid Act by a narrow 215-201 margin. The legislation, introduced by Rep. Dan Crenshaw, R-Texas, seeks to prevent Medicaid dollars from funding transgender treatments for minors—a move that has drawn sharp lines between Republicans and Democrats and reignited fierce debate over the rights of young people, the reach of federal healthcare, and the role of government in personal medical decisions.
Every House Republican who voted supported the bill, while the opposition came almost exclusively from the Democratic side of the aisle. More than 200 House Democrats voted against the measure, with only four breaking ranks to support it: Henry Cuellar and Vicente Gonzalez, both from Texas; Don Davis of North Carolina; and Marie Gluesenkamp Perez from Washington. According to Fox News, this split underscores the widening gap within the Democratic Party itself, especially as transgender issues become a flashpoint between moderates and progressives.
The legislation is clear in its intent: it would block federal reimbursement for specific gender surgeries performed on minors, as well as treatments such as hormone therapies. However, the bill does carve out exceptions, allowing puberty blockers prescribed for precocious puberty and gender-related surgeries performed to address injury, illness, or the potential death of a child. These exceptions, supporters argue, are meant to ensure that children with legitimate medical needs are not denied care. During the debate, House Energy & Commerce Committee Chairman Brett Guthrie, R-Ky., emphasized the fiscal impact, stating that the legislation would save $445 million over a decade for the Medicaid program. "It simply prohibits the use of Medicaid funding on specified procedures that are medically unnecessary," Guthrie said, according to Fox News.
Rep. Crenshaw, the bill's sponsor, did not mince words in his defense of the measure. "I'm not sure my colleagues even believe what they're saying," he remarked. "Today's great sin in medicine is perhaps one of the worst that we've seen in human history—a sick, twisted ideology parroted by social media, fueling social confusion." Crenshaw's comments reflect a growing sentiment among conservatives that gender-affirming care for minors is not only controversial but dangerous, and that federal dollars should not support it.
Yet, Democrats mounted a passionate defense of transgender healthcare access, warning that the bill represents a grave threat to vulnerable youth. Rep. Frank Pallone, D-N.J., described the act as an "extreme attack on medically necessary treatment for children." Rep. Mark Takano, D-Calif., went further, arguing, "This is Congress seeking to ban healthcare for the most vulnerable among us. The healthcare that trans youth receive is a decision that they should be able to make in consultation with their parents, therapists and doctors, not politicians." Takano also called out what he saw as hypocrisy in the legislation, noting that the procedures it bans "allow for the same exact care for non-transgender youth."
As the House debated transgender healthcare, another front in the nation’s culture war was unfolding in the courts. On December 9, Texas and Florida jointly filed a lawsuit against the U.S. Food and Drug Administration (FDA) in federal court in Wichita Falls, Texas, challenging the agency’s approval of mifepristone—the first drug in a two-drug regimen used for medication abortions. According to The Texas Tribune, the states argue that the FDA did not properly evaluate mifepristone’s safety and effectiveness when it was approved in 2000 and subsequently for its generic versions. The lawsuit also takes aim at the agency’s more recent decisions to expand access, including allowing the pills to be dispensed by mail.
Central to the legal challenge is the invocation of the Comstock Act of 1873, a long-dormant federal law that prohibits the mailing or delivery of anything intended for producing abortion. While the Biden administration has interpreted the Comstock Act as applying only to unlawful abortions, Texas and Florida contend that it should prevent the mailing of abortion-inducing drugs altogether. The lawsuit, as quoted by The Texas Tribune, claims, "The FDA’s regulation of mifepristone was political from the start," and calls for the drug’s removal from the market.
Mifepristone, when used in combination with misoprostol, is now the most common method for ending pregnancies in the United States. Numerous studies have shown that the drug is both safe and effective, a point abortion rights advocates are quick to emphasize. Shellie Hayes-McMahon, executive director of Planned Parenthood Advocates of Texas, warned in a public statement, "If they succeed in restricting access to mifepristone, abortion access will be devastated across the country, even in states where abortion remains legal. This lawsuit is not about safety or health care; it is about control. And nothing short of full control over our bodies will satisfy them."
Legal experts see the Texas lawsuit as part of a broader strategy by anti-abortion activists to shift the battleground from legislatures to the courts, particularly after the Supreme Court overturned Roe v. Wade. Mary Ziegler, a professor and abortion legal historian at the University of California Davis School of Law, told The Texas Tribune, "What we’re seeing is Texas is behaving more like Joe Biden as president than you would expect, right? This is not a situation where Ken Paxton is sitting back and saying, ‘You know, the FDA is going to make these changes.’" Ziegler added that, with less political appetite to take on abortion at the national level, the courts have become the primary arena for these disputes.
The timing of the lawsuit is notable. Just days before filing, Texas enacted House Bill 7, a law that allows private citizens to sue anyone who manufactures or distributes abortion drugs to or from the state. This law, combined with the federal lawsuit, signals a two-pronged approach: using both state and federal levers to clamp down on abortion pill access. And while Texas has already tested the limits of interstate legal battles—such as its failed attempt to pursue a New York doctor accused of prescribing abortion pills to a Texas woman—the new lawsuit could have far-reaching implications. Ziegler pointed out that a federal policy change on mifepristone could undermine so-called "abortion shield" laws in blue states designed to protect providers from prosecution elsewhere.
The FDA, for its part, has declined to comment on the ongoing litigation. But the stakes are high. Abortion rights advocates warn that if the lawsuit succeeds, it could upend access to medication abortion nationwide, not just in Texas and Florida. The outcome could determine whether millions of Americans retain access to what has become a critical option for reproductive healthcare.
With lawmakers and courts locked in high-stakes battles over both transgender healthcare and abortion access, the U.S. finds itself at a crossroads. The debates are not merely about medical procedures or government spending—they cut to the heart of questions about bodily autonomy, parental rights, and the proper limits of state power. As these issues play out, the nation watches closely, knowing that the decisions made now will shape the landscape of American healthcare and civil rights for years to come.
