Protect Children’s Innocence Act

I 118TH CONGRESS 1ST SESSION H. R. 1399 To amend chapter 110 of title 18, United States Code, to prohibit gender- affirming care on minors, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 7, 2023 Ms. GREENE of Georgia (for herself, Mrs. MILLER of Illinois, Mr. GOSAR, Mr. GOODEN of Texas, Mr. GROTHMAN, Mr. DUNCAN, Mrs. LUNA, Mrs. HARSHBARGER, Mr. NORMAN, Mr. NEHLS, Mr. GOOD of Virginia, Mr. HERN, Mr. ROSENDALE, Mr. BABIN, Mr. LAMBORN, Mr. HIGGINS of Louisiana, Mr. STEUBE, Ms. HAGEMAN, Mrs. LESKO, and Mr. BIGGS) introduced the following bill; which was referred to the Committee on the Judiciary, and in addition to the Committees on Ways and Means, En- ergy and Commerce, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consider- ation of such provisions as fall within the jurisdiction of the committee concerned 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 Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Protect Children’s In- 4 nocence Act’’. 5 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 1399 IH TITLE I—GENDER-AFFIRMING 1 CARE ON MINORS PROHIBITED 2 SEC. 101. GENDER-AFFIRMING CARE ON MINORS PROHIB- 3 ITED. 4 Chapter 110 of title 18, United States Code, is 5 amended— 6 (1) by adding at the end the following: 7 ‘‘§ 2260B. Gender-affirming care on minors 8 ‘‘(a) IN GENERAL.—Whoever, in any circumstance 9 described in subsection (e), knowingly performs any gen- 10 der-affirming care on a minor is guilty of a class C felony. 11 ‘‘(b) PROHIBITION ON PROSECUTION OF PERSON ON 12 WHOM INTERVENTION IS PERFORMED.—No person on 13 whom the gender-affirming care under subsection (a) is 14 performed may be arrested or prosecuted for an offense 15 under this section. 16 ‘‘(c) CIVIL ACTION.—A person on whom gender-af- 17 firming care is performed under this section may bring 18 a civil action for appropriate relief, including compen- 19 satory and punitive damages, against each person who 20 performed the gender-affirming care. 21 ‘‘(d) DEFINITIONS.—In this section: 22 ‘‘(1) GENDER-AFFIRMING CARE.— 23 ‘‘(A) IN GENERAL.—For purposes of this 24 chapter, except as provided in subparagraph 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 1399 IH (B), the term ‘gender-affirming care’ means, 1 with respect to an individual, any of the fol- 2 lowing: 3 ‘‘(i) Performing any surgery for the 4 purpose of changing the body of such indi- 5 vidual to correspond to a sex that differs 6 from their biological sex, including— 7 ‘‘(I) castration; 8 ‘‘(II) orchiectomy; 9 ‘‘(III) scrotoplasty; 10 ‘‘(IV) vasectomy; 11 ‘‘(V) hysterectomy; 12 ‘‘(VI) oophorectomy; 13 ‘‘(VII) ovariectomy; 14 ‘‘(VIII) metoidioplasty; 15 ‘‘(IX) penectomy; 16 ‘‘(X) phalloplasty; 17 ‘‘(XI) vaginoplasty; 18 ‘‘(XII) vaginectomy; 19 ‘‘(XIII) vulvoplasty; 20 ‘‘(XIV) reduction 21 thyrochondroplasty; 22 ‘‘(XV) chondrolaryngoplasty; and 23 ‘‘(XVI) mastectomy. 24 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 1399 IH ‘‘(ii) Any plastic surgery that femi- 1 nizes or masculinizes the facial features for 2 the purposes described in clause (i). 3 ‘‘(iii) Any placement of chest implants 4 to create feminine breasts for the purposes 5 described in clause (i). 6 ‘‘(iv) Any placement of fat or artificial 7 implants in the gluteal region for the pur- 8 poses described in clause (i). 9 ‘‘(v) Administering, supplying, pre- 10 scribing, dispensing, distributing, or other- 11 wise conveying to an individual medications 12 for the purposes described in clause (i), in- 13 cluding— 14 ‘‘(I) gonadotropin-releasing hor- 15 mone (GnRH) analogues or other pu- 16 berty-blocking drugs to stop or delay 17 normal puberty; 18 ‘‘(II) testosterone or other 19 androgens to biological females at 20 doses that are supraphysiologic to the 21 female sex; and 22 ‘‘(III) estrogen to biological 23 males at doses that are 24 supraphysiologic to the male sex. 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 1399 IH ‘‘(B) EXCEPTION.—Subparagraph (A) 1 shall not apply to the following individuals: 2 ‘‘(i) An individual with both ovarian 3 and testicular tissue. 4 ‘‘(ii) An individual with respect to 5 whom a physician has determined through 6 genetic or biochemical testing that the in- 7 dividual does not have normal sex chro- 8 mosome structure, sex steroid hormone 9 production, or sex steroid hormone action. 10 ‘‘(iii) An individual experiencing infec- 11 tion, disease, injury, or disorder caused or 12 exacerbated by previous gender transition 13 procedures. 