Text of US HB 3329 (2023)

I 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) in- troduced the following bill; which was referred to the Committee on En- ergy 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 Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3329 IH SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 1 (a) SHORT TITLE.—This Act may be cited as the 2 ‘‘End Taxpayer Funding of Gender Experimentation Act 3 of 2023’’. 4 (b) TABLE OF CONTENTS.—The table of contents of 5 this Act are as follows: 6 Sec. 1. Short title; table of contents. TITLE I—PROHIBITING FEDERALLY FUNDED GENDER TRANSITION PROCEDURES Sec. 101. Prohibiting taxpayer-funded gender transition procedures. Sec. 102. Amendment to table of chapters. TITLE II—APPLICATION UNDER THE AFFORDABLE CARE ACT Sec. 201. Clarifying application of prohibition to premium credits and cost- sharing reductions under ACA. TITLE I—PROHIBITING FEDER- 7 ALLY FUNDED GENDER TRAN- 8 SITION PROCEDURES 9 SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER TRAN- 10 SITION PROCEDURES. 11 Title 1, United States Code, is amended by adding 12 at the end the following new chapter: 13 ‘‘CHAPTER 4—PROHIBITING TAXPAYER- 14 FUNDED GENDER TRANSITION PROCE- 15 DURES 16 ‘‘301. Prohibition on funding for gender transition procedures. ‘‘302. Prohibition on funding for health benefits plans that cover gender transi- tion procedures. ‘‘303. Limitation on Federal facilities and employees. ‘‘304. Construction relating to separate coverage. ‘‘305. Construction relating to the use of non-Federal funds for health coverage. VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3329 IH ‘‘306. Construction relating to complications arising from gender transition pro- cedures. ‘‘307. Definitions. ‘‘§ 301. Prohibition on funding for gender transition 1 procedures 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 transition procedures. 6 ‘‘§ 302. Prohibition on funding for health benefits 7 plans that cover gender transition proce- 8 dures 9 ‘‘No funds authorized or appropriated by Federal 10 law, and none of the funds in any trust fund to which 11 funds are authorized or appropriated by Federal law, shall 12 be expended for health benefits coverage that includes cov- 13 erage of gender transition procedures. 14 ‘‘§ 303. Limitation on Federal facilities and employees 15 ‘‘No health care service furnished— 16 ‘‘(1) by or in a health care facility owned or op- 17 erated by the Federal Government; or 18 ‘‘(2) by any physician or other individual em- 19 ployed by the Federal Government to provide health 20 care services within the scope of the physician’s or 21 individual’s employment, 22 may include gender transition procedures. 23 VerDate Sep 11 2014 21:36 May 25, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3329 IH ‘‘§ 304. Construction relating to separate coverage 1 ‘‘Nothing in this chapter shall be construed as pro- 2 hibiting any individual, entity, State, or locality from pur- 3 chasing separate coverage for gender transition procedures 4 or health benefits coverage that include gender transition 5 procedures so long as such coverage is paid for entirely 6 with funds not authorized or appropriated by Federal law, 7 and such coverage shall not be purchased using matching 8 funds required for a federally subsidized program, includ- 9 ing a State or locality’s contribution of Medicaid matching 10 funds. 11 ‘‘§ 305. Construction relating to the use of non-Fed- 12 eral funds for health coverage 13 ‘‘Nothing in this chapter shall be construed as re- 14 stricting the ability of any non-Federal health benefits cov- 15 erage provider from offering coverage for gender transi- 16 tion procedures, or the ability of a State or locality to con- 17 tract separately with such a provider for such coverage, 18 so long as only funds not authorized or appropriated by 19 Federal law are used, and such coverage shall not be pur- 20 chased using matching funds required for a federally sub- 21 sidized program, including a State or locality’s contribu- 22 tion of Medicaid matching funds. 