[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1595 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 1595
To prohibit taxpayer-funded gender transition procedures, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 15, 2023
Mr. Marshall (for himself, Mrs. Blackburn, Mr. Braun, Mr. Cramer, Mr.
Daines, Mrs. Hyde-Smith, Mr. Lee, Mr. Mullin, Mr. Risch, Mr. Rubio, Mr.
Wicker, and Mr. Hawley) introduced the following bill; which was read
twice and referred to the Committee on Finance
_______________________________________________________________________
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 is 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
``Sec.
``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, or State or locality from purchasing separate
coverage for gender transition procedures or health benefits coverage
that includes gender transition procedures so long as such coverage is
paid for entirely using only 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's
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's 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 normally occur naturally in
healthy biological females; and
``(B) estrogen given to biological males at doses
that are profoundly larger or more potent than would
normally occur naturally 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 an individual 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 that
seeks--
``(i) to alter or remove physical or
anatomical characteristics or features that are
typical for the individual's biological sex; or
``(ii) to instill or create physiological
or anatomical characteristics that resemble a
sex different from the individual's birth sex.
``(B) Inclusions.--For purposes of subparagraph
(A), the term `medical or surgical service' includes--
``(i) physician's services;
``(ii) inpatient and outpatient hospital
services;
``(iii) prescribed drugs relating to gender
transition;
``(iv) a medical service that provides--
``(I) puberty-blocking drugs;
``(II) cross-sex hormones; or
``(III) other mechanisms to promote
the development of feminizing or
masculinizing features (in the opposite
sex); and
``(v) gender transition surgery.
``(C) Exclusions.--The term `gender transition
procedure' does not include--
``(i) services to individuals born with a
medically verifiable disorder of sex
development, including an individual with
external biological sex characteristics that
are irresolvably ambiguous, such as an
individual born with 46 XX chromosomes with
virilization, an individual born with 46 XY
chromosomes with undervirilization, or an
individual born having both ovarian and
testicular tissue;
``(ii) services provided when a physician
has otherwise diagnosed a disorder of sexual
development in which the physician has
determined through genetic or biochemical
testing that the individual does not have
normal sex chromosome structure, sex steroid
hormone production, or sex steroid hormone
action for a biological male or biological
female; or
``(iii) the treatment of any infection,
injury, disease, or disorder that has been
caused by or exacerbated by the performance of
gender transition procedures, whether or not
the gender transition procedure was performed
in accordance with State and Federal law or
whether or not funding for the gender
transition procedure is 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 the individual's biological sex in order to instill
or create physiological or anatomical characteristics
that resemble a sex different from the individual's
birth sex.
``(B) Inclusions.--The term `gender transition
surgery' includes genital gender transition surgery and
non-genital gender transition surgery.
``(C) Exclusions.--The term `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 the procedure is
performed, unless such procedure is performed for the
purpose of a gender transition or for the alleviation
of psychological or mental distress.
``(7) Genital gender transition surgery.--The term `genital
gender transition surgery' means a surgical procedure performed
for the purpose of assisting an individual with a gender
transition, including--
``(A) for biologically male patients, a penectomy,
orchiectomy, vaginoplasty, clitoroplasty, and
vulvoplasty; and
``(B) for biologically female patients, a
hysterectomy/ovariectomy, reconstruction of the fixed
part of the urethra with or without a metoidioplasty or
a phalloplasty, vaginectomy, scrotoplasty, and
implantation of erection or testicular prostheses.
``(8) Non-genital gender transition surgery.--The term
`non-genital gender transition surgery' means a surgical
procedure performed for the purpose of assisting an individual
with a gender transition, including--
``(A) for biologically male patients, augmentation
mammoplasty, facial feminization surgery, liposuction,
lipofilling, voice surgery, thyroid cartilage
reduction, gluteal augmentation (implants/lipofilling),
hair reconstruction, and various aesthetic procedures;
and
``(B) for biologically female patients,
subcutaneous mastectomy, voice surgery, liposuction,
lipofilling, pectoral implants, and various aesthetic
procedures.
``(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; and
``(B) synthetic drugs used in biological females
that stop the production of estrogen and 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 procedures.--
(A) In general.--Subparagraph (A) of section
36B(c)(3) 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 of title 1, United
States Code)''.
(B) Option to purchase or offer separate coverage
or plan.--Paragraph (3) of section 36B(c) 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 any
procedure described in section 306 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 Public
Law 111-148 (42 U.S.C. 18054(a)) is amended by adding at the end the
following new paragraph:
``(7) 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.--The amendments made by subsection (a) shall
apply to taxable years ending after the date that is 1 year after the
date of enactment of this Act, but only with respect to plan years
beginning after such date, and the amendment made by subsection (b)
shall apply to plan years beginning after such date.
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