[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 2357 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 2357
To amend chapter 110 of title 18, United States Code, to prohibit
gender-affirming care on minors, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 18, 2023
Mr. Vance introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend chapter 110 of title 18, United States Code, to prohibit
gender-affirming care on minors, 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.
This Act may be cited as the ``Protect Children's Innocence Act''.
TITLE I--GENDER-AFFIRMING CARE ON MINORS PROHIBITED
SEC. 101. GENDER-AFFIRMING CARE ON MINORS PROHIBITED.
Chapter 110 of title 18, United States Code, is amended--
(1) by adding at the end the following:
``Sec. 2260B. Gender-affirming care on minors
``(a) Definitions.--In this section:
``(1) Biological sex.--The term `biological sex' means the
indication of male or female sex by reproductive potential or
capacity, sex chromosomes, naturally occurring sex hormones,
gonads, or internal or external genitalia present at birth.
``(2) Gender-affirming care.--
``(A) In general.--Except as provided in
subparagraph (B), the term `gender-affirming care'
means, with respect to an individual, any of the
following:
``(i) Performing any surgery for the
purpose of changing the body of the individual
to correspond to a sex that differs from the
individual's biological sex, including--
``(I) castration;
``(II) orchiectomy;
``(III) scrotoplasty;
``(IV) vasectomy;
``(V) hysterectomy;
``(VI) oophorectomy;
``(VII) ovariectomy;
``(VIII) metoidioplasty;
``(IX) penectomy;
``(X) phalloplasty;
``(XI) vaginoplasty;
``(XII) vaginectomy;
``(XIII) vulvoplasty;
``(XIV) reduction
thyrochondroplasty;
``(XV) chondrolaryngoplasty; and
``(XVI) mastectomy.
``(ii) Any plastic surgery that feminizes
or masculinizes the facial features of the
individual for the purposes described in clause
(i).
``(iii) Any placement of chest implants in
the individual to create feminine breasts for
the purposes described in clause (i).
``(iv) Any placement of fat or artificial
implants in the gluteal region of the
individual for the purposes described in clause
(i).
``(v) Administering, supplying,
prescribing, dispensing, distributing, or
otherwise conveying to the individual
medications for the purposes described in
clause (i), including--
``(I) gonadotropin-releasing
hormone (commonly known as `GnRH')
analogues or other puberty-blocking
drugs to stop or delay normal puberty;
``(II) testosterone or other
androgens to a biological female at
doses that are supraphysiologic to the
female sex; and
``(III) estrogen to a biological
male at doses that are supraphysiologic
to the male sex.
``(B) Exception.--Subparagraph (A) shall not apply
to conduct with respect to the following individuals:
``(i) An individual with both ovarian and
testicular tissue.
``(ii) An individual who does not have
normal sex chromosome structure, sex steroid
hormone production, or sex steroid hormone
action, as determined by a physician through
genetic or biochemical testing.
``(iii) An individual experiencing
infection, disease, injury, or disorder caused
or exacerbated by previous gender transition
procedures.
``(iv) An individual suffering 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 a major bodily
function unless a procedure described in that
subparagraph is performed.
``(3) Minor.--The term `minor' means any individual under
the age of 18 years.
``(b) Prohibition on Performing Gender-affirming Care on Minors.--
``(1) Offense.--It shall be unlawful, in any circumstance
described in subsection (e), to knowingly perform any gender-
affirming care on a minor.
``(2) Penalty.--Any person who violates paragraph (1) shall
be fined under this title, imprisoned for not more than 12
years, or both.
``(c) Prohibition on Prosecution of Person on Whom Intervention Is
Performed.--A person on whom gender-affirming care is performed may not
be arrested or prosecuted for an offense under subsection (b).
``(d) Civil Action.--A person on whom gender-affirming care is
performed in violation of subsection (b) may bring a civil action in an
appropriate district court of the United States for appropriate relief,
including compensatory and punitive damages, against each person who
performed the gender-affirming care.
``(e) Circumstances Described.--The circumstances referred to in
subsection (b) are that--
``(1) the defendant or victim traveled in interstate or
foreign commerce, or traveled using a means, channel, facility,
or instrumentality of interstate or foreign commerce, in
furtherance of or in connection with the conduct described in
that subsection;
``(2) the defendant used a means, channel, facility, or
instrumentality of interstate or foreign commerce in
furtherance of or in connection with the conduct described in
that subsection;
``(3) any payment of any kind was made, directly or
indirectly, in furtherance of or in connection with the conduct
described in that subsection using any means, channel,
facility, or instrumentality of interstate or foreign commerce
or in or affecting interstate or foreign commerce;
``(4) the defendant transmitted in interstate or foreign
commerce any communication relating to or in furtherance of the
conduct described in that subsection--
``(A) using any means, channel, facility, or
instrumentality of interstate or foreign commerce; or
``(B) in or affecting interstate or foreign
commerce by any means or in any manner, including by
computer, mail, wire, or electromagnetic transmission;
``(5) any instrument, item, substance, or other object that
has traveled in interstate or foreign commerce was used to
perform the conduct described in that subsection;
``(6) the conduct described in that subsection occurred
in--
``(A) the special maritime and territorial
jurisdiction of the United States; or
``(B) a territory or possession of the United
States; or
``(7) the conduct described in that subsection otherwise
occurred in or affected interstate or foreign commerce.