23 VerDate Sep 11 2014 21:36 May 25, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3329 IH ‘‘§ 306. Construction relating to complications arising 1 from gender transition procedures 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 transition procedure. 6 ‘‘§ 307. Definitions 7 ‘‘For purposes of this chapter: 8 ‘‘(1) BIOLOGICAL SEX.—The term ‘biological 9 sex’ means the biological indication of male or fe- 10 male in the context of reproductive potential or ca- 11 pacity, such as sex chromosomes, naturally occurring 12 sex hormones, gonads, and non-ambiguous internal 13 and external genitalia present at birth, without re- 14 gard to an individual’s psychological, chosen, or sub- 15 jective experience of gender. 16 ‘‘(2) CROSS-SEX HORMONES.—The term ‘cross- 17 sex hormones’ means— 18 ‘‘(A) testosterone or other androgens given 19 to biological females at doses that are pro- 20 foundly larger or more potent than would natu- 21 rally occur in healthy biological females; or 22 ‘‘(B) estrogen given to biological males at 23 doses that are profoundly larger or more potent 24 than would naturally occur in healthy biological 25 males. 26 VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •HR 3329 IH ‘‘(3) GENDER.—The term ‘gender’ means the 1 psychological, behavioral, social, and cultural aspects 2 of being male or female. 3 ‘‘(4) GENDER TRANSITION.—The term ‘gender 4 transition’ means the process in which a person goes 5 from identifying with and living as a gender that 6 corresponds to his or her biological sex to identifying 7 with and living as a gender different from his or her 8 biological sex, and may involve social, legal, or phys- 9 ical changes. 10 ‘‘(5) GENDER TRANSITION PROCEDURE.— 11 ‘‘(A) IN GENERAL.—The term ‘gender 12 transition procedure’ means any medical or sur- 13 gical service, including physician’s services, in- 14 patient and outpatient hospital services, or pre- 15 scribed drugs related to gender transition, that 16 seek to alter or remove physical or anatomical 17 characteristics or features that are typical for 18 an individual’s biological sex, or to instill or cre- 19 ate physiological or anatomical characteristics 20 that resemble a sex different from an individ- 21 ual’s birth sex, including, without limitation, 22 medical services that provide puberty-blocking 23 drugs, cross-sex hormones, or other mechanisms 24 to promote the development of feminizing or 25 VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •HR 3329 IH masculinizing features (in the opposite sex), or 1 genital gender transition surgery or nongenital 2 gender transition surgery performed for the 3 purpose of assisting an individual with a gender 4 transition. 5 ‘‘(B) EXCEPTIONS.—The term ‘gender 6 transition procedure’ does not include— 7 ‘‘(i) services to those born with a 8 medically-verifiable disorder of sex develop- 9 ment, including a person with external bio- 10 logical sex characteristics that are 11 irresolvably ambiguous, such as those born 12 with 46 XX chromosomes with virilization, 13 46 XY chromosomes with undervirilization, 14 or having both ovarian and testicular tis- 15 sue; or services provided when a physician 16 has otherwise diagnosed a disorder of sex- 17 ual development, in which such physician 18 has determined through genetic or bio- 19 chemical testing that the person does not 20 have normal sex chromosome structure, sex 21 steroid hormone production, or sex steroid 22 hormone action for a biological male or bi- 23 ological female; or 24 VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •HR 3329 IH ‘‘(ii) the treatment of any infection, 1 injury, disease, or disorder that has been 2 caused by or exacerbated by the perform- 3 ance of a gender transition procedure, 4 whether or not such procedure was per- 5 formed in accordance with State or Fed- 6 eral law, or whether funding for such pro- 7 cedure was permissible under this chapter. 8 ‘‘(6) GENDER TRANSITION SURGERY.— 9 ‘‘(A) IN GENERAL.—The term ‘gender 10 transition surgery’ means any medical or sur- 11 gical service that seeks to surgically alter or re- 12 move healthy physical or anatomical character- 13 istics or features that are typical for an individ- 14 ual’s biological sex in order to instill or create 15 physiological or anatomical characteristics that 16 resemble a sex different from an individual’s 17 birth sex, including, without limitation, genital 18 gender reassignment surgery or non-genital 19 gender reassignment surgery performed for the 20 purpose of assisting an individual with a gender 21 transition. 