Text of US HB 2202 (2025)

I 119TH CONGRESS 1ST SESSION H. R. 2202 To prohibit taxpayer-funded gender transition procedures, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 18, 2025 Mr. LAMALFA introduced the following bill; which was referred to the Com- mittee on Energy and Commerce, and in addition to the Committees on the Judiciary, and Ways and Means, for a period to be subsequently de- termined 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 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 2025’’. 6 (b) TABLE OF CONTENTS.—The table of contents of 7 this Act is as follows: 8 Sec. 1. Short title; table of contents. VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 2 •HR 2202 IH 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 FEDER- 1 ALLY FUNDED GENDER TRAN- 2 SITION PROCEDURES 3 SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER TRAN- 4 SITION PROCEDURES. 5 Title 1, United States Code, is amended by adding 6 at the end the following new chapter: 7 ‘‘CHAPTER 4—PROHIBITING TAXPAYER- 8 FUNDED GENDER TRANSITION PROCE- 9 DURES 10 ‘‘Sec. ‘‘301. Prohibition on funding for gender transition procedures. ‘‘302. Prohibition on funding for health benefits plans that cover gender transi- tion 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 pro- cedures. ‘‘307. Definitions. ‘‘§ 301. Prohibition on funding for gender transition 11 procedures 12 ‘‘No funds authorized or appropriated by Federal 13 law, and none of the funds in any trust fund to which 14 funds are authorized or appropriated by Federal law, shall 15 be expended for any gender transition procedures. 16 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 3 •HR 2202 IH ‘‘§ 302. Prohibition on funding for health benefits 1 plans that cover gender transition proce- 2 dures 3 ‘‘No funds authorized or appropriated by Federal 4 law, and none of the funds in any trust fund to which 5 funds are authorized or appropriated by Federal law, shall 6 be expended for health benefits coverage that includes cov- 7 erage of gender transition procedures. 8 ‘‘§ 303. Limitation on Federal facilities and employees 9 ‘‘No health care service furnished— 10 ‘‘(1) by or in a health care facility owned or op- 11 erated by the Federal Government; or 12 ‘‘(2) by any physician or other individual em- 13 ployed by the Federal Government to provide health 14 care services within the scope of the physician’s or 15 individual’s employment, 16 may include gender transition procedures. 17 ‘‘§ 304. Construction relating to separate coverage 18 ‘‘Nothing in this chapter shall be construed as pro- 19 hibiting any individual, entity, or State or locality from 20 purchasing separate coverage for gender transition proce- 21 dures or health benefits coverage that includes gender 22 transition procedures so long as such coverage is paid for 23 entirely using only funds not authorized or appropriated 24 by Federal law and such coverage shall not be purchased 25 using matching funds required for a federally subsidized 26 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 4 •HR 2202 IH program, including a State’s or locality’s contribution of 1 Medicaid matching funds. 2 ‘‘§ 305. Construction relating to the use of non-Fed- 3 eral funds for health coverage 4 ‘‘Nothing in this chapter shall be construed as re- 5 stricting the ability of any non-Federal health benefits cov- 6 erage provider from offering coverage for gender transi- 7 tion procedures, or the ability of a State or locality to con- 8 tract separately with such a provider for such coverage, 9 so long as only funds not authorized or appropriated by 10 Federal law are used and such coverage shall not be pur- 11 chased using matching funds required for a federally sub- 12 sidized program, including a State’s or locality’s contribu- 13 tion of Medicaid matching funds. 14 ‘‘§ 306. Construction relating to complications arising 15 from gender transition procedures 16 ‘‘Nothing in this chapter shall be construed to apply 17 to the treatment of any infection, injury, disease, or dis- 18 order that has been caused by or exacerbated by the per- 19 formance of a gender transition procedure. 20 ‘‘§ 307. Definitions 21 ‘‘For purposes of this chapter: 22 ‘‘(1) FEMALE.—The term ‘female’, when used 23 to refer to a natural person, means an individual 24 who naturally has, had, will have, or would have, but 25 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 5 •HR 2202 IH for a congenital anomaly, historical accident, or in- 1 tentional or unintentional disruption, the reproduc- 2 tive system that at some point produces, transports, 3 and utilizes eggs for fertilization. 4 ‘‘(2) GENDER TRANSITION.