End Taxpayer Funding of Gender Experimentation Act of 2021

II 117TH CONGRESS 1ST SESSION S. 777 To prohibit taxpayer-funded gender reassignment medical interventions, and for other purposes. IN THE SENATE OF THE UNITED STATES MARCH 16, 2021 Mr. MARSHALL (for himself, Mr. BRAUN, Mr. COTTON, Mrs. BLACKBURN, Mr. LEE, and Mrs. HYDE-SMITH) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To prohibit taxpayer-funded gender reassignment medical interventions, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘End Taxpayer Funding of Gender Experimentation Act 5 of 2021’’. 6 (b) TABLE OF CONTENTS.—The table of contents of 7 this Act is as follows: 8 Sec. 1. Short title; table of contents. TITLE I—PROHIBITING FEDERALLY FUNDED GENDER REASSIGNMENT MEDICAL INTERVENTIONS VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 777 IS Sec. 101. Prohibiting taxpayer-funded gender reassignment medical interven- tions. 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 FEDER- 1 ALLY FUNDED GENDER REAS- 2 SIGNMENT MEDICAL INTER- 3 VENTIONS 4 SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER REAS- 5 SIGNMENT MEDICAL INTERVENTIONS. 6 Title 1, United States Code, is amended by adding 7 at the end the following new chapter: 8 ‘‘CHAPTER 4—PROHIBITING TAXPAYER- 9 FUNDED GENDER REASSIGNMENT 10 MEDICAL INTERVENTIONS 11 ‘‘301. Prohibition on funding for gender reassignment medical interventions. ‘‘302. Prohibition on funding for health benefits plans that cover gender reas- signment medical interventions. ‘‘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 reassignment medical interventions. ‘‘307. Treatment of individuals born with medically verifiable disorder of sex de- velopment. ‘‘308. Gender reassignment medical intervention defined. ‘‘§ 301. Prohibition on funding for gender reassign- 12 ment medical interventions 13 ‘‘No funds authorized or appropriated by Federal 14 law, and none of the funds in any trust fund to which 15 funds are authorized or appropriated by Federal law, shall 16 VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 777 IS be expended for any gender reassignment medical inter- 1 vention. 2 ‘‘§ 302. Prohibition on funding for health benefits 3 plans that cover gender reassignment 4 medical interventions 5 ‘‘No funds authorized or appropriated by Federal 6 law, and none of the funds in any trust fund to which 7 funds are authorized or appropriated by Federal law, shall 8 be expended for health benefits coverage that includes cov- 9 erage of gender reassignment medical interventions. 10 ‘‘§ 303. Limitation on Federal facilities and employees 11 ‘‘No health care service furnished— 12 ‘‘(1) by or in a health care facility owned or op- 13 erated by the Federal Government; or 14 ‘‘(2) by any physician or other individual em- 15 ployed by the Federal Government to provide health 16 care services within the scope of the physician’s or 17 individual’s employment, 18 may include gender reassignment medical interventions. 19 ‘‘§ 304. Construction relating to separate coverage 20 ‘‘Nothing in this chapter shall be construed as pro- 21 hibiting any individual, entity, or State or locality from 22 purchasing separate coverage for gender reassignment 23 medical interventions or health benefits coverage that in- 24 cludes gender reassignment medical interventions so long 25 VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 777 IS as such coverage is paid for entirely using only funds not 1 authorized or appropriated by Federal law and such cov- 2 erage shall not be purchased using matching funds re- 3 quired for a federally subsidized program, including a 4 State’s or locality’s contribution of Medicaid matching 5 funds. 6 ‘‘§ 305. Construction relating to the use of non-Fed- 7 eral funds for health coverage 8 ‘‘Nothing in this chapter shall be construed as re- 9 stricting the ability of any non-Federal health benefits cov- 10 erage provider from offering coverage for gender reassign- 11 ment medical interventions, or the ability of a State or 12 locality to contract separately with such a provider for 13 such coverage, so long as only funds not authorized or ap- 14 propriated by Federal law are used and such coverage 15 shall not be purchased using matching funds required for 16 a federally subsidized program, including a State’s or lo- 17 cality’s contribution of Medicaid matching funds. 