[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3329 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 3329
To prohibit taxpayer-funded gender transition procedures, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 15, 2023
Mr. LaMalfa (for himself, Mrs. Boebert, Mr. Lamborn, Mr. Gosar, Mr.
Banks, Mr. Duncan, Mr. Babin, Mr. Rouzer, Mr. Barr, Mr. Rosendale, Mr.
Weber of Texas, Mr. Brecheen, Mr. Norman, Mrs. Miller of Illinois, Mr.
Grothman, Mr. Wilson of South Carolina, Mr. Mills, Mr. Burlison, Mr.
Smith of New Jersey, Mr. Aderholt, Mrs. McClain, Mrs. Lesko, Mrs.
Harshbarger, Mr. Nehls, Mr. Kelly of Mississippi, Mr. Ogles, Mr.
Fallon, Mr. LaTurner, Mr. Davidson, Mr. Gaetz, Ms. Tenney, Mr. Allen,
Mr. Roy, and Mr. Mooney) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on the Judiciary, and Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To prohibit taxpayer-funded gender transition procedures, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``End Taxpayer
Funding of Gender Experimentation Act of 2023''.
(b) Table of Contents.--The table of contents of this Act are as
follows:
Sec. 1. Short title; table of contents.
TITLE I--PROHIBITING FEDERALLY FUNDED GENDER TRANSITION PROCEDURES
Sec. 101. Prohibiting taxpayer-funded gender transition procedures.
Sec. 102. Amendment to table of chapters.
TITLE II--APPLICATION UNDER THE AFFORDABLE CARE ACT
Sec. 201. Clarifying application of prohibition to premium credits and
cost-sharing reductions under ACA.
TITLE I--PROHIBITING FEDERALLY FUNDED GENDER TRANSITION PROCEDURES
SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER TRANSITION PROCEDURES.
Title 1, United States Code, is amended by adding at the end the
following new chapter:
``CHAPTER 4--PROHIBITING TAXPAYER-FUNDED GENDER TRANSITION PROCEDURES
``301. Prohibition on funding for gender transition procedures.
``302. Prohibition on funding for health benefits plans that cover
gender transition procedures.
``303. Limitation on Federal facilities and employees.
``304. Construction relating to separate coverage.
``305. Construction relating to the use of non-Federal funds for health
coverage.
``306. Construction relating to complications arising from gender
transition procedures.
``307. Definitions.
``Sec. 301. Prohibition on funding for gender transition procedures
``No funds authorized or appropriated by Federal law, and none of
the funds in any trust fund to which funds are authorized or
appropriated by Federal law, shall be expended for any gender
transition procedures.
``Sec. 302. Prohibition on funding for health benefits plans that cover
gender transition procedures
``No funds authorized or appropriated by Federal law, and none of
the funds in any trust fund to which funds are authorized or
appropriated by Federal law, shall be expended for health benefits
coverage that includes coverage of gender transition procedures.
``Sec. 303. Limitation on Federal facilities and employees
``No health care service furnished--
``(1) by or in a health care facility owned or operated by
the Federal Government; or
``(2) by any physician or other individual employed by the
Federal Government to provide health care services within the
scope of the physician's or individual's employment,
may include gender transition procedures.
``Sec. 304. Construction relating to separate coverage
``Nothing in this chapter shall be construed as prohibiting any
individual, entity, State, or locality from purchasing separate
coverage for gender transition procedures or health benefits coverage
that include gender transition procedures so long as such coverage is
paid for entirely with funds not authorized or appropriated by Federal
law, and such coverage shall not be purchased using matching funds
required for a federally subsidized program, including a State or
locality's contribution of Medicaid matching funds.
``Sec. 305. Construction relating to the use of non-Federal funds for
health coverage
``Nothing in this chapter shall be construed as restricting the
ability of any non-Federal health benefits coverage provider from
offering coverage for gender transition procedures, or the ability of a
State or locality to contract separately with such a provider for such
coverage, so long as only funds not authorized or appropriated by
Federal law are used, and such coverage shall not be purchased using
matching funds required for a federally subsidized program, including a
State or locality's contribution of Medicaid matching funds.
``Sec. 306. Construction relating to complications arising from gender
transition procedures
``Nothing in this chapter shall be construed to apply to the
treatment of any infection, injury, disease, or disorder that has been
caused by or exacerbated by the performance of a gender transition
procedure.
