It Could Happen Here - How We Saved Trans Medicaid Healthcare Coverage

Episode Date: July 21, 2025

Mia talks with journalists David Forbes, Mady Castigan, and Mira Lazine of the new Trans News Network about how mass grassroots action driven by trans journalism defeated the GOP's ban on Medicaid covering trans healthcare and how we can do it again. Sources: https://transnewsnetwork.networkforgood.com/ https://thefreeradical.org/dont-panic-the-battle-over-the-trans-medicaid-ban-is-far-from-over-heres-how-to-fight-back/ https://ashevilleblade.com‪‪ Social Media: @thefreeradical.org‬, @davidforbes.bsky.social‬, @madycast.com‬See omnystudio.com/listener for privacy information.

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Welcome to Get Appened Here, a podcast that played some role in the defeat of the Republicans' proposed ban on using Medicaid to pay for trans health care. I am your host, Mia Wong, and with me are three of the people who helped make this whole thing possible. This is David Forbes, a journalist from the Ashfall Blade and Maddie Casta News, Maddie Castigan of the namesake Maddie Casta News, and Mira Lazine of Free Radical and also Maddie Casta News. And all of you, welcome to the show. Congratulations on your defeat of the Republican Party

and helping to save trans healthcare for unbelievably large numbers of people in this country. Yeah, thanks. I'm happy to be here. Yeah, it's kind of like a sentence that's kind of hard to accept. And you know, in a lot of ways, it is really, what we've been trying to say,

it's been like a collective effort of everyone involved, especially the people, the grassroots. And you know, like, I guess to give listeners a little bit of context. So going back to May, they're in the big beautiful bill that unfortunately did pass. Originally Republicans included a ban on government funding for Medicaid for gender transition procedures and originally it was for minors in the house. Then right before they passed it through the house, they actually removed the minors clause so it was applying for all adults on Medicaid who are trans.

At this point, everyone started kind of freaking out which is very reasonable because you know, there's over 200,000 trans people on Medicaid. Depending on the numbers like 180,000 or 270,000 depending on who you ask. And so what we found is that, a lot of other sources have told us this that the bird rule, which is basically, parliamentary procedure in the Senate that only exists in the Senate

because of the filibuster pretty much is one way that we could kill this is what they told us back in May. And so that's something that we reported on and tried to take like, basically like a don't panic angle or don't panic yet at least, like that there's a lot of ways to fight back against this. And we provided, you know, templates for here's how you can email your senators.

And this is exactly what you should tell them. You should call them, you call specific people on specific committees and tell specific things to them. And, you know, of course, a lot of other organizations and people also chipped into this. A4TE had a campaign and whatnot. But I think at the end of the day, what really pushed the needle was people calling in and waking Democrats up to this issue. And basically, what ended up happening

is we blew Senate White in, basically argued to the parliamentarian that, hey, this trans-Medicaid ban, it's not a budgetary matter. It's actually a policy matter. And the parliamentarian agreed and ruled that it was basically a 60 vote threshold and not a 50 vote threshold. So what that meant is that as long as all Democrats,

or at least 40 Democrats, 41 Democrats, were opposing this measure, it was basically guaranteed to be kicked out of the bill. And we did end up having enough Democrats to basically ensure that that provision didn't make it into law, even though, unfortunately, the bill did pass, you know, today. Yeah. I think one thing that's notable about this, I think one thing that emerged in our discussions and while she's not on the podcast, I really want to thank Kareen Green for very invaluable like policy insight into some of this and some of the specific like ways and weaknesses

to go after politicians on this. And you know, certainly we were not alone in this. I think there were a lot of grassroots organizations as well. And I think kind of the approach that emerged and was successful, I think it's kind of important how it happened because one, it identified a specific weakness. We weren't just vaguely asking legislators to do something about this. And two, I think it did something which traditionally, definitely democratic politicians, but even a lot of the gay, to use a term popular among a lot of trans activists, like big lobbying

groups and establishment nonprofits have been loath to do, which has got angry at Democrats. It warned them that people were watching. It wasn't like, pretty please, will you do something to stop this? And from two decades dealing with politicians, that's a much more effective way to approach. If you're just going to ask nicely, they'll ignore you, they'll ignore your entire demographic if you're marginalized. If they're afraid of you, however, if they're worried about their phone lines being shut down with pushback, people getting angry at them, then they get worried and feel like they need to do something. So I think both with our article and with some of the other

