[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3329 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 3329

To prohibit taxpayer-funded gender transition procedures, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 15, 2023

  Mr. LaMalfa (for himself, Mrs. Boebert, Mr. Lamborn, Mr. Gosar, Mr. 
Banks, Mr. Duncan, Mr. Babin, Mr. Rouzer, Mr. Barr, Mr. Rosendale, Mr. 
Weber of Texas, Mr. Brecheen, Mr. Norman, Mrs. Miller of Illinois, Mr. 
 Grothman, Mr. Wilson of South Carolina, Mr. Mills, Mr. Burlison, Mr. 
   Smith of New Jersey, Mr. Aderholt, Mrs. McClain, Mrs. Lesko, Mrs. 
   Harshbarger, Mr. Nehls, Mr. Kelly of Mississippi, Mr. Ogles, Mr. 
 Fallon, Mr. LaTurner, Mr. Davidson, Mr. Gaetz, Ms. Tenney, Mr. Allen, 
   Mr. Roy, and Mr. Mooney) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
the Committees on the Judiciary, 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 transition procedures, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``End Taxpayer 
Funding of Gender Experimentation Act of 2023''.
    (b) Table of Contents.--The table of contents of this Act are as 
follows:

Sec. 1. Short title; table of contents.
   TITLE I--PROHIBITING FEDERALLY FUNDED GENDER TRANSITION PROCEDURES

Sec. 101. Prohibiting taxpayer-funded gender transition procedures.
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 FEDERALLY FUNDED GENDER TRANSITION PROCEDURES

SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER TRANSITION PROCEDURES.

    Title 1, United States Code, is amended by adding at the end the 
following new chapter:

 ``CHAPTER 4--PROHIBITING TAXPAYER-FUNDED GENDER TRANSITION PROCEDURES

``301. Prohibition on funding for gender transition procedures.
``302. Prohibition on funding for health benefits plans that cover 
                            gender transition procedures.
``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 
                            transition procedures.
``307. Definitions.
``Sec. 301. Prohibition on funding for gender transition procedures
    ``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 any gender 
transition procedures.
``Sec. 302. Prohibition on funding for health benefits plans that cover 
              gender transition procedures
    ``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 transition procedures.
``Sec. 303. Limitation on Federal facilities and employees
    ``No health care service furnished--
            ``(1) by or in a health care facility owned or operated by 
        the Federal Government; or
            ``(2) by any physician or other individual employed by the 
        Federal Government to provide health care services within the 
        scope of the physician's or individual's employment,
may include gender transition procedures.
``Sec. 304. Construction relating to separate coverage
    ``Nothing in this chapter shall be construed as prohibiting any 
individual, entity, State, or locality from purchasing separate 
coverage for gender transition procedures or health benefits coverage 
that include gender transition procedures so long as such coverage is 
paid for entirely with funds not authorized or appropriated by Federal 
law, and such coverage shall not be purchased using matching funds 
required for a federally subsidized program, including a State 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 transition procedures, 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, and such coverage shall not be purchased using 
matching funds required for a federally subsidized program, including a 
State or locality's contribution of Medicaid matching funds.
``Sec. 306. Construction relating to complications arising from gender 
              transition procedures
    ``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 transition 
procedure.
``Sec. 307. Definitions
    ``For purposes of this chapter:
            ``(1) Biological sex.--The term `biological sex' means the 
        biological indication of male or female in the context of 
        reproductive potential or capacity, such as sex chromosomes, 
        naturally occurring sex hormones, gonads, and non-ambiguous 
        internal and external genitalia present at birth, without 
        regard to an individual's psychological, chosen, or subjective 
        experience of gender.
            ``(2) Cross-sex hormones.--The term `cross-sex hormones' 
        means--
                    ``(A) testosterone or other androgens given to 
                biological females at doses that are profoundly larger 
                or more potent than would naturally occur in healthy 
                biological females; or
                    ``(B) estrogen given to biological males at doses 
                that are profoundly larger or more potent than would 
                naturally occur in healthy biological males.
            ``(3) Gender.--The term `gender' means the psychological, 
        behavioral, social, and cultural aspects of being male or 
        female.
            ``(4) Gender transition.--The term `gender transition' 
        means the process in which a person goes from identifying with 
        and living as a gender that corresponds to his or her 
        biological sex to identifying with and living as a gender 
        different from his or her biological sex, and may involve 
        social, legal, or physical changes.
            ``(5) Gender transition procedure.--
                    ``(A) In general.--The term `gender transition 
                procedure' means any medical or surgical service, 
                including physician's services, inpatient and 
                outpatient hospital services, or prescribed drugs 
                related to gender transition, that seek to alter or 
                remove physical or anatomical characteristics or 
                features that are typical for an individual's 
                biological sex, or to instill or create physiological 
                or anatomical characteristics that resemble a sex 
                different from an individual's birth sex, including, 
                without limitation, medical services that provide 
                puberty-blocking drugs, cross-sex hormones, or other 
                mechanisms to promote the development of feminizing or 
                masculinizing features (in the opposite sex), or 
                genital gender transition surgery or nongenital gender 
                transition surgery performed for the purpose of 
                assisting an individual with a gender transition.
                    ``(B) Exceptions.--The term `gender transition 
                procedure' does not include--
                            ``(i) services to those born with a 
                        medically-verifiable disorder of sex 
                        development, including a person with external 
                        biological sex characteristics that are 
                        irresolvably ambiguous, such as those born with 
                        46 XX chromosomes with virilization, 46 XY 
                        chromosomes with undervirilization, or having 
                        both ovarian and testicular tissue; or services 
                        provided when a physician has otherwise 
                        diagnosed a disorder of sexual development, in 
                        which such physician has determined through 
                        genetic or biochemical testing that the person 
                        does not have normal sex chromosome structure, 
                        sex steroid hormone production, or sex steroid 
                        hormone action for a biological male or 
                        biological female; or
                            ``(ii) the treatment of any infection, 
                        injury, disease, or disorder that has been 
                        caused by or exacerbated by the performance of 
                        a gender transition procedure, whether or not 
                        such procedure was performed in accordance with 
                        State or Federal law, or whether funding for 
                        such procedure was permissible under this 
                        chapter.
            ``(6) Gender transition surgery.--
                    ``(A) In general.--The term `gender transition 
                surgery' means any medical or surgical service that 
                seeks to surgically alter or remove healthy physical or 
                anatomical characteristics or features that are typical 
                for an individual's biological sex in order to instill 
                or create physiological or anatomical characteristics 
                that resemble a sex different from an individual's 
                birth sex, including, without limitation, genital 
                gender reassignment surgery or non-genital gender 
                reassignment surgery performed for the purpose of 
                assisting an individual with a gender transition.
                    ``(B) Exception.--Gender transition surgery does 
                not include any procedure undertaken because the 
                individual suffers 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 major bodily function unless 
                surgery is performed.
            ``(7) Genital gender transition surgery.--The term `genital 
        gender transition surgery' includes surgical procedures such as 
        penectomy, orchiectomy, vaginoplasty, clitoroplasty, or 
        vulvoplasty for biologically male patients, or hysterectomy/
        ovariectomy, reconstruction of the fixed part of the urethra 
        with or without a metoidioplasty or a phalloplasty, 
        vaginectomy, scrotoplasty, or implantation of erection or 
        testicular prostheses for biologically female patients when 
        performed for the purpose of assisting an individual with a 
        gender transition.
            ``(8) Non-genital gender transition surgery.--The term 
        `non-genital gender transition surgery' means surgical 
        procedures including augmentation mammoplasty, facial 
        feminization surgery, liposuction, lipofilling, voice surgery, 
        thyroid cartilage reduction, gluteal augmentation (implants or 
        lipofilling), hair reconstruction, or other aesthetic 
        procedures for biologically male patients or subcutaneous 
        mastectomy, voice surgery, liposuction, lipofilling, pectoral 
        implants, or other aesthetic procedures for biologically female 
        patients, when performed for the purpose of assisting an 
        individual with a gender transition.
            ``(9) Puberty-blocking drugs.--The term `puberty-blocking 
        drugs' means--
                    ``(A) Gonadotropin-releasing hormone (GnRH) 
                analogues or other synthetic drugs used in biological 
                males to stop luteinizing hormone secretion and 
                therefore testosterone secretion;
                    ``(B) synthetic drugs used in biological females 
                that stop the production of estrogen; and
                    ``(C) progesterone when used to delay or suppress 
                pubertal development in children for the purpose of 
                assisting an individual with a gender transition.''.