—The term ‘gender 5 transition’ means the process in which an individual 6 goes from identifying with or presenting as his or 7 her sex to identifying with or presenting a self-pro- 8 claimed identity that does not correspond with or is 9 different from his or her sex, and may be accom- 10 panied with social, legal, or physical changes. 11 ‘‘(3) GENDER TRANSITION PROCEDURE.— 12 ‘‘(A) IN GENERAL.—The term ‘gender 13 transition procedure’ means any hormonal or 14 surgical intervention for the purpose of gender 15 transition, including— 16 ‘‘(i) gonadotropin-releasing hormone 17 (GnRH) agonists or any other puberty- 18 blocking or suppressing drugs to stop or 19 delay normal puberty; 20 ‘‘(ii) testosterone, estrogen, progester- 21 one, or other androgens to an individual at 22 doses that are supraphysiologic to what 23 would normally be produced endogenously 24 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 6 •HR 2202 IH in a healthy individual of the same age and 1 sex; 2 ‘‘(iii) castration; 3 ‘‘(iv) orchiectomy; 4 ‘‘(v) scrotoplasty; 5 ‘‘(vi) implantation of erection or tes- 6 ticular prostheses; 7 ‘‘(vii) vasectomy; 8 ‘‘(viii) hysterectomy; 9 ‘‘(ix) oophorectomy; 10 ‘‘(x) ovariectomy; 11 ‘‘(xi) reconstruction of the fixed part 12 of the urethra with or without a 13 metoidioplasty or a phalloplasty; 14 ‘‘(xii) metoidioplasty; 15 ‘‘(xiii) penectomy; 16 ‘‘(xiv) phalloplasty; 17 ‘‘(xv) vaginoplasty; 18 ‘‘(xvi) clitoroplasty 19 ‘‘(xvii) vaginectomy; 20 ‘‘(xviii) vulvoplasty; 21 ‘‘(xix) reduction thyrochondroplasty; 22 ‘‘(xx) chondrolaryngoplasty; 23 ‘‘(xxi) mastectomy; 24 ‘‘(xxii) tubal ligation; 25 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 7 •HR 2202 IH ‘‘(xxiii) sterilization; 1 ‘‘(xxiv) any plastic, cosmetic, or aes- 2 thetic surgery that feminizes or 3 masculinizes the facial or other physio- 4 logical features of an individual; 5 ‘‘(xxv) any placement of chest im- 6 plants to create feminine breasts; 7 ‘‘(xxvi) any placement of fat or artifi- 8 cial implants in the gluteal region; 9 ‘‘(xxvii) augmentation mammoplasty; 10 ‘‘(xxviii) liposuction; 11 ‘‘(xxix) lipofilling; 12 ‘‘(xxx) voice surgery; 13 ‘‘(xxxi) hair reconstruction; 14 ‘‘(xxxii) pectoral implants; and 15 ‘‘(xxxiii) the removal of any otherwise 16 healthy or non-diseased body part or tis- 17 sue. 18 ‘‘(B) EXCLUSIONS.—The term ‘gender 19 transition procedure’ does not include the fol- 20 lowing when furnished to an individual by a 21 health care provider with the consent of such 22 individual or, if applicable, such individual’s 23 parents or legal guardian: 24 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 8 •HR 2202 IH ‘‘(i) Services to individuals born with 1 a medically verifiable disorder of sex devel- 2 opment, including an individual with exter- 3 nal sex characteristics that are irresolvably 4 ambiguous, such as an individual born with 5 46 XX chromosomes with virilization, an 6 individual born with 46 XY chromosomes 7 with undervirilization, or an individual 8 born having both ovarian and testicular 9 tissue. 10 ‘‘(ii) Services provided when a physi- 11 cian has otherwise diagnosed a disorder of 12 sexual development in which the physician 13 has determined through genetic or bio- 14 chemical testing that the individual does 15 not have normal sex chromosome struc- 16 ture, sex steroid hormone production, or 17 sex steroid hormone action for a healthy 18 individual of the same sex and age. 19 ‘‘(iii) The treatment of any infection, 20 injury, disease, or disorder that has been 21 caused by or exacerbated by the perform- 22 ance of gender transition procedures, 23 whether or not the gender transition proce- 24 dure was performed in accordance with 25 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 9 •HR 2202 IH State and Federal law or whether or not 1 funding for the gender transition proce- 2 dure is permissible under this section. 3 ‘‘(iv) Any procedure undertaken be- 4 cause the individual suffers from a physical 5 disorder, physical injury, or physical illness 6 (but not claimed mental distress) that 7 would, as certified by a physician, place 8 the individual in imminent danger of death 9 or impairment of major bodily function, 10 unless the procedure is performed. 11 ‘‘(v) Puberty suppression or blocking 12 prescription drugs for the purpose of nor- 13 malizing puberty for a minor experiencing 14 precocious puberty. 15 ‘‘(vi) Male circumcision. 16 ‘‘(4) MALE.—The term ‘male’, when used to 17 refer to a natural person, means an individual who 18 naturally has, had, will have, or would have, but for 19 a congenital anomaly, historical accident, or inten- 20 tional or unintentional disruption, the reproductive 21 system that at some point produces, transports, and 22 utilizes sperm for fertilization. 23 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 10 •HR 2202 IH ‘‘(5) SEX.