Text of US SB 1551 (2025)

II 119TH CONGRESS 1ST SESSION S. 1551 To deny tax deductions and other Federal funding for the costs of gender transition procedures. IN THE SENATE OF THE UNITED STATES MAY 1, 2025 Mr. MARSHALL (for himself, Mr. RICKETTS, Mr. CASSIDY, and Mr. LEE) in- troduced the following bill; which was read twice and referred to the Com- mittee on Finance A BILL To deny tax deductions and other Federal funding for the costs of gender transition procedures. 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 ‘‘No Subsidies for Gen- 4 der Transition Procedures Act’’. 5 SEC. 2. DENIAL OF MEDICAL EXPENSE TAX DEDUCTION. 6 (a) IN GENERAL.—Subsection (d) of section 213 of 7 the Internal Revenue Code of 1986 is amended by adding 8 at the end the following new paragraph: 9 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 2 •S 1551 IS ‘‘(12) EXPENSES RELATING TO GENDER TRAN- 1 SITION.— 2 ‘‘(A) IN GENERAL.—The term ‘medical 3 care’ does not include any gender transition 4 procedure. 5 ‘‘(B) DEFINITIONS.—For purposes of this 6 paragraph— 7 ‘‘(i) GENDER TRANSITION PROCE- 8 DURE.— 9 ‘‘(I) IN GENERAL.—The term 10 ‘gender transition procedure’ means 11 any hormonal or surgical intervention 12 for the purpose of gender transition, 13 including— 14 ‘‘(aa) the provision of 15 gonadotropin-releasing hormone 16 agonists or other puberty-sup- 17 pression drugs or puberty-block- 18 ing drugs to stop or delay nor- 19 mally-timed puberty in an indi- 20 vidual who does not identify as 21 his or her sex, 22 ‘‘(bb) the provision of testos- 23 terone, estrogen, progesterone, or 24 other androgen blockers to an in- 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 3 •S 1551 IS dividual at doses which are 1 supraphysiologic to what would 2 normally be produced 3 endogenously in a healthy indi- 4 vidual of the same age and sex, 5 with the intent to align an indi- 6 vidual’s physical appearance with 7 an identity that differs from his 8 or her sex, 9 ‘‘(cc) surgical procedures 10 that attempt to transform an in- 11 dividual’s physical appearance to 12 align with an identity that differs 13 from his or her sex or that at- 14 tempt to alter or remove an indi- 15 vidual’s sexual organs to mini- 16 mize or destroy their natural bio- 17 logical functions, 18 ‘‘(dd) castration, vasectomy, 19 penectomy, orchiectomy, 20 vaginoplasty, clitoroplasty, 21 vulvoplasty, mastectomy, 22 hysterectomy, oophorectomy, 23 ovariectomy, reconstruction of 24 the fixed part of the urethra with 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 4 •S 1551 IS or without metoidioplasty or 1 phalloplasty, metoidioplasty, 2 phalloplasty, vaginectomy, 3 scrotoplasty, implantation of 4 erection or testicular prostheses, 5 reduction thyrochondroplasty, 6 chondrolaryngoplasty, tubal liga- 7 tion, sterilization, augmentation 8 mammoplasty, placement of chest 9 implants to create feminine 10 breasts, placement of fat or arti- 11 ficial implants in the gluteal re- 12 gion, liposuction, lipofilling, voice 13 surgery, hair reconstruction, pec- 14 toral implants, any plastic, cos- 15 metic, or aesthetic surgery which 16 feminizes or masculinizes the fa- 17 cial or other physiological fea- 18 tures of an individual, and any 19 removal of any otherwise healthy 20 or non-diseased body part or tis- 21 sue. 22 ‘‘(II) EXCLUSIONS.—The term 23 ‘gender transition procedure’ does not 24 include, when furnished to an indi- 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 5 •S 1551 IS vidual by a health care provider with 1 the consent of such individual (or, if 2 applicable, such individual’s parents 3 or legal guardian)— 4 ‘‘(aa) services to individuals 5 born with a medically verifiable 6 disorder of sex development, in- 7 cluding an individual with exter- 8 nal sex characteristics which are 9 irresolvably ambiguous, such as 10 an individual born with 46 XX 11 chromosomes with virilization, an 12 individual born with 46 XY chro- 13 mosomes with undervirilization, 14 or an individual born having both 15 ovarian and testicular tissue, 16 ‘‘(bb) services relating to 17 any other physician-diagnosed 18 disorder of sexual development 19 with respect to