14 ‘‘(iv) An individual suffering from a 15 physical disorder, physical injury, or phys- 16 ical illness that would, as certified by a 17 physician, place the individual in imminent 18 danger of death or impairment of a major 19 bodily function unless the procedure is per- 20 formed. 21 ‘‘(2) BIOLOGICAL SEX.—The term ‘biological 22 sex’ means the indication of male or female sex by 23 reproductive potential or capacity, sex chromosomes, 24 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 1399 IH naturally occurring sex hormones, gonads, or inter- 1 nal or external genitalia present at birth. 2 ‘‘(3) MINOR.—The term ‘minor’ means any per- 3 son under the age of eighteen years. 4 ‘‘(e) CIRCUMSTANCES DESCRIBED.—For purposes of 5 subsection (a), the circumstances described in this sub- 6 section are that— 7 ‘‘(1) the defendant or victim traveled in inter- 8 state or foreign commerce, or traveled using a 9 means, channel, facility, or instrumentality of inter- 10 state or foreign commerce, in furtherance of or in 11 connection with the conduct described in subsection 12 (a); 13 ‘‘(2) the defendant used a means, channel, fa- 14 cility, or instrumentality of interstate or foreign 15 commerce in furtherance of or in connection with 16 the conduct described in subsection (a); 17 ‘‘(3) any payment of any kind was made, di- 18 rectly or indirectly, in furtherance of or in connec- 19 tion with the conduct described in subsection (a) 20 using any means, channel, facility, or instrumen- 21 tality of interstate or foreign commerce or in or af- 22 fecting interstate or foreign commerce; 23 ‘‘(4) the defendant transmitted in interstate or 24 foreign commerce any communication relating to or 25 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 1399 IH in furtherance of the conduct described in subsection 1 (a) using any means, channel, facility, or instrumen- 2 tality of interstate or foreign commerce or in or af- 3 fecting interstate or foreign commerce by any means 4 or in manner, including by computer, mail, wire, or 5 electromagnetic transmission; 6 ‘‘(5) any instrument, item, substance, or other 7 object that has traveled in interstate or foreign com- 8 merce was used to perform the conduct described in 9 subsection (a); 10 ‘‘(6) the conduct described in subsection (a) oc- 11 curred within the special maritime and territorial ju- 12 risdiction of the United States, or any territory or 13 possession of the United States; or 14 ‘‘(7) the conduct described in subsection (a) 15 otherwise occurred in or affected interstate or for- 16 eign commerce. 17 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec- 18 tion shall be construed as prohibiting provision of the med- 19 ical services described in subsection (d)(1)(A) to address 20 legitimate health issues, such as any male or female repro- 21 ductive cancers, apart from changing the body to cor- 22 respond to a sex that differs from one’s biological sex.’’; 23 and 24 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 1399 IH (2) by amending the table of sections for such 1 chapter by adding at the end the following: 2 ‘‘2260B. Gender-affirming care on minors.’’. TITLE II—PROHIBITING FEDER- 3 ALLY FUNDED GENDER-AF- 4 FIRMING CARE 5 SEC. 201. PROHIBITING TAXPAYER-FUNDED GENDER-AF- 6 FIRMING CARE. 7 Title 1, United States Code, is amended by adding 8 at the end the following new chapter: 9 ‘‘CHAPTER 4—PROHIBITING TAXPAYER- 10 FUNDED GENDER-AFFIRMING CARE 11 ‘‘301. Prohibition on funding for gender-affirming care. ‘‘302. Prohibition on funding for health benefits plans that cover gender-affirm- ing care. ‘‘303. Limitation on Federal facilities and employees, Federal lands and terri- tories, and Tribal territories. ‘‘304. Construction relating to separate coverage. ‘‘305. Construction relating to the use of non-Federal funds for health coverage. ‘‘306. Construction relating to complications arising from gender-affirming care. ‘‘307. Treatment of individuals born with medically verifiable disorder of sex de- velopment. ‘‘308. Gender-affirming care defined. ‘‘309. Rule of construction. ‘‘§ 301. Prohibition on funding for gender-affirming 12 care 13 ‘‘No funds authorized or appropriated by Federal 14 law, and none of the funds in any trust fund to which 15 funds are authorized or appropriated by Federal law, in- 16 cluding funds provided under titles XVIII, XIX, and XXI 17 of the Social Security Act, shall be expended for any