End Taxpayer Funding of Gender Experimentation Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 1927 To prohibit taxpayer-funded gender reassignment medical interventions, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 16, 2021 Mr. LAMALFA (for himself, Mr. NORMAN, Mr. ALLEN, Mr. GROTHMAN, Mr. DUNCAN, Mr. LAMBORN, Mr. HICE of Georgia, Mrs. MILLER of Illinois, Mr. STEUBE, Mr. KELLY of Mississippi, Mr. JORDAN, Mr. BANKS, Mr. WEBER of Texas, Mr. ADERHOLT, Mr. BABIN, and Mr. GOOD of Vir- ginia) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on the Ju- diciary, 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 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 VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 1927 IH (b) TABLE OF CONTENTS.—The table of contents of 1 this Act is as follows: 2 Sec. 1. Short title; table of contents. TITLE I—PROHIBITING FEDERALLY FUNDED GENDER REASSIGNMENT MEDICAL INTERVENTIONS 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- 3 ALLY FUNDED GENDER REAS- 4 SIGNMENT MEDICAL INTER- 5 VENTIONS 6 SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER REAS- 7 SIGNMENT MEDICAL INTERVENTIONS. 8 Title 1, United States Code, is amended by adding 9 at the end the following new chapter: 10 ‘‘CHAPTER 4—PROHIBITING TAXPAYER- 11 FUNDED GENDER REASSIGNMENT 12 MEDICAL INTERVENTIONS 13 ‘‘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. VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 1927 IH ‘‘§ 301. Prohibition on funding for gender reassign- 1 ment medical interventions 2 ‘‘No funds authorized or appropriated by Federal 3 law, and none of the funds in any trust fund to which 4 funds are authorized or appropriated by Federal law, shall 5 be expended for any gender reassignment medical inter- 6 vention. 7 ‘‘§ 302. Prohibition on funding for health benefits 8 plans that cover gender reassignment 9 medical interventions 10 ‘‘No funds authorized or appropriated by Federal 11 law, and none of the funds in any trust fund to which 12 funds are authorized or appropriated by Federal law, shall 13 be expended for health benefits coverage that includes cov- 14 erage of gender reassignment medical interventions. 15 ‘‘§ 303. Limitation on Federal facilities and employees 16 ‘‘No health care service furnished— 17 ‘‘(1) by or in a health care facility owned or op- 18 erated by the Federal Government; or 19 ‘‘(2) by any physician or other individual em- 20 ployed by the Federal Government to provide health 21 care services within the scope of the physician’s or 22 individual’s employment, 23 may include gender reassignment medical interventions. 24 VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 1927 IH ‘‘§ 304. Construction relating to separate coverage 1 ‘‘Nothing in this chapter shall be construed as pro- 2 hibiting any individual, entity, or State or locality from 3 purchasing separate coverage for gender reassignment 4 medical interventions or health benefits coverage that in- 5 cludes gender reassignment medical interventions so long 6 as such coverage is paid for entirely using only funds not 7 authorized or appropriated by Federal law and such cov- 8 erage shall not be purchased using matching funds re- 9 quired for a federally subsidized program, including a 10 State’s or locality’s contribution of Medicaid matching 11 funds. 12 ‘‘§ 305. Construction relating to the use of non-Fed- 13 eral funds for health coverage 14 ‘‘Nothing in this chapter shall be construed as re- 15 stricting the ability of any non-Federal health benefits cov- 16 erage provider from offering coverage for gender reassign- 17 ment medical interventions, or the ability of a State or 18 locality to contract separately with such a provider for 19 such coverage, so long as only funds not authorized or ap- 20 propriated by Federal law are used and such coverage 21 shall not be purchased using matching funds required for 22 a federally subsidized program, including a State’s or lo- 23 cality’s contribution of Medicaid matching funds. 