Marley Gotterer was recovering from surgery at home in New York when she first heard that House Republicans had passed a massive domestic policy package in the wee hours of Thursday morning.

She had prepared for nearly two years for her facial feminization surgery, a series of surgical procedures. She met with surgeons, therapists and case managers at Amida Care, a nonprofit health plan for LGBTQ+ Medicaid recipients and those living with HIV.

Her surgery, which was fully covered under Medicaid, has already made a huge difference in her life and for her mental health. She now feels an instant lightness when she sees herself in the mirror. She said she caught a glimpse of herself on a video call with friends and asked if someone had put a beauty filter on.

“I had intense gender euphoria and I felt at home in myself,” the 27-year-old comedian said. “I feel like there’s this new start in life that I’m excited about and hopeful for.”

But that hope has now been tempered.