grassroots groups involved, it really kind of put the focus back on what people can do, but it did it by identifying weakness and then pressing really hard on it. And I think that's kind of a break with how some of the very unsuccessful higher level tactics that have been used or not been used against transphobic legislation before. Yeah, and I think it's important to, you know, look at the changing terrain of this all because a lot of the sort of gay ink lobbying efforts

were based on conditions that don't exist anymore. And you could argue how effective they were back in like, you know, like 2015. Yeah. Right. And I still think there were more effective things that could have been done then. There is no argument now. Like you can't you can't just rely on sort of like access to democratic politicians and

being like, oh, hey, we're this org, you want this thing to happen. And we saw this a lot. This is something that our policy analyst friend, Corrine Green, who I've had in the show before was talking about with like with the Biden administration, was the way that all of these orgs sort of just fell in line behind the Biden administration, like fucking over trans people's healthcare in ways that no one ever really talked about. And that kind of access model got flipped, you know, whatever they were trying to do before, and you can, you know, you can have arguments about like, what they thought they were doing. At this before. And you can, you know, you can have arguments about like,

what they thought they were doing at this point is just like, no, like, you're not existing to like protect queer people. You're existing to protect the Democrats from queer people. And, you know, and the situation we're in now is one where, and there was some very, very scary reporting coming out of the Democrats where it was like, it wasn't clear if they were actually going to try to whip the votes together, like to actually vote against this stuff. And so like we're at a point where regardless of whatever you would have supported before, and again, like I think I think they were wrong before, but like now

no you had this is the only way to do this shit like there's no other mechanism. Yeah, so this has been something I've especially noticed in like reporting on this because myself and Matty, we both co-reported on the initial story breaking the effect that the Medicaid ban was going in there. Matty especially did all the stuff with the bird rule. When we initially started working on the story, it was just a small tip we had that there was going to be something big coming in the next funding bill. And I can definitely speak that at the time, Democrats lobbyists and so forth, they were just very like business as usual, right? They were just even knowing that a lot of this was kind of had the chance of emerging and that there was going to be a lot of bad stuff emerging a lot of it was still like

trying to use these old tactics from way back when to just act like everything is still as if it's you know, 2015 2014 and Once everything started to unfurl and the Medicaid ban became added in to the bill itself, witnessing it all from just a reporting perspective was like, it felt like watching them all go into panic mode and yet at the same time be like, trying to find ways to kind of push us to the side. Yeah.

like trying to find ways to kind of push us to the side. And while I am of course, like God, so incredibly thankful we were able to play any type of role in getting this done. Like, so it, it's become a narrative among so many, um, for lack of a better phrasing proponents of gay ink, proponents of the status quo, proponents of just, you proponents of the status quo, proponents of just, you know, your social democracy types, that the way forward is to be nice, to beg and plead for our rights, to hope that they give us it if we ask really, really nicely and we beg and plead and

we say thank you and we don't be too rude or else we'll earn it and we'll deserve what a little gift you know it's like what ultimately became the final straw was like we sent out a push for every single just reader follower every single listener of podcasts like everyone at home who just spread this around put pressure on the politicians, made it clear this wasn't acceptable, made it clear that no, they can't just ignore us and act like we don't exist. And that no, they can't just wash their hands away and pretend like this is all fine and that their records came that no, this is something that matters.

This is something that has to be fought. And it really boiled down to just the intense like pressure everyone put publicly like, yeah. And I think it is just a very ultimate testament to how the true power in any political system lies not with just a handful of elected nepo babies that end up getting into office, but with the regular people who make their voice heard, who band together and aren't afraid to say, hey, this shit is fucked up. We need to do something about it. I always had to be so good no one could ignore me.

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but like if they go, no, what else do you have then if you don't have some other kind of leverage? And one thing I've seen consistently at local, state, and federal levels, is the odds are a lot better if people are angry and the politicians are afraid. So I think building that, that's the real advantage that grassroots have. Yo, stop caring about the politicians. Are your friends or really care about us? Because generally the answer is they don't, not if them are our friends. And more focus on what can you and your communities, your friends, the larger networks you're a part of, do to make their lives miserable until the part of the status quo you're trying to fight becomes unsustainable for them too.

