[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1399 Introduced in House (IH)]

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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, Energy and 
     Commerce, and Education and the Workforce, 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 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) In General.--Whoever, in any circumstance described in 
subsection (e), knowingly performs any gender-affirming care on a minor 
is guilty of a class C felony.
    ``(b) Prohibition on Prosecution of Person on Whom Intervention Is 
Performed.--No person on whom the gender-affirming care under 
subsection (a) is performed may be arrested or prosecuted for an 
offense under this section.
    ``(c) Civil Action.--A person on whom gender-affirming care is 
performed under this section may bring a civil action for appropriate 
relief, including compensatory and punitive damages, against each 
person who performed the gender-affirming care.
    ``(d) Definitions.--In this section:
            ``(1) Gender-affirming care.--
                    ``(A) In general.--For purposes of this chapter, 
                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 such individual 
                        to correspond to a sex that differs from their 
                        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 for the 
                        purposes described in clause (i).
                            ``(iii) Any placement of chest implants to 
                        create feminine breasts for the purposes 
                        described in clause (i).
                            ``(iv) Any placement of fat or artificial 
                        implants in the gluteal region for the purposes 
                        described in clause (i).
                            ``(v) Administering, supplying, 
                        prescribing, dispensing, distributing, or 
                        otherwise conveying to an individual 
                        medications for the purposes described in 
                        clause (i), including--
                                    ``(I) gonadotropin-releasing 
                                hormone (GnRH) analogues or other 
                                puberty-blocking drugs to stop or delay 
                                normal puberty;
                                    ``(II) testosterone or other 
                                androgens to biological females at 
                                doses that are supraphysiologic to the 
                                female sex; and
                                    ``(III) estrogen to biological 
                                males at doses that are 
                                supraphysiologic to the male sex.
                    ``(B) Exception.--Subparagraph (A) shall not apply 
                to the following individuals:
                            ``(i) An individual with both ovarian and 
                        testicular tissue.
                            ``(ii) An individual with respect to whom a 
                        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.
                            ``(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 the procedure is performed.
            ``(2) 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.
            ``(3) Minor.--The term `minor' means any person under the 
        age of eighteen years.
    ``(e) Circumstances Described.--For purposes of subsection (a), the 
circumstances described in this subsection 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 
        subsection (a);
            ``(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 
        subsection (a);
            ``(3) any payment of any kind was made, directly or 
        indirectly, in furtherance of or in connection with the conduct 
        described in subsection (a) 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 subsection (a) using any means, channel, 
        facility, or instrumentality of interstate or foreign commerce 
        or in or affecting interstate or foreign commerce by any means 
        or in 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 subsection (a);
            ``(6) the conduct described in subsection (a) occurred 
        within the special maritime and territorial jurisdiction of the 
        United States, or any territory or possession of the United 
        States; or
            ``(7) the conduct described in subsection (a) 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 (d)(1)(A) to address legitimate health issues, such as any 
male or female reproductive cancers, apart from changing the body to 
correspond to a sex that differs from one's biological sex.''; and
            (2) by amending the table of sections for such chapter 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 new chapter:

     ``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 lands 
                            and territories, 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 development.
``308. Gender-affirming care defined.
``309. Rule of construction.
``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 
              lands and territories, and Tribal territories
    ``No health care service furnished--
            ``(1) by or in a health care facility owned or operated by 
        the Federal Government, Federal land or territory, or a Tribal 
        territory; or
            ``(2) by any physician or other individual employed by the 
        Federal Government, Federal land or territory, or a Tribal 
        territory to provide health care services within the scope of 
        the physician's or individual's employment,
may include gender-affirming care.
``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-affirming care or health benefits coverage that 
includes gender-affirming care so long as such coverage is paid for 
entirely using only funds not authorized or appropriated by Federal 
law, federal programs, platforms, or infrastructure, such coverage does 
not cover any practice that would be subject to penalty under section 
2260B of title 18, United States Code, 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-affirming care, 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, such coverage does not cover any practice that 
would be subject to penalty under section 2260B of title 18, United 
States Code, 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-
              affirming care
    ``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-affirming care. 
This rule of construction shall be applicable without regard to whether 
the gender-affirming care was performed in accord with Federal or State 
law, and without regard to whether funding for the gender-affirming 
care is permissible under section 307.
``Sec. 307. Treatment of individuals born with medically verifiable 
              disorder of sex development
    ``The limitations established in sections 301, 302, and 303 shall 
not apply with respect to an individual described in section 
2260B(d)(1)(B) of title 18, United States Code.
``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(d)(1) of title 18, 
United States Code.
``Sec. 309. Rule of construction
    ``Nothing in this chapter shall be construed as prohibiting 
provision of the medical services described in section 2260B(d)(1)(A) 
of title 18, United States Code, to address any male or female 
reproductive cancers, apart from changing the body to correspond to a 
sex that differs from one'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 new item:

``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 new paragraph:
            ``(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(d) 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(d) of title 18, United States 
        Code).''.

SEC. 402. IMMIGRATION CONSEQUENCES WITH RESPECT TO PROVIDING GENDER-
              AFFIRMING CARE.

    (a) Definitions.--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(d) 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), strike ``or'' at the end;
            (2) in clause (iv), strike the comma at the end and insert 
        ``, or''; and
            (3) by adding at the end 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 that has not attained the age 
        of 18 years old is deportable.''.
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