18 ‘‘§ 306. Construction relating to complications arising 19 from gender reassignment medical inter- 20 ventions 21 ‘‘Nothing in this chapter shall be construed to apply 22 to the treatment of any infection, injury, disease, or dis- 23 order that has been caused by or exacerbated by the per- 24 formance of a gender reassignment medical intervention. 25 VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 777 IS This rule of construction shall be applicable without re- 1 gard to whether the gender reassignment medical inter- 2 vention was performed in accord with Federal or State 3 law, and without regard to whether funding for the gender 4 reassignment medical intervention is permissible under 5 section 307. 6 ‘‘§ 307. Treatment of individuals born with medically 7 verifiable disorder of sex development 8 ‘‘The limitations established in sections 301, 302, 9 and 303 shall not apply with respect to the following indi- 10 viduals: 11 ‘‘(1) An individual with external biological sex 12 characteristics that are irresolvably ambiguous, such 13 as those born with 46 XX chromosomes with 14 virilization, 46 XY chromosomes with 15 undervirilization, or having both ovarian and testic- 16 ular tissue. 17 ‘‘(2) An individual with respect to whom a phy- 18 sician has determined through genetic or biochemical 19 testing that the individual does not have normal sex 20 chromosome structure, sex steroid hormone produc- 21 tion, or sex steroid hormone action for a biological 22 male or female. 23 VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 777 IS ‘‘§ 308. Gender reassignment medical intervention de- 1 fined 2 ‘‘For purposes of this chapter, the term ‘gender reas- 3 signment medical intervention’ means— 4 ‘‘(1) performing a surgery that sterilizes an in- 5 dividual, including castration, vasectomy, 6 hysterectomy, oophorectomy, metoidioplasty, 7 penectomy, phalloplasty, and vaginoplasty, to change 8 the body of such individual to correspond to a sex 9 that is discordant with biological sex; 10 ‘‘(2) performing a mastectomy on an individual 11 for the purpose described in paragraph (1); and 12 ‘‘(3) administering or supplying to an individual 13 medications for the purpose described in paragraph 14 (1), including— 15 ‘‘(A) GnRH agonists or other puberty- 16 blocking drugs to stop or delay normal puberty; 17 ‘‘(B) testosterone or other androgens to bi- 18 ological females at doses that are 19 supraphysiologic to the female sex; and 20 ‘‘(C) estrogen to biological males at doses 21 that are supraphysiologic to the male sex.’’. 22 SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 23 The table of chapters for title 1, United States Code, 24 is amended by adding at the end the following new item: 25 VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 777 IS ‘‘4. Prohibiting taxpayer-funded gender reassignment medical interventions .......................................... 301’’. TITLE II—APPLICATION UNDER 1 THE AFFORDABLE CARE ACT 2 SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 3 PREMIUM CREDITS AND COST-SHARING RE- 4 DUCTIONS UNDER ACA. 5 (a) IN GENERAL.— 6 (1) DISALLOWANCE OF REFUNDABLE CREDIT 7 AND COST-SHARING REDUCTIONS FOR COVERAGE 8 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 9 COVERAGE FOR GENDER REASSIGNMENT MEDICAL 10 INTERVENTIONS.— 11 (A) IN GENERAL.—Subparagraph (A) of 12 section 36B(c)(3) of the Internal Revenue Code 13 of 1986 is amended by inserting before the pe- 14 riod at the end the following: ‘‘or any health 15 plan that includes coverage for gender reassign- 16 ment medical interventions (other than any 17 gender reassignment medical intervention or 18 treatment described in section 306 or 307 of 19 title 1, United States Code)’’. 20 (B) OPTION TO PURCHASE OR OFFER SEP- 21 ARATE COVERAGE OR PLAN.—Paragraph (3) of 22 section 36B(c) of such Code is amended by 23 VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 777 IS adding at the end the following new subpara- 1 graph: 2 ‘‘(C) SEPARATE COVERAGE OR PLAN FOR 3 GENDER REASSIGNMENT MEDICAL INTERVEN- 4 TIONS ALLOWED.— 5 ‘‘(i) OPTION TO PURCHASE SEPARATE 6 COVERAGE OR PLAN.