What I heard from people on the hill, or people close to people on the hill, is basically that the whole bird rule maneuver for this specific provision. There was definitely whispers of it, especially among lobbyists and maybe some staffers. But until he was being publicly advocated for this specific tool to be used by constituents towards senators, Democratic senators specifically, it wasn't really hugely in consideration

or that wasn't something they were planning to do in a very strong way. Maybe it would have happened eventually, but it definitely does seem like the constituent pressure specifically did help make Democrats realize that, hey, we're watching you. We're watching you do whether you're invoking these parliamentary procedures that you aren't supposed to know about. You're not supposed to know about this stuff, right? It's like, it's really obscure stuff that no one knows about except like super autistic policy nerds like me and Karen probably. But yeah, and this kind of stuff is really what turns the needles. And like, you can look at the other side too, right? Like,

you know, there are extremely effective lobbies in Congress you can look at. You can look at the other side too, right? Like, you know, there are extremely effective lobbies in Congress you can look at. You can look at the lobby that literally got this provision into the bill. They sent a letter to Speaker Johnson saying, hey, you should expand this from minors only to adults because we think this will actually help us survive the bird rule better. And this was a public letter, right? And you know, you might say, oh, well, that's not a big deal, right? It's just a letter, right? But how many gay rights organizations released a letter to Democrats saying they should invoke the bird rule? I'm not aware of any. Well, I think that's a key part of this is that, yes, eventually, some of those groups

did start belatedly moving against this. Yes, eventually, as we'll probably get into a second, some politicians did in various ways start moving against this. But I think it's important not to get kind of the cart before the horse. That came after the grassroots pressure, came after weeks of people getting angry at them, blowing up their phones, very public criticism. All the things that I think we're told a lot of the time by liberals and Democrats were not supposed to do, you know, be nice or your concerns won't be heard. Well, turns out is that the exact opposite of the case. And you mentioned those conservative lobbyists, people know, you know, I don't think it's always a rule that the tactics or enemy can be adopted for various reasons. But the NRA and all these terrible groups don't go into Congress going,

hey, please be nice to us. They go in going, do this, or we're going to make your life hell. And if you're, this is a terrain people are gonna fight on. That's how you have to fight as far as, because that's what moves politicians at every level is, it's, oh my God, I do not want this group angry at me. And there's one thing I wanna add too to is since the bird rolls and folk in the band was taken out, there is emerged a common narrative online.

It's not really one specific person doing this. It's just kind of something that's kind of collectively emerged in that claiming that the credit lies with politicians, with lobbyists, with staff, or it's with all these anonymous people behind closed doors who are supposedly the ones that actually did the work and no one else matters. I want to strongly emphasize that that is not only not true, but dangerous rhetoric. It's propaganda. It's propaganda. Yes. It's an attempt to reinforce the role that the state has in subjugating everyone to reinforce the fact that, oh no, the way things are is perfect. You can trust all these leaders to protect you when no, you can't. They are the

reason we got in this mess. The gaying tactics are the things that have failed and led to this in the first place. Liberals had plenty of opportunities to prevent this and they didn't and ultimately the reason that this narrative spreads is because At the end of the day gay ink is called that for a reason because well Yes Their interests happen to align on the realm of queer rights because they themselves are queer

At the end of the day, they are still representing the upper class and their primary interests are still going to be with protecting the upper class and protecting the role they have in subjugating the lower class and subjugating marginalized people who are not in their economic class. Yeah, which is most trans people, like almost all of us. Yeah. And this is like really important because I don't think the intersections of queerness and definitely not trans in class get talked about nearly enough. Yeah. Which is that queer and trans are overwhelmingly working class demographics.

