SB 1257
Destabilizing transgender healthcare access in Texas by incentivizing insurers to abandon coverage
What's in the bill?
SB 1257 mandates that health insurers covering gender-affirming care must also cover any costs related to “detransitioning” (i.e., surgeries, therapies), even for individuals who were not enrolled in the same insurance plan during their initial transition; any and all possible adverse effects of gender-affirming care, including lifelong monitoring and reconstructive procedures; annual mental and physical health screenings for individuals who have undergone transition-related care.
What does it mean?
Increasing the cost of care
Insurance companies are by nature risk averse. By requiring that any plans that include coverage for gender-affirming care also include a whole host of other medical services, the cost of covering gender-affirming care will escalate. This will likely be passed along to the end consumer, increasing the cost of insurance for trans people in the state of Texas.
Insurance companies ending coverage for gender-affirming care
In the past with bills that hint at even small changes, we have seen a swift and extreme response from infamously risk-averse companies like insurers. Rather than increasing the cost of insurance plans that cover gender-affirming care, insurers may immediately stop covering gender-affirming care to avoid open-ended liability for detransition costs.
Tedium and more paperwork
Healthcare providers may face complex billing requirements, prior authorization hurdles, and documentation demands. This would delay essential care for trans people living in Texas.
Unreliable healthcare
If patients are unable to afford care due to increased insurance cost or coverage being dropped by their insurer, many may turn to unlicensed providers or DIY treatments. This shift poses a serious risk to trans people who require specialized care to navigate health care challenges.
What can we do now?
Reaching Out to Insurers
Equality Texas is reaching out to insurance providers that cover gender-affirming care before the legislation goes into effect. We’ve provided specific steps they can take to ensure coverage remains affordable and accessible, while remaining compliant with the law.
Frequently Asked Questions
What do I do if my current healthcare plan changes?
If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the company’s decision and have it reviewed by a third party. Insurers have to tell you why they’ve denied your claim or ended your coverage. And they have to let you know how you can dispute their decisions.
What will health insurance companies have to do?
The bill mandates that any healthcare insurance plan in Texas that covers gender-affirming care must also provide coverage for any and all adverse effects, including procedures or treatments for reversals of such transitions. This applies to new or renewed health plans starting January 1, 2026, and takes effect on September 1, 2025.
Will this bill prevent insurers from covering gender-affirming care?
While the bill does not explicitly prohibit insurers from covering gender-affirming care, requiring coverage for all possible adverse effects and reversals may incentivize insurers to end care rather than take on the additional risk and cost.
How will this bill affect the cost of health insurance?
There is concern that requiring insurers to cover all adverse effects and reversals could increase the cost of insurance plans that cover gender-affirming care. Some experts and advocates warn this could make such coverage prohibitively expensive or lead insurers to drop it entirely.
What does “reversal” mean in the context of this bill?
“Reversal” refers to medical treatments or procedures intended to undo or counteract the effects of a previous gender transition. The bill requires insurers to cover these treatments if they already cover transition-related care.
How does SB 1257 compare to other bills on gender-affirming care in Texas?
Unlike other Texas laws, this bill does not outright ban gender-affirming care. Instead, it focuses on insurance coverage for complications and reversals. However, it comes as part of a broader legislative push in Texas and other states to restrict or eliminate access to gender-affirming care.
What are the potential consequences for transgender Texans seeking care?
If insurers stop covering gender-affirming care to avoid liability for adverse effects and reversals, transgender Texans may lose access to medically necessary care. If insurers continue to offer coverage, out-of-pocket costs could increase.
Are there any exceptions or limitations in the bill?
The bill applies only to health benefit plans that already cover gender transition procedures or treatments. It does not require all plans to cover gender-affirming care, only that those that do must also cover related adverse effects and reversals.