We Pay, Too”: The Truth About Transgender and Non-Binary Americans’ Contributions and the Injustice of Healthcare Denial

By Rev. Paula Josephine Sadler

Universal Rainbow Faith

> “To deny healthcare to any group of taxpayers is not fiscal conservatism—it is moral corruption.”

As the U.S. House advances the so-called “One Big Beautiful Bill,” which aims to strip transgender individuals of access to gender-affirming care through Medicaid, CHIP, and ACA subsidies, the nation stands at a critical juncture. For the 2.3 million transgender Americans—and countless more non-binary and gender-diverse individuals—this isn't merely a policy debate. It's a stark denial of humanity, legality, and basic economic fairness.

Let us be unequivocal: Transgender and non-binary people pay taxes. We contribute. We uphold the very systems now being weaponized against us.

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📊 Economic Reality: Transgender Americans Are Taxpayers

Consider the numbers:

2.3 million adults in the U.S. identify as transgender. This figure likely underrepresents the actual number, as many may not disclose their gender identity due to societal stigma and discrimination.

Assuming 50% are employed full-time at an average annual wage of $35,000:

$4.025 billion/year in combined federal and state income taxes

$3.09 billion/year in Social Security and Medicare payroll taxes

$500 million to $2 billion/year in unemployment and disability insurance contributions

Beyond employment taxes, transgender and non-binary individuals engage in consumer spending like all Americans:

With a conservative estimate of $20,000 in annual spending per person:

$20,000 x 2.3 million = $46 billion in consumer spending

At a 6% sales tax average = $2.76 billion in state/local sales tax revenue

Total estimated annual contribution: Over $10–12 billion to public systems.

Yet, despite these substantial contributions, transgender individuals are being told they're unworthy of the very benefits they help fund.

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🏥 Healthcare Costs and Access Disparities

The proposed ban would eliminate access to essential, medically recommended care—including hormone therapy, puberty blockers, surgeries, and mental health support. Major medical associations affirm that these are not elective procedures—they are life-saving treatments.

Average Medicaid Cost for Transgender Healthcare: Studies estimate that the average annual cost to Medicaid for gender-affirming care ranges from $20 to $20,000 per person, depending on the services provided. Hormone therapy may cost $240 to $1,200/year, and while gender-affirming surgeries vary, most individuals do not undergo surgical procedures. The overall expenditure is a minuscule fraction of total Medicaid spending.

In stark contrast, the U.S. military allocates approximately $84 million annually on erectile dysfunction medications, including $41.6 million on Viagra alone . This expenditure is eight times the estimated cost of providing gender-affirming care to transgender service members .

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💸 Tax Cuts for the Wealthy and Healthcare Costs for Families

The "One Big Beautiful Bill" also proposes substantial tax cuts that disproportionately benefit the wealthiest Americans:

Households in the top 1% could see a $44,190 tax cut, while middle-class households earning between $51,000 and $92,999 would receive an average of $815 .

Meanwhile, healthcare costs continue to burden American families:

Average annual premium for a family of four: Approximately $23,968 .

Average monthly premium for child-only health insurance: Around $311, totaling $3,732 annually .

Median household income in the U.S.: Approximately $75,000 .

This means that families are spending over 30% of their income on health insurance premiums alone, far exceeding the recommended 5%–10% of income allocation for healthcare expenses .

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🧠 Historical Parallels of Exclusion

This isn't the first time in U.S. history that a group of taxpayers has been denied access to services:

Black Americans were denied education, housing, and healthcare during Jim Crow, even as they paid taxes like everyone else.

Women paid taxes while being denied the vote, credit access, and full employment rights.

LGBTQ+ people funded the healthcare system while being abandoned during the HIV/AIDS crisis.

Now, it's transgender people—many of whom are low-income, disabled, veterans, or people of color—being targeted.

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💔 The Human Cost

To erase our healthcare is to say we do not matter. But we do matter:

We work. We parent. We serve in the military. We run businesses.

We pay our taxes.

And we live under constant threat of erasure—from both violence and legislation.

Let us remember: many of these same lawmakers receiving federal salaries and health coverage have themselves never missed a taxpayer-funded paycheck.

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📣 A Call for Equity, Not Exclusion

It's time to stop treating transgender and non-binary people as political pawns. These are human beings, not budget lines.

No one should have to prove their worthiness for healthcare after already paying for it.

No one should be told their life-saving care is “optional” while others’ is essential.

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🕊️ A Moral, Economic, and Civil Right

Medicaid, Medicare, and Social Security are not welfare. They are earned benefits, funded by all Americans—trans, cis, gay, straight, Black, white, rich, and poor.

Denying care to transgender people is not about budgets. It is about bias.

And we see it.

Let history remember this moment not as another stain of discrimination, but as the moment we stood up for truth, justice, and dignity for all.

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🖊️ Authored by:

Rev. Paula Josephine Sadler

Transgender spiritual leader, author, and founder of Universal Rainbow Faith Church

📍Las Vegas, NV

🌐 www.universalrainbowfaith.org