Yep. Like the legislators, you know, like Sarah McBride, but also like the people running gang organizations are not just like not generally representative of our wider communities in a lot of ways. They also just have had incredibly different lives, almost always with some exceptions. They've been part of the gentry their entire lives. And most queer and trans people, especially trans people are as far from the gentry as you get. So that does create this massive gulf. But also, I think it's one reason

these groups are so out of touch. But also, I think it does, if we put the power back on ourselves, if we realize that this kind of grassroots anger is much more representative of where queer and trans people are, if this willingness to fight directly in whatever tactics people choose is much more in keeping with queer culture and tradition and history, then I think there's a lot of power there. And I think this is an example of successfully wielding that. I think Mira was correct about this propaganda that's kind of been spreading in the

wake. And it was particularly, I think, egregious because it specifically like cried to credit Sarah McBride, who had just come off a really obnoxious interview with the New York Times where she was literally against all the aggressive trans rights. And then after the man finally got killed, this, you know, various sources, and honestly, no, no, anyone hearing this stuff and whatever capacity is a journalist, activist, whatever, I think it's just professionally good to be more skeptical when these kinds of convenient narratives emerge. But yeah, kind of emerged all behind the scenes. She'd been doing so much. Yeah, sure. In public, she'd been, you know, very either low key or refusing to defend trans rights at all, even justifying some

of the narratives of our enemies. But sure, she was doing all this behind the scenes. She refused to fucking do anything when they banned trans people from fucking bathrooms in DC. Yes. Like in Capitol Hill. She wouldn't even defend her own staffers. Yes, exactly. So like, it's worth being skeptical to claim that, oh, she was doing so much behind the scenes. However, you know, if she was prompted in the last week of a multi-week effort to suddenly start taking some action based on anger, great.

Part of the point of these strategies is to prompt people who don't want to act into feeling like they're forced to act. But I think in 20 years of covering politics at various levels, if politicians don't like something, you will know. If't like something, you will know. If they support something, you will know. They will be very loud and very public because the public platform is one of the biggest powers they have, as well as doing whatever behind the scenes. If they're quiet about something or even seem opposite to it, especially if it involves a group on the front lines like trans communities. And then later on, they try to kind of take

back credit of saying, Oh, look, you know, we were doing so much behind the scenes. That is pretty universally a tactic to demobilize people. Yeah. And I want to note that the point of us saying this is not to say that, you know, Sarah McBride or, you know, Safers or other people didn't do anything like, of course, they did stuff, right? Like they voted, they were voting, they probably made some phone calls and stuff. Right. But what we're saying is like, okay, they basically did the bare minimum of what they're supposed to do, right?

Like, and that was only after a huge pressure campaign from the grassroots and from people who they would literally not be even in office without. Like I did the math in an article way back in last November, and there's like exit polls showing that like 86% of LGBTQ people voted for Democrats last year. That's like a crazy margin. That's like, it's up there with, you know, black voters and LGBTQ people are like the biggest spaces

of the Democratic party, right? Like they would have lost three or four more Senate seats. They would, it would have been like a 56 or 57 seat chamber if it were not for literally the people that are advocating for this healthcare. And it's so absurd that like Sarah McBride, what she did was, if we assume everything that's been said is true about this, what she's done is basically she got Democrats to not vote to take away the health care of 200,000 trans people, which is like, why was that even a question? Like, this is the actual story that came out of this, in my opinion, that was bigger is that this was ever in question that there might be like seven or eight Democrats who would vote to ban Medicaid from 200,000, 300,000 trans people. Medicaid from 200,000, 300,000 trans people. And the fact that we're supposed to give them a huge applause for not doing that is kind of obscene to me.

Yeah. I think the readiness to thank politicians kind of cuts against the grassroots anger and organizing that works so well here. Because you don't want them... Actually, I think it's generally a good rule not to thank politicians because what you want to constantly keep them in, I think it's generally a good rule not to thank politicians, because what you want to constantly keep them in, if that's the terrain you're going to fight on, is they need to feel like they're on thin ice. They need to worry, their staff needs to worry about, okay, we got to keep this out of the bill because, holy hell, you do not want those queers mad at you. That's where you want to get closer to if putting pressure

on politicians is what needs to happen. And so buying these narratives, thanking them, that takes the pressure off. Don't ever do that, you know? Yes. And so I think it's kind of important to quote the internet masterpiece, old drill tweet, like you do underneath circumstances have to hand it to them. At best, they acted late grudgingly after they faced a ton of anger that resulted and was helped amplified by a ton of work from bluntly like working class trans people and working class queer people. Yeah, and I would argue that what Representative McBride did specifically, even assuming that it did like help us in the short term with this bill, the way that she's been kind of

