The Senate voted 83-12 on Tuesday to advance the National Defense Authorization Act (NDAA) for a final vote on Wednesday. The $895.2 billion military bill contains a provision restricting gender-affirming care for the trans children of military members covered by Tricare, the military’s medical insurance. Sen. Tammy Baldwin (D-WI) has led efforts to eliminate the provision.

The NDAA contains a provision banning any medical treatment for “gender dysphoria that could result in sterilization” for those under 18. It’s unclear if the current legislation would ban puberty blockers (which don’t affect fertility), hormone replacement therapies (which can), or mastectomies (which are rarely ever performed on minors).

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The NDAA would remove gender-affirming care coverage for servicemembers’ trans children.

Baldwin introduced an amendment to eliminate the provision; 20 other Democratic senators supported her amendment.

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“Let’s be clear: we’re talking about parents who are in uniform serving our country who have earned the right to make the best decisions for their families,” Baldwin said in a statement. “I trust our servicemembers and their doctors to make the best healthcare decisions for their kids, not politicians.”

Every major medical and mental health association in the U.S., representing more than 1.3 million U.S. doctors, supports youth access to gender-affirming care, calling it safe, essential, and effective for trans minors’ overall well-being.

Currently, the restriction on gender-affirming care remains in the bill. Last week, the House passed the NDAA in a 281-140 vote. Rep. Chris Pappas (D-NH) was among the 81 Democrats who supported the bill and was the only out gay House member to do so. Pappas said he supported the bill because it contains pay raises for junior servicemembers and Pentagon childcare workers, addresses staffing shortages at Veterans’ Affairs centers in rural areas, and funds projects that generate $1.5 billion to his home state of New Hampshire.

Pappas wrote that he remains “incredibly frustrated that this process was politicized in the worst way” and blamed House Speaker Johnson (R-CA) for adding “unnecessary riders to limit care for some LGBTQ+ individuals.” Johnson may have allowed the Tricare restriction into the bill to buffet conservative support for the upcoming 2025 vote to keep him as House Speaker.

The current version of the NDAA still needs a final Senate vote and the signature of President Joe Biden to become law. The Democrat-controlled Senate could potentially remove the provision before passing its own version of the NDAA, and Biden has previously pledged to veto any legislation that harms the LGBTQ+ community.

In addition to the trans healthcare restriction, the bill also contains provisions blocking the Defense Department from teaching about critical race theory in its academic institutions or military trainings, and freezes any military hiring on positions related to diversity, equity and inclusion (DEI) efforts. It also didn’t contain a provision to expand access to in vitro fertilization (IVF) services to service members whose infertility wasn’t caused by service-related illnesses or injuries.

”I hope we can find a path to pass an NDAA as soon as tomorrow,” Senate Majority Leader Chuck Schumer (D-NY) said in a floor speech, adding that it’s not “a perfect bill” but has “very good things” that Democrats wanted. ”To be sure, the NDAA has some bad provisions Democrats would not have included,” Schumer said. “And there are other provisions that were left out of NDAA which we still hope can get done elsewhere.”

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