``Sec. 307. Definitions
``For purposes of this chapter:
``(1) Biological sex.--The term `biological sex' means the
biological indication of male or female in the context of
reproductive potential or capacity, such as sex chromosomes,
naturally occurring sex hormones, gonads, and non-ambiguous
internal and external genitalia present at birth, without
regard to an individual's psychological, chosen, or subjective
experience of gender.
``(2) Cross-sex hormones.--The term `cross-sex hormones'
means--
``(A) testosterone or other androgens given to
biological females at doses that are profoundly larger
or more potent than would naturally occur in healthy
biological females; or
``(B) estrogen given to biological males at doses
that are profoundly larger or more potent than would
naturally occur in healthy biological males.
``(3) Gender.--The term `gender' means the psychological,
behavioral, social, and cultural aspects of being male or
female.
``(4) Gender transition.--The term `gender transition'
means the process in which a person goes from identifying with
and living as a gender that corresponds to his or her
biological sex to identifying with and living as a gender
different from his or her biological sex, and may involve
social, legal, or physical changes.
``(5) Gender transition procedure.--
``(A) In general.--The term `gender transition
procedure' means any medical or surgical service,
including physician's services, inpatient and
outpatient hospital services, or prescribed drugs
related to gender transition, that seek to alter or
remove physical or anatomical characteristics or
features that are typical for an individual's
biological sex, or to instill or create physiological
or anatomical characteristics that resemble a sex
different from an individual's birth sex, including,
without limitation, medical services that provide
puberty-blocking drugs, cross-sex hormones, or other
mechanisms to promote the development of feminizing or
masculinizing features (in the opposite sex), or
genital gender transition surgery or nongenital gender
transition surgery performed for the purpose of
assisting an individual with a gender transition.
``(B) Exceptions.--The term `gender transition
procedure' does not include--
``(i) services to those born with a
medically-verifiable disorder of sex
development, including a person with external
biological sex characteristics that are
irresolvably ambiguous, such as those born with
46 XX chromosomes with virilization, 46 XY
chromosomes with undervirilization, or having
both ovarian and testicular tissue; or services
provided when a physician has otherwise
diagnosed a disorder of sexual development, in
which such physician has determined through
genetic or biochemical testing that the person
does not have normal sex chromosome structure,
sex steroid hormone production, or sex steroid
hormone action for a biological male or
biological female; or
``(ii) the treatment of any infection,
injury, disease, or disorder that has been
caused by or exacerbated by the performance of
a gender transition procedure, whether or not
such procedure was performed in accordance with
State or Federal law, or whether funding for
such procedure was permissible under this
chapter.
``(6) Gender transition surgery.--
``(A) In general.--The term `gender transition
surgery' means any medical or surgical service that
seeks to surgically alter or remove healthy physical or
anatomical characteristics or features that are typical
for an individual's biological sex in order to instill
or create physiological or anatomical characteristics
that resemble a sex different from an individual's
birth sex, including, without limitation, genital
gender reassignment surgery or non-genital gender
reassignment surgery performed for the purpose of
assisting an individual with a gender transition.
``(B) Exception.--Gender transition surgery does
not include any procedure undertaken because the
individual suffers from a physical disorder, physical
injury, or physical illness that would, as certified by
a physician, place the individual in imminent danger of
death or impairment of major bodily function unless
surgery is performed.
``(7) Genital gender transition surgery.--The term `genital
gender transition surgery' includes surgical procedures such as
penectomy, orchiectomy, vaginoplasty, clitoroplasty, or
vulvoplasty for biologically male patients, or hysterectomy/
ovariectomy, reconstruction of the fixed part of the urethra
with or without a metoidioplasty or a phalloplasty,
vaginectomy, scrotoplasty, or implantation of erection or
testicular prostheses for biologically female patients when
performed for the purpose of assisting an individual with a
gender transition.
``(8) Non-genital gender transition surgery.--The term
`non-genital gender transition surgery' means surgical
procedures including augmentation mammoplasty, facial
feminization surgery, liposuction, lipofilling, voice surgery,
thyroid cartilage reduction, gluteal augmentation (implants or
lipofilling), hair reconstruction, or other aesthetic
procedures for biologically male patients or subcutaneous
mastectomy, voice surgery, liposuction, lipofilling, pectoral
implants, or other aesthetic procedures for biologically female
patients, when performed for the purpose of assisting an
individual with a gender transition.