``(f) Rule of Construction.--Nothing in this section shall be
construed as prohibiting provision of the medical services described in
subsection (a)(2)(A) to address legitimate health issues, such as any
male or female reproductive cancers, apart from changing the body of an
individual to correspond to a sex that differs from the individual's
biological sex.''; and
(2) in the table of sections, by adding at the end the
following:
``2260B. Gender-affirming care on minors.''.
TITLE II--PROHIBITING FEDERALLY FUNDED GENDER-AFFIRMING CARE
SEC. 201. PROHIBITING TAXPAYER-FUNDED GENDER-AFFIRMING CARE.
Title 1, United States Code, is amended by adding at the end the
following:
``CHAPTER 4--PROHIBITING TAXPAYER-FUNDED GENDER-AFFIRMING CARE
``301. Prohibition on funding for gender-affirming care.
``302. Prohibition on funding for health benefits plans that cover
gender-affirming care.
``303. Limitation on Federal facilities and employees, Federal land and
territories, and Tribal territories.
``304. Effect on separate coverage.
``305. Effect on use of non-Federal funds for health coverage.
``306. Application to complications arising from gender-affirming care.
``307. Application to individuals born with medically verifiable
disorder of sex development.
``308. Gender-affirming care defined.
``309. Effect of chapter.
``Sec. 301. Prohibition on funding for gender-affirming care
``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, including funds provided under titles
XVIII, XIX, and XXI of the Social Security Act, shall be expended for
any gender-affirming care.
``Sec. 302. Prohibition on funding for health benefits plans that cover
gender-affirming care
``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-affirming care.
``Sec. 303. Limitation on Federal facilities and employees, Federal
land and territories, and Tribal territories
``Gender-affirming care may not be included in any health care
service furnished by--
``(1) a health care facility owned or operated by the
Federal Government;
``(2) a health care facility operated on Federal land, in a
territory, or in a Tribal territory; or
``(3) any physician or other individual providing health
care services within the scope of the physician's or
individual's employment who is--
``(A) employed by the Federal Government; or
``(B) employed by a health care facility operated
on Federal land, in a territory, or in a Tribal
territory.
``Sec. 304. Effect on separate coverage
``Nothing in this chapter prohibits any individual, entity, or
State or locality from purchasing separate coverage for gender-
affirming care or health benefits coverage that includes gender-
affirming care, on the condition that such coverage--
``(1) is paid for entirely using funds--
``(A) not authorized or appropriated by Federal
law; or
``(B) not received from Federal programs,
platforms, or infrastructure;
``(2) does not cover any practice that would be subject to
penalty under section 2260B of title 18; and
``(3) is not purchased using matching funds required for a
federally subsidized program, including a State's or locality's
contribution of Medicaid matching funds.
``Sec. 305. Effect on use of non-Federal funds for health coverage
``Nothing in this chapter restricts the ability of any non-Federal
health benefits coverage provider from offering coverage for gender-
affirming care, or the ability of a State or locality to contract
separately with such a provider for such coverage, on the condition
that such coverage--
``(1) is paid for entirely using funds--
``(A) not authorized or appropriated by Federal
law; or
``(B) not received from Federal programs,
platforms, or infrastructure;
``(2) does not cover any practice that would be subject to
penalty under section 2260B of title 18; and
``(3) is not purchased using matching funds required for a
federally subsidized program, including a State's or locality's
contribution of Medicaid matching funds.
``Sec. 306. Application to complications arising from gender-affirming
care
``Nothing in this chapter applies to the treatment of any
infection, injury, disease, or disorder that has been caused or
exacerbated by the performance of a gender-affirming care, regardless
of whether--
``(1) the gender-affirming care was performed in accordance
with Federal or State law; or
``(2) funding for the gender-affirming care is permissible
under section 307.
``Sec. 307. Application to individuals born with medically verifiable
disorder of sex development
``The prohibitions and limitations described in sections 301, 302,
and 303 shall not apply to conduct with respect to an individual
described in section 2260B(a)(2)(B) of title 18.