—Nothing in subpara- 7 graph (A) shall be construed as prohibiting 8 any individual from purchasing separate 9 coverage for gender reassignment medical 10 interventions described in such subpara- 11 graph, or a health plan that includes such 12 gender reassignment medical interventions, 13 so long as no credit is allowed under this 14 section with respect to the premiums for 15 such coverage or plan. 16 ‘‘(ii) OPTION TO OFFER COVERAGE OR 17 PLAN.—Nothing in subparagraph (A) shall 18 restrict any non-Federal health insurance 19 issuer offering a health plan from offering 20 separate coverage for gender reassignment 21 medical interventions described in such 22 subparagraph, or a plan that includes such 23 gender reassignment medical interventions, 24 so long as premiums for such separate cov- 25 VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS 9 •S 777 IS erage or plan are not paid for with any 1 amount attributable to the credit allowed 2 under this section (or the amount of any 3 advance payment of the credit under sec- 4 tion 1412 of the Patient Protection and 5 Affordable Care Act).’’. 6 (2) DISALLOWANCE OF SMALL EMPLOYER 7 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN 8 WHICH INCLUDES COVERAGE FOR GENDER REAS- 9 SIGNMENT MEDICAL INTERVENTIONS.—Subsection 10 (h) of section 45R of the Internal Revenue Code of 11 1986 is amended— 12 (A) by striking ‘‘Any term’’ and inserting 13 the following: 14 ‘‘(1) IN GENERAL.—Any term’’; and 15 (B) by adding at the end the following new 16 paragraph: 17 ‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING 18 COVERAGE FOR GENDER REASSIGNMENT MEDICAL 19 INTERVENTIONS.— 20 ‘‘(A) IN GENERAL.—The term ‘qualified 21 health plan’ does not include any health plan 22 that includes coverage for gender reassignment 23 medical interventions (other than any gender 24 reassignment medical intervention or treatment 25 VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS 10 •S 777 IS described in section 306 or 307 of title 1, 1 United States Code). 2 ‘‘(B) SEPARATE COVERAGE OR PLAN FOR 3 GENDER REASSIGNMENT MEDICAL INTERVEN- 4 TIONS ALLOWED.— 5 ‘‘(i) OPTION TO PURCHASE SEPARATE 6 COVERAGE OR PLAN.—Nothing in subpara- 7 graph (A) shall be construed as prohibiting 8 any employer from purchasing for its em- 9 ployees separate coverage for gender reas- 10 signment medical interventions described 11 in such subparagraph, or a health plan 12 that includes such gender reassignment 13 medical interventions, so long as no credit 14 is allowed under this section with respect 15 to the employer contributions for such cov- 16 erage or plan. 17 ‘‘(ii) OPTION TO OFFER COVERAGE OR 18 PLAN.—Nothing in subparagraph (A) shall 19 restrict any non-Federal health insurance 20 issuer offering a health plan from offering 21 separate coverage for gender reassignment 22 medical interventions described in such 23 subparagraph, or a plan that includes such 24 gender reassignment medical interventions, 25 VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS 11 •S 777 IS so long as such separate coverage or plan 1 is not paid for with any employer contribu- 2 tion eligible for the credit allowed under 3 this section.’’. 4 (b) APPLICATION TO MULTI-STATE PLANS.—Section 5 1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 6 amended by adding at the end the following new para- 7 graph: 8 ‘‘(8) COVERAGE CONSISTENT WITH FEDERAL 9 POLICY REGARDING GENDER REASSIGNMENT MED- 10 ICAL INTERVENTIONS.—In entering into contracts 11 under this subsection, the Director shall ensure that 12 no multi-State qualified health plan offered in an 13 Exchange provides health benefits coverage for 14 which the expenditure of Federal funds is prohibited 15 under chapter 4 of title 1, United States Code.’’. 16 (c) EFFECTIVE DATE.—The amendments made by 17 subsection (a) shall apply to taxable years ending after 18 the date that is one year after the date of enactment of 19 this Act, but only with respect to plan years beginning 20 after such date, and the amendment made by subsection 21 (b) shall apply to plan years beginning after such date. 22 Æ VerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6301 E:\BILLS\S777.IS S777 pamtmann on DSKBC07HB2PROD with BILLS