A provision in the House-passed reconciliation bill would be another step toward a long-term GOP goal of eliminating federal funding for transgender health care.

Why it matters: If the provision survives intact, the reconciliation package would become the second major federal law with gender-affirming care restrictions.

What's inside: The bill would ban federal funds from being used for gender-affirming care in Medicaid and CHIP after lawmakers made a late change to the draft and expanded the prohibition to both youths and adults.

• It comes after Congress added restrictions to last year's defense authorization bill that banned the military from covering surgeries for transgender troops and paying for gender-affirming care for servicemembers' dependents.
• A key question is whether the latest provision will survive the "Byrd bath" when the Senate takes up the reconciliation bill, or if it's deemed out of order because it's unrelated to the budget.

State of play: A manager's amendment released just hours before the reconciliation package went to the House floor last week expanded a proposed ban on federal Medicaid funds being used to pay for puberty blockers, hormone treatment and surgery.

• The reconciliation bill also has implications for ACA coverage of gender-affirming care because it prohibits health plans from covering "gender transition procedures" as an essential benefit beginning in 2027.

Between the lines: Some have likened the step-by-step defunding measures to Hyde Amendment prohibitions on abortion funding that date to the 1970s and have become a standard part of the appropriations process.

• The Human Rights Campaign said that last year's defense bill marked the "first anti-LGBTQ+ federal law enacted since the Defense of Marriage Act in 1996."
• "Any restriction of health care for the trans community … would be devastating, but especially the wide reach of this will impact so many Americans," said Tyler Hack of the Christopher Street Project, a transgender advocacy group.

The Trump administration is moving administratively with its own restrictions across agencies.

• Yesterday, HHS sent a letter to health care providers and state medical boards that said they should update treatment protocols around gender-affirming care based on the agency's review of the treatments.

By the numbers: More than 185,000 transgender adults use Medicaid as their primary insurance, per recent data compiled by the Williams Institute at the UCLA School of Law. LGBT individuals are also twice as likely as non-LGBT adults to have Medicaid as their primary insurance.

The bottom line: With Republicans maintaining that the federal government shouldn't pay for gender-affirming care, advocacy groups say those already receiving treatment will be deeply affected if funding is cut off.

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The Trump administration is expected to send a rescissions package to the Hill next week that could set off a debate over the extent of cuts to health programs overseas.

Why it matters: Foreign aid sent through USAID and through PEPFAR historically had bipartisan support, which could make votes to codify DOGE cuts a dicey proposition for some Republicans.

Driving the news: Although it's not yet clear which health programs will be targeted, the package to be sent to Congress on Tuesday will include $8.3 billion in cuts to foreign assistance from both USAID and the African Development Foundation, Axios' Hans Nichols reported.

• It's not clear the extent to which PEPFAR would also be included.
• Outside HIV/AIDS, health programs at USAID include addressing malaria, tuberculosis and maternal health.

The big picture: DOGE has already made steep cuts to USAID, though Congress' codifying the moves would make the changes more permanent.

• PEPFAR currently has a waiver to continue some of its activities, but it's limited and doesn't cover many HIV prevention efforts, said Jen Kates, director of the Global Health & HIV Policy Program at KFF.
• There is also a question of whether even some activities covered by the waiver have enough funding and staff left to operate.

What we're watching: Some members, particularly in the Senate, could push back on some of the cuts.

• "There's going to be a lot of pressure on Republicans to pass rescissions to support the president," Kates said. "However, some of these programs might be no-goes for some members."

1. Vaccine canceled: Moderna said HHS told it that the government will no longer fund late-stage development of a bird flu mRNA vaccine that showed positive clinical trial data, Tina Reed reports.
2. China biotech: Beijing has passed the U.S. in clinical trials and is licensing discoveries to American companies, marking a turning point in the race to dominate the life sciences, Adriel Bettelheim and Maya Goldman report.
3. Missouri abortions: A new ruling from the state's highest court cut off access to the procedure, adding a twist into the legal battle over a post-Roe ban that voters overturned in November, Adriel reports.
4. Publishing threat: HHS Secretary Robert F. Kennedy Jr. is threatening to forbid government scientists from publishing in the world's leading medical journals, which he branded "corrupt," The Guardian reports.