talking about this internally and in the New York Times interview is actually extremely like dangerous for trans people because like, believe it or not, they're not going to stop with this bill. They're going to do it again. They're going to do it again, probably in budget bills or another reconciliation bill. And at some point, it's going to come down to the wire where Democrats will have to publicly defend the right of trans people to have health care and to be alive and to exist. That's going to happen at some point. And what McBride has been telling everyone, what she's been telling as her client in the New York Times,

what she was telling Democrats behind the scenes, according to the notice article, is that you can't talk about these issues. You have to be really quiet. You just have to do it behind the scenes because it's too hot topic of an issue. You know, you don't want to accidentally like, I don't know, show the world that trans people might actually deserve to exist. It doesn't even make sense. I think they just, it doesn't, they just like feel gross arguing it like personally, like they don't, there's no political, like, there's no like good political catalyst. They just feel gross talking about trans people is my opinion that this is why they don't want to do it there's it's like it's bad for them politically

they will lose votes they will like lose political power they just like hate us basically i don't know Don't let biased algorithms, or degree screens, or exclusive professional networks, or stereotypes keep you from discovering the half of the workforce who are stars. Workers skill through alternative routes rather than a bachelor's degree. It's time to tear the paper ceiling and see the stars beyond it. Find out how you can make stars part of your talent strategy at tearthepaperceiling.org, brought to you by Opportunity at Work and the Ad Council.

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to your favorite shows. We should never be nice or kind or thank politicians like both Maddie and David had said. They are not our friends. Like there is a popular approach that I think a lot of people end up having towards these kind of quote unquote leaders, that they are somehow these like mythical saviors of everyone that they're all leading these nonprofits, they're leading these companies, these governments save us. They are not our friends. They do not give a shit about us. You would be surprised the things I've heard behind closed doors that they have said. They are not your friends. They hate every single fucking poor person. They will never say that

vocally, but they hate us. Especially the trans ones. Oh yeah, oh yeah. And it's like, want us to be subservient to them until the day we fucking die. Because it's all about consolidating their own power. And the kind of core that I'm getting at here is kill the idol in your head. You should never have an idol. Like there is no person worth idolizing. Not only not gay, not even only not anyone in this call, this this this podcast, not no one at all should be idolized because doing that is placing

all the power in the hands of people you don't know, in the hands of people who are just as human as anyone else. And even if they're very good people who do good things, are fundamentally capable of fucking up and doing bad. And if you idolize someone, you end up condoning everything they do, whether you even say it or otherwise, it comes with the territory. Fundamentally, you should not rely on other people to save you. You should rely on you and your community. You need to fucking work with your community to bring about the outcomes you want. And I mean you, the listener, like you specifically, yes, you need to work with your community to bring about what you need.

20.00 I think that's kind of the message that should emerge from this is no one in Washington, no organization, politician, are the ones with the power here. You are. You and your friends are, you and your community are. And I know we've said that a little bit before, but it's worth re-emphasizing how much people can do when they get together and decide to do something about these issues. Yeah, and I think that's a really good note to end on. However, comma, before we do that, very exciting news. Do y'all want to introduce the new News Network? Hell yeah. We have huge news to announce that's related to the news website that we used to write

this article about the Berggrubel, formerly known as Maddiecast News will now be known as Trans News Network. And we're basically relaunching completely. We're switching up our business model from technically was a for-profit before, but now it's going to be a fiscally sponsored nonprofit of community partners. And we're also moving a subset to Beehive. And so, as Mira and David were saying earlier, like, we don't want you to rely on us to save you.

Like, it's kind of like a team effort, right? Like, we do have a part to play. We'll help you give you information, but we also could use help from you. We could use help from the listener, especially people who do have, you know, some people have more time, some people have more resources or money. And one thing that we are looking to do with our relaunch is to fundraise so we can basically ensure that basically our journalists like Mira and David have the financial stability they need to continue making journalism like this.