24 VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 1927 IH ‘‘§ 306. Construction relating to complications arising 1 from gender reassignment medical inter- 2 ventions 3 ‘‘Nothing in this chapter shall be construed to apply 4 to the treatment of any infection, injury, disease, or dis- 5 order that has been caused by or exacerbated by the per- 6 formance of a gender reassignment medical intervention. 7 This rule of construction shall be applicable without re- 8 gard to whether the gender reassignment medical inter- 9 vention was performed in accord with Federal or State 10 law, and without regard to whether funding for the gender 11 reassignment medical intervention is permissible under 12 section 307. 13 ‘‘§ 307. Treatment of individuals born with medically 14 verifiable disorder of sex development 15 ‘‘The limitations established in sections 301, 302, 16 and 303 shall not apply with respect to the following indi- 17 viduals: 18 ‘‘(1) An individual with external biological sex 19 characteristics that are irresolvably ambiguous, such 20 as those born with 46 XX chromosomes with viriliza- 21 tion, 46 XY chromosomes with undervirilization, or 22 having both ovarian and testicular tissue. 23 ‘‘(2) An individual with respect to whom a phy- 24 sician has determined through genetic or biochemical 25 testing that the individual does not have normal sex 26 VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 1927 IH chromosome structure, sex steroid hormone produc- 1 tion, or sex steroid hormone action for a biological 2 male or female. 3 ‘‘§ 308. Gender reassignment medical intervention de- 4 fined 5 ‘‘For purposes of this chapter, the term ‘gender reas- 6 signment medical intervention’ means— 7 ‘‘(1) performing a surgery that sterilizes an in- 8 dividual, including castration, vasectomy, hysterecto- 9 my, oophorectomy, metoidioplasty, penectomy, phal- 10 loplasty, and vaginoplasty, to change the body of 11 such individual to correspond to a sex that is dis- 12 cordant with biological sex; 13 ‘‘(2) performing a mastectomy on an individual 14 for the purpose described in paragraph (1); and 15 ‘‘(3) administering or supplying to an individual 16 medications for the purpose described in paragraph 17 (1), including— 18 ‘‘(A) GnRH agonists or other puberty- 19 blocking drugs to stop or delay normal puberty; 20 ‘‘(B) testosterone or other androgens to bi- 21 ological females at doses that are supraphysio- 22 logic to the female sex; and 23 ‘‘(C) estrogen to biological males at doses 24 that are supraphysiologic to the male sex.’’. 25 VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 1927 IH SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 1 The table of chapters for title 1, United States Code, 2 is amended by adding at the end the following new item: 3 ‘‘4. Prohibiting taxpayer-funded gender reassignment medical interventions .......................................... 301’’. TITLE II—APPLICATION UNDER 4 THE AFFORDABLE CARE ACT 5 SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 6 PREMIUM CREDITS AND COST-SHARING RE- 7 DUCTIONS UNDER ACA. 8 (a) IN GENERAL.— 9 (1) DISALLOWANCE OF REFUNDABLE CREDIT 10 AND COST-SHARING REDUCTIONS FOR COVERAGE 11 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 12 COVERAGE FOR GENDER REASSIGNMENT MEDICAL 13 INTERVENTIONS.— 14 (A) IN GENERAL.—Subparagraph (A) of 15 section 36B(c)(3) of the Internal Revenue Code 16 of 1986 is amended by inserting before the pe- 17 riod at the end the following: ‘‘or any health 18 plan that includes coverage for gender reassign- 19 ment medical interventions (other than any 20 gender reassignment medical intervention or 21 treatment described in section 306 or 307 of 22 title 1, United States Code)’’. 23 VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 1927 IH (B) OPTION TO PURCHASE OR OFFER SEP- 1 ARATE COVERAGE OR PLAN.—Paragraph (3) of 2 section 36B(c) of such Code is amended by 3 adding at the end the following new subpara- 4 graph: 5 ‘‘(C) SEPARATE COVERAGE OR PLAN FOR 6 GENDER REASSIGNMENT MEDICAL INTERVEN- 7 TIONS ALLOWED.— 8 ‘‘(i) OPTION TO PURCHASE SEPARATE 9 COVERAGE OR PLAN.