22 ‘‘(B) EXCEPTION.—Gender transition sur- 23 gery does not include any procedure undertaken 24 because the individual suffers from a physical 25 VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 9 •HR 3329 IH disorder, physical injury, or physical illness that 1 would, as certified by a physician, place the in- 2 dividual in imminent danger of death or impair- 3 ment of major bodily function unless surgery is 4 performed. 5 ‘‘(7) GENITAL GENDER TRANSITION SUR- 6 GERY.—The term ‘genital gender transition surgery’ 7 includes surgical procedures such as penectomy, 8 orchiectomy, vaginoplasty, clitoroplasty, or 9 vulvoplasty for biologically male patients, or 10 hysterectomy/ovariectomy, reconstruction of the 11 fixed part of the urethra with or without a 12 metoidioplasty or a phalloplasty, vaginectomy, 13 scrotoplasty, or implantation of erection or testicular 14 prostheses for biologically female patients when per- 15 formed for the purpose of assisting an individual 16 with a gender transition. 17 ‘‘(8) NON-GENITAL GENDER TRANSITION SUR- 18 GERY.—The term ‘non-genital gender transition sur- 19 gery’ means surgical procedures including augmenta- 20 tion mammoplasty, facial feminization surgery, 21 liposuction, lipofilling, voice surgery, thyroid car- 22 tilage reduction, gluteal augmentation (implants or 23 lipofilling), hair reconstruction, or other aesthetic 24 procedures for biologically male patients or subcuta- 25 VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 10 •HR 3329 IH neous mastectomy, voice surgery, liposuction, 1 lipofilling, pectoral implants, or other aesthetic pro- 2 cedures for biologically female patients, when per- 3 formed for the purpose of assisting an individual 4 with a gender transition. 5 ‘‘(9) PUBERTY-BLOCKING DRUGS.—The term 6 ‘puberty-blocking drugs’ means— 7 ‘‘(A) Gonadotropin-releasing hormone 8 (GnRH) analogues or other synthetic drugs 9 used in biological males to stop luteinizing hor- 10 mone secretion and therefore testosterone secre- 11 tion; 12 ‘‘(B) synthetic drugs used in biological fe- 13 males that stop the production of estrogen; and 14 ‘‘(C) progesterone when used to delay or 15 suppress pubertal development in children for 16 the purpose of assisting an individual with a 17 gender transition.’’. 18 SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 19 The table of chapters for title 1, United States Code, 20 is amended by adding at the end the following new item: 21 ‘‘4. Prohibiting taxpayer-funded gender transition pro- cedures ....................................................................... 301’’. VerDate Sep 11 2014 21:36 May 25, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6211 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 11 •HR 3329 IH TITLE II—APPLICATION UNDER 1 THE AFFORDABLE CARE ACT 2 SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 3 PREMIUM CREDITS AND COST-SHARING RE- 4 DUCTIONS UNDER ACA. 5 (a) IN GENERAL.— 6 (1) DISALLOWANCE OF REFUNDABLE CREDIT 7 AND COST-SHARING REDUCTIONS FOR COVERAGE 8 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 9 COVERAGE FOR GENDER TRANSITION PROCE- 10 DURES.— 11 (A) IN GENERAL.—Section 36B(c)(3)(A) 12 of the Internal Revenue Code of 1986 is 13 amended by inserting before the period at the 14 end the following: ‘‘or any health plan that in- 15 cludes coverage for gender transition procedures 16 (other than any procedure described in section 17 306 or 307 of title 1, United States Code)’’. 18 (B) OPTION TO PURCHASE OR OFFER SEP- 19 ARATE COVERAGE OR PLAN.—Section 36B(c)(3) 20 of such Code is amended by adding at the end 21 the following new subparagraph: 22 ‘‘(C) SEPARATE COVERAGE OR PLAN FOR 23 GENDER TRANSITION PROCEDURES AL- 24 LOWED.— 25 VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 12 •HR 3329 IH ‘‘(i) OPTION TO PURCHASE SEPARATE 1 COVERAGE OR PLAN.