AmEx shareholders reject proposal to study risks of ‘gender-affirming care’ for minors’ health plans

Nobody ever said challenging transgender medical procedures for minors from corporate healthcare plans would be easy.

American Express shareholders overwhelmingly defeated a shareholder resolution to examine the company’s coverage for sex-reassignment drugs and surgeries for underage patients, with 99.57% voting against the proposal.

The results from the proxy vote held after Tuesday’s annual shareholders’ meeting came as a disappointment — but not a surprise — to supporters of Proposal 4, given the outsized role of proxy advisory firms such as BlackRock, Vanguard and State Street in shareholder voting.

“This result is not surprising at all,” said Tim Schwarzenberger, director of corporate engagement for Inspire Investing, a financial services firm dedicated to “biblically responsible investing.”

“When you start seeing vote outcomes approaching 99% against proposals identifying legitimate company risks, it raises serious questions about how concentrated and institutionalized the proxy voting system has become and whether the process still reflects genuine shareholder democracy rather than the type of predetermined outcomes more commonly associated with authoritarian regimes,” he said in a Friday statement.

Mr. Schwarzenberger said that Inspire Investing has been “actively pushing for proxy reform for years, particularly pass-through proxy voting, where the votes of the actual end investors are truly reflected.”

Proposal 4 asked the American Express Board of Directors to analyze and report back on the “legal, regulatory, political, reputational, and other relevant risks of providing transgender treatments for minors on its healthcare plans.”

The board recommended a no vote on the resolution, saying its healthcare plan selection process “already incorporates consideration of relevant risks.”

American Express has neither confirmed nor denied that “gender-affirming care” is included in its employee-benefits plans, but the Human Rights Campaign gave the company a perfect score of 100 on its 2026 Corporate Equality Index.

To achieve that score, the “American Express Company reported that it adopted radical adolescent transgender treatments recommended by the World Professional Association for Transgender Health (WPATH),” according to the shareholder resolution.

In its statement, the board said it no longer participates in the HRC survey, “so a stated foundation of the proposal no longer exists.”

The HRC’s 2026 index said American Express “has not yet submitted a 2026 CEI survey,” indicating that the latest score is based on responses from previous years.

Those backing the proposal included the conservative Alliance Defending Freedom, part of a coalition that filed 74 shareholder resolutions in the 2024-25 season aimed at challenging left-wing “corporate cancel culture.”

Jeremy Tedesco, vice president of the ADF’s Counter Censorship Task Force, urged American Express and other companies to eliminate gender-transition drugs and surgeries for minors from their employer-provided insurance plans.

“Paying for the sterilization of children by covering so-called ’sex change’ operations of minors is unacceptable,” said Mr. Tedesco in a Friday statement. “This result is a reflection of a problematic system rather than shareholder sentiment. American Express and every company should stop covering these harmful, legally risky procedures that irreparably harm young women and girls.”