SEC. 102. 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 transition              301''.
                            procedures.

          TITLE II--APPLICATION UNDER THE AFFORDABLE CARE ACT

SEC. 201. 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 transition procedures.--
                    (A) In general.--Section 36B(c)(3)(A) 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 
                transition procedures (other than any procedure 
                described in section 306 or 307 of title 1, United 
                States Code)''.
                    (B) Option to purchase or offer separate coverage 
                or plan.--Section 36B(c)(3) of such Code is amended by 
                adding at the end the following new subparagraph:
                    ``(C) Separate coverage or plan for gender 
                transition procedures 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 
                        transition procedures described in such 
                        subparagraph, or a health plan that includes 
                        such gender transition procedures, so long as 
                        no credit is allowed under this section with 
                        respect to the premiums for such coverage or 
                        plan.
                            ``(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 transition procedures described in such 
                        subparagraph, or a plan that includes such 
                        gender transition procedures, 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).''.
            (2) Disallowance of small employer health insurance expense 
        credit for plan which includes coverage for gender transition 
        procedures.--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 transition procedures.--
                    ``(A) In general.--The term `qualified health plan' 
                does not include any health plan that includes coverage 
                for gender transition procedures (other than a 
                procedure described in section 306 or 307 of title 1, 
                United States Code).
                    ``(B) Separate coverage or plan for gender 
                transition procedures 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 transition procedures described in 
                        such subparagraph, or a health plan that 
                        includes such gender transition procedures, so 
                        long as no credit is allowed under this section 
                        with respect to the employer contributions for 
                        such coverage or plan.
                            ``(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 transition procedures described in such 
                        subparagraph, or a plan that includes such 
                        gender transition procedures, so long as such 
                        separate coverage or plan is not paid for with 
                        any employer contribution eligible for the 
                        credit allowed under this section.''.
    (b) Application to Multi-State Plans.--Section 1334(a) of the 
Patient Protection and Affordable Care Act (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 transition procedures.--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.--
            (1) Effective date with respect to premium credits and cost 
        sharing reductions.--The amendments made by subsection (a) 
        shall apply to taxable years 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.
            (2) Effective date for application to multi-state plans.--
        The amendment made by subsection (b) shall apply to plan years 
        beginning on the date that is one year after the date of 
        enactment of this Act.
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