—The term ‘sex’, when referring to 1 an individual’s sex, means to refer to either male or 2 female, as biologically determined.’’. 3 SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 4 The table of chapters for title 1, United States Code, 5 is amended by adding at the end the following new item: 6 ‘‘4. Prohibiting taxpayer-funded gender transition pro- cedures ....................................................................... 301’’. TITLE II—APPLICATION UNDER 7 THE AFFORDABLE CARE ACT 8 SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 9 PREMIUM CREDITS AND COST-SHARING RE- 10 DUCTIONS UNDER ACA. 11 (a) IN GENERAL.— 12 (1) DISALLOWANCE OF REFUNDABLE CREDIT 13 AND COST-SHARING REDUCTIONS FOR COVERAGE 14 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 15 COVERAGE FOR GENDER PROCEDURES.— 16 (A) IN GENERAL.—Subparagraph (A) of 17 section 36B(c)(3) of the Internal Revenue Code 18 of 1986 is amended by inserting before the pe- 19 riod at the end the following: ‘‘or any health 20 plan that includes coverage for gender transi- 21 tion procedures, as defined in section 307 of 22 title 1, United States Code (other than any pro- 23 cedure described in section 306 of such title)’’. 24 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 11 •HR 2202 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 TRANSITION PROCEDURES AL- 7 LOWED.— 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 transition procedures 13 described in such subparagraph, or a 14 health plan that includes such gender tran- 15 sition procedures, so long as no credit is 16 allowed under this section with respect to 17 the premiums for such coverage or plan. 18 ‘‘(ii) OPTION TO OFFER COVERAGE OR 19 PLAN.—Nothing in subparagraph (A) shall 20 restrict any non-Federal health insurance 21 issuer offering a health plan from offering 22 separate coverage for gender transition 23 procedures described in such subpara- 24 graph, or a plan that includes such gender 25 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 12 •HR 2202 IH transition procedures, so long as premiums 1 for such separate coverage or plan are not 2 paid for with any amount attributable to 3 the credit allowed under this section (or 4 the amount of any advance payment of the 5 credit under section 1412 of the Patient 6 Protection and Affordable Care Act).’’. 7 (2) DISALLOWANCE OF SMALL EMPLOYER 8 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN 9 WHICH INCLUDES COVERAGE FOR GENDER TRANSI- 10 TION PROCEDURES.—Subsection (h) of section 45R 11 of the Internal Revenue Code of 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 TRANSITION PROCE- 19 DURES.— 20 ‘‘(A) IN GENERAL.—In this section, the 21 term ‘qualified health plan’ does not include 22 any health plan that includes coverage for gen- 23 der transition procedures, as defined in section 24 307 of title 1, United States Code (other than 25 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 13 •HR 2202 IH any procedure described in section 306 of such 1 title). 2 ‘‘(B) SEPARATE COVERAGE OR PLAN FOR 3 GENDER TRANSITION PROCEDURES AL- 4 LOWED.— 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 tran- 10 sition procedures described in such sub- 11 paragraph, or a health plan that includes 12 such gender transition procedures, so long 13 as no credit is allowed under this section 14 with respect to the employer contributions 15 for 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 transition 21 procedures described in such subpara- 22 graph, or a plan that includes such gender 23 transition procedures, so long as such sep- 24 arate coverage or plan is not paid for with 25 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS 14 •HR 2202 IH any employer contribution eligible for the 1 credit allowed under this section.’’. 2 (b) APPLICATION TO MULTI-STATE PLANS.—Section 3 1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 4 amended by adding at the end the following new para- 5 graph: 6 ‘‘(8) COVERAGE CONSISTENT WITH FEDERAL 7 POLICY REGARDING GENDER TRANSITION PROCE- 8 DURES.—In entering into contracts under this sub- 9 section, the Director shall ensure that no multi-State 10 qualified health plan offered in an Exchange pro- 11 vides health benefits coverage for which the expendi- 12 ture of Federal funds is prohibited under chapter 4 13 of title 1, United States Code.’’. 14 (c) EFFECTIVE DATE.—The amendments made by 15 subsection (a) shall apply to taxable years ending after 16 the date that is 1 year after the date of enactment of this 17 Act, but only with respect to plan years beginning after 18 such date, and the amendment made by subsection (b) 19 shall apply to plan years beginning after such date. 20 Æ VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6301 E:\BILLS\H2202.IH H2202 ssavage on LAPJG3WLY3PROD with BILLS