``(9) Puberty-blocking drugs.--The term `puberty-blocking
drugs' means--
``(A) Gonadotropin-releasing hormone (GnRH)
analogues or other synthetic drugs used in biological
males to stop luteinizing hormone secretion and
therefore testosterone secretion;
``(B) synthetic drugs used in biological females
that stop the production of estrogen; and
``(C) progesterone when used to delay or suppress
pubertal development in children for the purpose of
assisting an individual with a gender transition.''.
SEC. 102. AMENDMENT TO TABLE OF CHAPTERS.
The table of chapters for title 1, United States Code, is amended
by adding at the end the following new item:
``4. Prohibiting taxpayer-funded gender transition 301''.
procedures.
TITLE II--APPLICATION UNDER THE AFFORDABLE CARE ACT
SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO PREMIUM CREDITS AND
COST-SHARING REDUCTIONS UNDER ACA.
(a) In General.--
(1) Disallowance of refundable credit and cost-sharing
reductions for coverage under qualified health plan which
provides coverage for gender transition procedures.--
(A) In general.--Section 36B(c)(3)(A) of the
Internal Revenue Code of 1986 is amended by inserting
before the period at the end the following: ``or any
health plan that includes coverage for gender
transition procedures (other than any procedure
described in section 306 or 307 of title 1, United
States Code)''.
(B) Option to purchase or offer separate coverage
or plan.--Section 36B(c)(3) of such Code is amended by
adding at the end the following new subparagraph:
``(C) Separate coverage or plan for gender
transition procedures allowed.--
``(i) Option to purchase separate coverage
or plan.--Nothing in subparagraph (A) shall be
construed as prohibiting any individual from
purchasing separate coverage for gender
transition procedures described in such
subparagraph, or a health plan that includes
such gender transition procedures, so long as
no credit is allowed under this section with
respect to the premiums for such coverage or
plan.
``(ii) Option to offer coverage or plan.--
Nothing in subparagraph (A) shall restrict any
non-Federal health insurance issuer offering a
health plan from offering separate coverage for
gender transition procedures described in such
subparagraph, or a plan that includes such
gender transition procedures, so long as
premiums for such separate coverage or plan are
not paid for with any amount attributable to
the credit allowed under this section (or the
amount of any advance payment of the credit
under section 1412 of the Patient Protection
and Affordable Care Act).''.
(2) Disallowance of small employer health insurance expense
credit for plan which includes coverage for gender transition
procedures.--Subsection (h) of section 45R of the Internal
Revenue Code of 1986 is amended--
(A) by striking ``Any term'' and inserting the
following:
``(1) In general.--Any term''; and
(B) by adding at the end the following new
paragraph:
``(2) Exclusion of health plans including coverage for
gender transition procedures.--
``(A) In general.--The term `qualified health plan'
does not include any health plan that includes coverage
for gender transition procedures (other than a
procedure described in section 306 or 307 of title 1,
United States Code).
``(B) Separate coverage or plan for gender
transition procedures allowed.--
``(i) Option to purchase separate coverage
or plan.--Nothing in subparagraph (A) shall be
construed as prohibiting any employer from
purchasing for its employees separate coverage
for gender transition procedures described in
such subparagraph, or a health plan that
includes such gender transition procedures, so
long as no credit is allowed under this section
with respect to the employer contributions for
such coverage or plan.
``(ii) Option to offer coverage or plan.--
Nothing in subparagraph (A) shall restrict any
non-Federal health insurance issuer offering a
health plan from offering separate coverage for
gender transition procedures described in such
subparagraph, or a plan that includes such
gender transition procedures, so long as such
separate coverage or plan is not paid for with
any employer contribution eligible for the
credit allowed under this section.''.
(b) Application to Multi-State Plans.--Section 1334(a) of the
Patient Protection and Affordable Care Act (42 U.S.C. 18054(a)) is
amended by adding at the end the following new paragraph:
``(8) Coverage consistent with federal policy regarding
gender transition procedures.--In entering into contracts under
this subsection, the Director shall ensure that no multi-State
qualified health plan offered in an Exchange provides health
benefits coverage for which the expenditure of Federal funds is
prohibited under chapter 4 of title 1, United States Code.''.
(c) Effective Date.--
(1) Effective date with respect to premium credits and cost
sharing reductions.--The amendments made by subsection (a)
shall apply to taxable years after the date that is one year
after the date of enactment of this Act, but only with respect
to plan years beginning after such date.
(2) Effective date for application to multi-state plans.--
The amendment made by subsection (b) shall apply to plan years
beginning on the date that is one year after the date of
enactment of this Act.
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