On Wednesday, the Washington State Senate passed HB 1971, a first-of-its-kind bill from House Rep. Nicole Macri that compels insurance companies in the state to cover up to a year’s supply of hormone replacement therapy, starting in January 2026. Now it's on its way to the governor's desk. For trans people, whose health care is under federal attack, it’s coming at a clutch time.

Insurers typically cover a one to three month supply of most drugs, including hormones. Their rationale is that dispensing any more than that at a time comes with the risk of paying for drugs they didn’t have to pay for, like if someone switches insurance plans before they’re due for a refill (or, like, dies unexpectedly).

Rep. Macri thought an exception was in order after seeing the results of a survey from the state LGBTQ commission that found trans and nonbinary people across the state were very worried about losing access to their medications.

It’s a founded fear. The federal government is waging its ideological war against evidence-based trans care through executive order. President Donald Trump’s attempt to ban care outright for trans people under 19 is held up in the federal courts at the moment, but in the meantime his agency goons are trying to take it away from the poorest trans people they can find, who depend on the government for healthcare.

Last week, the Dr. Mehmet Oz-led Centers for Medicaid and Medicare Services (CMS) sent a letter telling state Medicaid programs to stop covering kids’s gender care, which made unfounded claims that gender-affirming care is harmful and cited the UK’s questionable “Cass Review” on youth care as gospel. The Trump administration is also trying to exclude coverage for trans health care under Affordable Care Act plans. According to a Kaiser Family Foundation/ Washington Post Survey, about 21 percent of trans adults were on medicaid (compared with 14 percent of cis adults). 

For Heather Johnson of Port Townsend, 2026 seems a long time to wait when this administration has gone so far on trans care in the three months Trump’s been back in office.

A bill that allows her stock up is welcome, but Johnson is on her partner’s government health care plan. She wonders what will happen when open enrollment comes around. Will the federal government interfere before the day she can fill that 12-month prescription?

“Anything could happen between now and then,” Johnson says. “It doesn’t change the fact that I feel like I still need to work on stockpiling, but as far as the future goes, I’m excited.”

Washington state—which has some of the strongest protections for trans medical care in the country, including a requirement for insurers to cover all gender affirming care—is not likely to cave to the feds. Washington State Insurance Commissioner Patty Kuderer said as much in a letter to CMS on April 11, writing that the rule was discriminatory and violated both state and federal law.

“CMS is coming quickly with attacks on access to care so I’m glad we passed this bill, which mitigates some of the risk,” sponsor Rep. Macri said by phone. “Not all, but it does mitigate some.”

So what’s materially changing for patients on HRT in Washington? If Gov. Bob Ferguson signs the bill as expected, come January 2026, those on estrogen can stock up on a year of medication. Patients on testosterone are likely limited to a 6 month supply because it’s a steroid and controlled substance, according to Rep. Macri. It’s not dangerous if taken as prescribed but is easily abused for sports doping (sorry, boys). Insurers will still be able to limit scripts to three months if there's a shortage, and limit patients to one 12-month refill every nine months.

But HRT is not just a “trans” treatment. Plenty of trans people take it, but they’re not even the majority. Doctors give HRT to postmenopausal cis women, cis men with hypogonadism (low-T), cancer survivors, and people with endocrine disorders. Consistent access is important for them all because HRT is not a set and forget type treatment. Hormones are taken either daily in pill form or weekly as an injection, sometimes for the rest of a patient’s life.

Stopping suddenly brings on unpleasant symptoms like unsteady sleep, moodiness, and a fatigued sluggishness. The endocrine system is a network of glands and tissues that function as a chemical postal service, telling the body things disparate as “we hungry” and “grow boobs.” Complex and important for basic function, the endocrine system doesn’t appreciate being jerked around. Being able to pick up HRT in bulk could keep that from happening to fewer people, even those who simply struggle to get to the pharmacy on time.

If the federal government takes HRT away from trans people, the consequences could be a bit nightmarish. Stop treatment abruptly and the changes someone has waited months or years can begin to fade. In their place sprout features they don’t want—wide hips for some, a beard for others, and subtle markers of gender like skin texture. It’s not just a physical reversion, but a loss of control that comes with a wave of dysphoric feeling and elevated risk of depression and suicidal thoughts.

The bill passed the House on a party line vote, but 10 of the 19 Republicans in the Senate voted for it. Not to help trans people or anything, as a few made clear, however obliquely, on the floor in Olympia.

“Once again, I’ll reiterate, the vast majority are cancer survivors, post-menopausal women, or like my daughter who has endometriosis,” said Ron Muzzall (R-Whidbey Island). “This is going to have a very positive impact on individuals in our society who have no choice to take what is prescribed to them by their doctor.”

Sen. Keith Wagoner (R-Sedro-Wooley), whose daughter is a cancer survivor and takes HRT, said it was unfortunate this bill got inflamed on the “fringes” because it addressed “as the chair called it” gender-affirming care.

“That is such a small part of what this bill does that I feel it should not be considered,” he says.

The story has been updated since its original publication to correct the spelling of Patty Kuderer's last name.