—Nothing in subpara- 2 graph (A) shall be construed as prohibiting 3 any individual from purchasing separate 4 coverage for gender transition procedures 5 described in such subparagraph, or a 6 health plan that includes such gender tran- 7 sition procedures, so long as no credit is 8 allowed under this section with respect to 9 the premiums for such coverage or plan. 10 ‘‘(ii) OPTION TO OFFER COVERAGE OR 11 PLAN.—Nothing in subparagraph (A) shall 12 restrict any non-Federal health insurance 13 issuer offering a health plan from offering 14 separate coverage for gender transition 15 procedures described in such subpara- 16 graph, or a plan that includes such gender 17 transition procedures, so long as premiums 18 for such separate coverage or plan are not 19 paid for with any amount attributable to 20 the credit allowed under this section (or 21 the amount of any advance payment of the 22 credit under section 1412 of the Patient 23 Protection and Affordable Care Act).’’. 24 VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 13 •HR 3329 IH (2) DISALLOWANCE OF SMALL EMPLOYER 1 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN 2 WHICH INCLUDES COVERAGE FOR GENDER TRANSI- 3 TION PROCEDURES.—Subsection (h) of section 45R 4 of the Internal Revenue Code of 1986 is amended— 5 (A) by striking ‘‘Any term’’ and inserting 6 the following: 7 ‘‘(1) IN GENERAL.—Any term’’; and 8 (B) by adding at the end the following new 9 paragraph: 10 ‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING 11 COVERAGE FOR GENDER TRANSITION PROCE- 12 DURES.— 13 ‘‘(A) IN GENERAL.—The term ‘qualified 14 health plan’ does not include any health plan 15 that includes coverage for gender transition 16 procedures (other than a procedure described in 17 section 306 or 307 of title 1, United States 18 Code). 19 ‘‘(B) SEPARATE COVERAGE OR PLAN FOR 20 GENDER TRANSITION PROCEDURES AL- 21 LOWED.— 22 ‘‘(i) OPTION TO PURCHASE SEPARATE 23 COVERAGE OR PLAN.—Nothing in subpara- 24 graph (A) shall be construed as prohibiting 25 VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 14 •HR 3329 IH any employer from purchasing for its em- 1 ployees separate coverage for gender tran- 2 sition procedures described in such sub- 3 paragraph, or a health plan that includes 4 such gender transition procedures, so long 5 as no credit is allowed under this section 6 with respect to the employer contributions 7 for such coverage or plan. 8 ‘‘(ii) OPTION TO OFFER COVERAGE OR 9 PLAN.—Nothing in subparagraph (A) shall 10 restrict any non-Federal health insurance 11 issuer offering a health plan from offering 12 separate coverage for gender transition 13 procedures described in such subpara- 14 graph, or a plan that includes such gender 15 transition procedures, so long as such sep- 16 arate coverage or plan is not paid for with 17 any employer contribution eligible for the 18 credit allowed under this section.’’. 19 (b) APPLICATION TO MULTI-STATE PLANS.—Section 20 1334(a) of the Patient Protection and Affordable Care Act 21 (42 U.S.C. 18054(a)) is amended by adding at the end 22 the following new paragraph: 23 ‘‘(8) COVERAGE CONSISTENT WITH FEDERAL 24 POLICY REGARDING GENDER TRANSITION PROCE- 25 VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB 15 •HR 3329 IH DURES.—In entering into contracts under this sub- 1 section, the Director shall ensure that no multi-State 2 qualified health plan offered in an Exchange pro- 3 vides health benefits coverage for which the expendi- 4 ture of Federal funds is prohibited under chapter 4 5 of title 1, United States Code.’’. 6 (c) EFFECTIVE DATE.— 7 (1) EFFECTIVE DATE WITH RESPECT TO PRE- 8 MIUM CREDITS AND COST SHARING REDUCTIONS.— 9 The amendments made by subsection (a) shall apply 10 to taxable years after the date that is one year after 11 the date of enactment of this Act, but only with re- 12 spect to plan years beginning after such date. 13 (2) EFFECTIVE DATE FOR APPLICATION TO 14 MULTI-STATE PLANS.—The amendment made by 15 subsection (b) shall apply to plan years beginning on 16 the date that is one year after the date of enactment 17 of this Act. 18 Æ VerDate Sep 11 2014 03:37 May 25, 2023 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6301 E:\BILLS\H3329.IH H3329 pbinns on DSKJLVW7X2PROD with $$_JOB