And so we're launching with a fundraiser and we're going to have a link, I guess, with the podcast description. And there will be like, you know, you can get a free gift if you donate a certain amount. That's a huge way to help. But as well, you know, you also need to actually listen to the things that people in your community say, like, what are the things people in your community are saying that can help? What are other ways that you can contribute back to save yourselves basically, because we're all in this together. And yeah. I think also, one of the reasons I'm really excited about the TransNews Network and the transition as it were to the TransNews Network is that I think our collective experiences

and our experience with this fight as well have shown that there is a real need for hard-hitting, powerful, unrepentantly radical and trans journalism. Trans journalism that actually gets trans communities and proceeds kind of to take the fight from there. And so that's, that is badly needed. And I think we are from our own experiences and from kind of what we've all built working together like able to be part of that Yeah, and just to add one thing because I know How many trans people are artistic and need to hear this about out? I'm one of those This is explicitly your workers co-op. We are doing this radical from the ground up. Everyone gets equal say

This is a community thing. This is not some like, oh, you know, we're doing this. But then there's a nice CEO who makes 500 K. No, this is the money is going to the journalists who need it. This is a group of us basically deciding, hey, we need to fucking keep doing this work. We want to we need to support. We need help. Yeah. And we're joining the bandwagon of all these news outlets doing workers co-ops because that's the only way you can fucking make money in this industry nowadays. It's also the fairest and best way to do it. Yep. It's objectively the best and most ethical

way to do this under the hellscape of capitalism. Yep. And, uh, you know, Tamira's point, and I'm going to, we went on this podcast earlier this year to talk about trans journalism. And you might want to listen to that as well if you're curious on like just the struggles that a lot of us have dealt with. And number one is, you know, the material need for money basically. And I'm going to say what I said in that episode again, which is that $100 for some people like, you know, let's say working class trans person is very different compared to $100 for people in other social classes, you know, maybe someone working in

tech or something like maybe you'll get a dinner at the hundred dollars and it's not a big deal to you, right? It could be life changing for someone else who's literally like spending their life creating news to help trans people. Like, you know, this article that we wrote, it wasn't a huge amount of money that that took to create that. But at the same time, we don't have a lot of money to go around. Like, it's been basically a small number of people. We have a good number of like paid subscribers too. But really, in order to keep expanding the way we want to, we really need more money. And it's gonna be so huge to trans people everywhere. So, yeah. So if someone has money and is interested in supporting trans journalism, that is all

the things we've just talked about, and I think makes a real difference, yeah, please sign up as a paid subscriber, donate to the fundraiser. Every single dollar of that, we will put to use. Yep. Our first goal is basically to hire one of our journalists as a part-time W-2 employee, which would be literally life-changing. So yeah. Yeah. And we said this in the last episode and we're going to say it again.

Working class trans journalism can exist if you support it. And every single dollar that you send to a working class trans journalist is going a hundred times further than it's going for any other thing you can do Yeah, so like like it's going so much further that it is giving it to like fucking the Human Rights Committee or whatever the fuck Like wait, what's his what's the actual name of that organization Human Rights campaign? Yeah. Yeah, that one. Yeah. Yeah. Yeah Oh, by the way, did I mention it's tax deductible? So Gotta throw that in there if you itemize your deductions, if you give like $100 to us, then you get to pay like, you know, whatever, like $30 less goes to

the federal government, which means slightly less money for ICE in Israel. That's how I see it anyway. Please, dear God, I'm tired of living off my measly savings. Dear God, please. Yeah, you can tell they're really trying to sell this. And also, I think, like, you know, Meir and myself both do other trans journalism work. I'm part of the editor at the Asheville Blade, which is a local trans journalist co-op. And, you know, we've seen how far that goes. So, yeah, like the more support for trans journalism period, Trans News Network, the free radical Ashville Blade, some of the other projects out there, the better.

Yep. And this has been Naked Appen here. Support trans journalism and go keep fighting the good fight. It Could Happen Here is a production of Cool Zone Media. For more podcasts from Cool Zone Media, visit our website, coolzonedmedia.com, or check us out on the iHeart Radio app, Apple podcasts, or wherever you listen to podcasts. You can now find sources for It Could Happen Here listed directly in episode descriptions. Thanks for listening.

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