—Nothing in subpara- 10 graph (A) shall be construed as prohibiting 11 any individual from purchasing separate 12 coverage for gender reassignment medical 13 interventions described in such subpara- 14 graph, or a health plan that includes such 15 gender reassignment medical interventions, 16 so long as no credit is allowed under this 17 section with respect to the premiums for 18 such coverage or plan. 19 ‘‘(ii) OPTION TO OFFER COVERAGE OR 20 PLAN.—Nothing in subparagraph (A) shall 21 restrict any non-Federal health insurance 22 issuer offering a health plan from offering 23 separate coverage for gender reassignment 24 medical interventions described in such 25 VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 1927 IH subparagraph, or a plan that includes such 1 gender reassignment medical interventions, 2 so long as premiums for such separate cov- 3 erage or plan are not paid for with any 4 amount attributable to the credit allowed 5 under this section (or the amount of any 6 advance payment of the credit under sec- 7 tion 1412 of the Patient Protection and 8 Affordable Care Act).’’. 9 (2) DISALLOWANCE OF SMALL EMPLOYER 10 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN 11 WHICH INCLUDES COVERAGE FOR GENDER REAS- 12 SIGNMENT MEDICAL INTERVENTIONS.—Subsection 13 (h) of section 45R of the Internal Revenue Code of 14 1986 is amended— 15 (A) by striking ‘‘Any term’’ and inserting 16 the following: 17 ‘‘(1) IN GENERAL.—Any term’’; and 18 (B) by adding at the end the following new 19 paragraph: 20 ‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING 21 COVERAGE FOR GENDER REASSIGNMENT MEDICAL 22 INTERVENTIONS.— 23 ‘‘(A) IN GENERAL.—The term ‘qualified 24 health plan’ does not include any health plan 25 VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 1927 IH that includes coverage for gender reassignment 1 medical interventions (other than any gender 2 reassignment medical intervention or treatment 3 described in section 306 or 307 of title 1, 4 United States Code). 5 ‘‘(B) SEPARATE COVERAGE OR PLAN FOR 6 GENDER REASSIGNMENT MEDICAL INTERVEN- 7 TIONS ALLOWED.— 8 ‘‘(i) OPTION TO PURCHASE SEPARATE 9 COVERAGE OR PLAN.—Nothing in subpara- 10 graph (A) shall be construed as prohibiting 11 any employer from purchasing for its em- 12 ployees separate coverage for gender reas- 13 signment medical interventions described 14 in such subparagraph, or a health plan 15 that includes such gender reassignment 16 medical interventions, so long as no credit 17 is allowed under this section with respect 18 to the employer contributions for such cov- 19 erage or plan. 20 ‘‘(ii) OPTION TO OFFER COVERAGE OR 21 PLAN.—Nothing in subparagraph (A) shall 22 restrict any non-Federal health insurance 23 issuer offering a health plan from offering 24 separate coverage for gender reassignment 25 VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 1927 IH medical interventions described in such 1 subparagraph, or a plan that includes such 2 gender reassignment medical interventions, 3 so long as such separate coverage or plan 4 is not paid for with any employer contribu- 5 tion eligible for the credit allowed under 6 this section.’’. 7 (b) APPLICATION TO MULTI-STATE PLANS.—Section 8 1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 9 amended by adding at the end the following new para- 10 graph: 11 ‘‘(7) COVERAGE CONSISTENT WITH FEDERAL 12 POLICY REGARDING GENDER REASSIGNMENT MED- 13 ICAL INTERVENTIONS.—In entering into contracts 14 under this subsection, the Director shall ensure that 15 no multi-State qualified health plan offered in an 16 Exchange provides health benefits coverage for 17 which the expenditure of Federal funds is prohibited 18 under chapter 4 of title 1, United States Code.’’. 19 (c) EFFECTIVE DATE.—The amendments made by 20 subsection (a) shall apply to taxable years ending after 21 the date that is one year after the date of enactment of 22 this Act, but only with respect to plan years beginning 23 VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1927.IH H1927 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 1927 IH after such date, and the amendment made by subsection 1 (b) shall apply to plan years beginning after such date. 2 Æ VerDate Sep 11 2014 23:29 May 11, 2021 Jkt 019200 PO 00000 Frm [Text truncated for display. 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