gen- 18 der-affirming care. 19 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 1399 IH ‘‘§ 302. Prohibition on funding for health benefits 1 plans that cover gender-affirming care 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 health benefits coverage that includes cov- 6 erage of gender-affirming care. 7 ‘‘§ 303. Limitation on Federal facilities and employ- 8 ees, Federal lands and territories, and 9 Tribal territories 10 ‘‘No health care service furnished— 11 ‘‘(1) by or in a health care facility owned or op- 12 erated by the Federal Government, Federal land or 13 territory, or a Tribal territory; or 14 ‘‘(2) by any physician or other individual em- 15 ployed by the Federal Government, Federal land or 16 territory, or a Tribal territory to provide health care 17 services within the scope of the physician’s or indi- 18 vidual’s employment, 19 may include gender-affirming care. 20 ‘‘§ 304. Construction relating to separate coverage 21 ‘‘Nothing in this chapter shall be construed as pro- 22 hibiting any individual, entity, or State or locality from 23 purchasing separate coverage for gender-affirming care or 24 health benefits coverage that includes gender-affirming 25 care so long as such coverage is paid for entirely using 26 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 1399 IH only funds not authorized or appropriated by Federal law, 1 federal programs, platforms, or infrastructure, such cov- 2 erage does not cover any practice that would be subject 3 to penalty under section 2260B of title 18, United States 4 Code, and such coverage shall not be purchased using 5 matching funds required for a federally subsidized pro- 6 gram, including a State’s or locality’s contribution of Med- 7 icaid matching funds. 8 ‘‘§ 305. Construction relating to the use of non-Fed- 9 eral funds for health coverage 10 ‘‘Nothing in this chapter shall be construed as re- 11 stricting the ability of any non-Federal health benefits cov- 12 erage provider from offering coverage for gender-affirming 13 care, or the ability of a State or locality to contract sepa- 14 rately with such a provider for such coverage, so long as 15 only funds not authorized or appropriated by Federal law 16 are used, such coverage does not cover any practice that 17 would be subject to penalty under section 2260B of title 18 18, United States Code, and such coverage shall not be 19 purchased using matching funds required for a federally 20 subsidized program, including a State’s or locality’s con- 21 tribution of Medicaid matching funds. 22 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 1399 IH ‘‘§ 306. Construction relating to complications arising 1 from gender-affirming care 2 ‘‘Nothing in this chapter shall be construed to apply 3 to the treatment of any infection, injury, disease, or dis- 4 order that has been caused by or exacerbated by the per- 5 formance of a gender-affirming care. This rule of con- 6 struction shall be applicable without regard to whether the 7 gender-affirming care was performed in accord with Fed- 8 eral or State law, and without regard to whether funding 9 for the gender-affirming care is permissible under section 10 307. 11 ‘‘§ 307. Treatment of individuals born with medically 12 verifiable disorder of sex development 13 ‘‘The limitations established in sections 301, 302, 14 and 303 shall not apply with respect to an individual de- 15 scribed in section 2260B(d)(1)(B) of title 18, United 16 States Code. 17 ‘‘§ 308. Gender-affirming care defined 18 ‘‘For purposes of this chapter, the term ‘gender-af- 19 firming care’ has the meaning given such term in section 20 2260B(d)(1) of title 18, United States Code. 21 ‘‘§ 309. Rule of construction 22 ‘‘Nothing in this chapter shall be construed as pro- 23 hibiting provision of the medical services described in sec- 24 tion 2260B(d)(1)(A) of title 18, United States Code, to 25 address any male or female reproductive cancers, apart 26 VerDate Sep 11 2014 00:00 May 02, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H1399.IH H1399 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 1399 IH from changing the body to correspond to a sex that differs 1 from one’s biological sex.’’. 2 SEC. 202. AMENDMENT TO TABLE OF CHAPTERS. 3 The table of chapters for title 1, United States Code, 4 is amended by adding at the end the following new item: 5 ‘‘4. Prohibiting taxpayer-funded gender-affirm [Text truncated for display. Full text available on Congress.gov.]