``Sec. 308. Gender-affirming care defined
``For purposes of this chapter, the term `gender-affirming care'
has the meaning given such term in section 2260B of title 18.
``Sec. 309. Effect of chapter
``Nothing in this chapter prohibits the provision of the medical
services described in section 2260B(a)(2)(B) of title 18, to address
any male or female reproductive cancers (other than medical services to
change the body of an individual to correspond to a sex that differs
from the individual's biological sex).''.
SEC. 202. AMENDMENT TO TABLE OF CHAPTERS.
The table of chapters for title 1, United States Code, is amended
by adding at the end the following:
``4. Prohibiting taxpayer-funded gender-affirming care...... 301''.
TITLE III--APPLICATION UNDER THE AFFORDABLE CARE ACT
SEC. 301. 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-affirming care.--
(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-affirming care (other than any gender-
affirming care or treatment described in section 306 or
307 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-
affirming care 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-
affirming care described in such subparagraph,
or a health plan that includes such gender-
affirming care, so long as no credit is allowed
under this section with respect to the premiums
for such coverage or plan and such coverage or
plan does not cover any practice that would be
subject to penalty under section 2260B of title
18, United States Code.
``(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-affirming care described in such
subparagraph, or a plan that includes such
gender-affirming care, 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) and such coverage or plan does not
cover any practice that would be subject to
penalty under section 2260B of title 18, United
States Code.''.
(2) Disallowance of small employer health insurance expense
credit for plan which includes coverage for gender-affirming
care.--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-affirming care.--
``(A) In general.--The term `qualified health plan'
does not include any health plan that includes coverage
for gender-affirming care (other than any gender-
affirming care or treatment described in section 306 or
307 of title 1, United States Code).
``(B) Separate coverage or plan for gender-
affirming care 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-affirming care described in such
subparagraph, or a health plan that includes
such gender-affirming care, so long as no
credit is allowed under this section with
respect to the employer contributions for such
coverage or plan and such coverage does not
cover any practice that would be subject to
penalty under section 2260B of title 18, United
States Code.
``(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-affirming care described in such
subparagraph, or a plan that includes such
gender-affirming care, so long as such separate
coverage or plan is not paid for with any
employer contribution eligible for the credit
allowed under this section and such coverage or
plan does not cover any practice that would be
subject to penalty under section 2260B of title
18, United States Code.''.
(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:
``(8) Coverage consistent with federal policy regarding
gender-affirming care.--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 one 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.
TITLE IV--ADDITIONAL PROVISIONS
SEC. 401. PROHIBITION ON INSTITUTIONS OF HIGHER EDUCATION AND
ACCREDITING AGENCIES OR ASSOCIATIONS.
(a) Prohibition on Institutions of Higher Education.--Section
487(a) of the Higher Education Act of 1965 (20 U.S.C. 1094(a)) is
amended by adding at the end the following:
``(30) The institution will not offer instruction in
gender-affirming care (as defined in section 2260B of title 18,
United States Code).''.
(b) Prohibition on Accrediting Agencies or Associations.--Section
496(a) of the Higher Education Act of 1965 (20 U.S.C. 1099b(a)) is
amended--
(1) by striking ``and'' at the end of paragraph (7);
(2) by striking the period at the end of paragraph (8) and
inserting ``; and''; and
(3) by adding at the end the following:
``(9) such agency or association does not accredit any
institution that offers instruction in gender-affirming care
(as defined in section 2260B of title 18, United States
Code).''.
SEC. 402. IMMIGRATION CONSEQUENCES WITH RESPECT TO PROVIDING GENDER-
AFFIRMING CARE.
(a) Definition of Gender-Affirming Care.--Section 101(a) of the
Immigration and Nationality Act (8 U.S.C. 1101(a)) is amended by adding
at the end the following:
``(53) The term `gender-affirming care' shall have the
meaning given such term in section 2260B of title 18, United
States Code.''.
(b) Classes of Aliens Ineligible for Visas or Admission.--Section
212(a)(1)(A) of the Immigration and Nationality Act (8 U.S.C.
1182(a)(1)(A)) is amended--
(1) in clause (iii)(II), by striking ``or'' at the end;
(2) in clause (iv), by striking the comma at the end and
inserting ``, or''; and
(3) by inserting after clause (iv) the following:
``(v) who is determined to have performed
gender-affirming care on a child that has not
attained the age of 18 years old,''.
(c) Classes of Deportable Aliens.--Section 237(a) of the
Immigration and Nationality Act (8 U.S.C. 1227(a)) is amended by adding
at the end the following:
``(8) Gender-affirming care.--Any alien who has performed
gender-affirming care on a child who has not attained the age
of 18 years old is deportable.''.
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