which the physi- 20 cian has determined through ge- 21 netic or biochemical testing that 22 the individual does not have nor- 23 mal sex chromosome structure, 24 sex steroid hormone production, 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 6 •S 1551 IS or sex steroid hormone action for 1 a healthy male or female of the 2 same age, 3 ‘‘(cc) the treatment of any 4 infection, injury, disease, or dis- 5 order caused or exacerbated by 6 the performance of gender transi- 7 tion procedures, without regard 8 to whether the gender transition 9 procedure was performed in ac- 10 cordance with State and Federal 11 law or whether the gender transi- 12 tion procedure is treated as med- 13 ical care under this section, 14 ‘‘(dd) any procedure under- 15 taken because the individual suf- 16 fers from a physical disorder, 17 physical injury, or physical illness 18 (but not mental, behavioral, or 19 emotional distress or a mental, 20 behavioral, or emotional disorder) 21 which would, as certified by a 22 physician, place the individual in 23 imminent danger of death or im- 24 pairment of major bodily function 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 7 •S 1551 IS unless the procedure is performed 1 to alleviate said physical disorder, 2 physical injury, or physical ill- 3 ness, 4 ‘‘(ee) procedures to restore 5 or reconstruct the body of the in- 6 dividual in order to correspond to 7 the individual’s sex after one or 8 more previous gender transition 9 procedures, which may include 10 the removal of a pseudo phallus 11 or breast augmentation, 12 ‘‘(ff) puberty suppression or 13 puberty-blocking prescription 14 drugs for the purpose of normal- 15 izing puberty for a minor experi- 16 encing precocious puberty, or 17 ‘‘(gg) male circumcision. 18 ‘‘(ii) GENDER TRANSITION.—The 19 term ‘gender transition’ means the process 20 by which an individual goes from identi- 21 fying with or presenting as his or her sex 22 to identifying with or presenting as a self- 23 proclaimed identity which does not cor- 24 respond with or is different from his or her 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 8 •S 1551 IS sex, and may be accompanied by social, 1 legal, or physical changes. 2 ‘‘(iii) SEX.—The term ‘sex’, when re- 3 ferring to an individual’s sex, means either 4 male or female, as biologically determined. 5 ‘‘(iv) FEMALE.—The term ‘female’, 6 when used to refer to a natural person, 7 means a person belonging, at conception, 8 to the sex characterized by a reproductive 9 system with the biological function of pro- 10 ducing eggs (ova). 11 ‘‘(v) MALE.—The term ‘male’, when 12 used to refer to a natural person, means a 13 person belonging, at conception, to the bio- 14 logical sex characterized by a reproductive 15 system with the biological function of pro- 16 ducing sperm.’’. 17 (b) EFFECTIVE DATE.—The amendment made by 18 this section shall apply to taxable years beginning after 19 the date of the enactment of this Act. 20 SEC. 3. PROHIBITING FEDERAL MEDICAID FUNDING FOR 21 GENDER TRANSITION PROCEDURES. 22 (a) IN GENERAL.—Section 1903(i) of the Social Se- 23 curity Act (42 U.S.C. 1396b(i)) is amended— 24 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 9 •S 1551 IS (1) in paragraph (26), by striking ‘‘; or’’ and 1 inserting a semicolon; 2 (2) in paragraph (27), by striking the period at 3 the end and inserting ‘‘; or’’; 4 (3) by inserting after paragraph (27) the fol- 5 lowing new paragraph: 6 ‘‘(28) with respect to any amounts expended for 7 any specified gender transition procedure (as defined 8 in section 1905(kk)) to an individual enrolled in a 9 State plan under this title (or a waiver of such 10 plan), including any amounts expended for the ad- 11 ministration of a State program that furnishes any 12 such procedure.’’; and 13 (4) in the flush left matter at the end, by strik- 14 ing ‘‘and (18),’’ and inserting ‘‘(18), and (28)’’. 15 (b) PROHIBITING FEDERAL MEDICAID FUNDING FOR 16 GENDER TRANSITION PROCEDURES.—Section 1905 of 17 the Social Security Act (42 U.S.C. 1396d) is amended by 18 adding at the end the following new subsection: 19 ‘‘(kk) PROHIBITING FEDERAL MEDICAID FUNDING 20 FOR SPECIFIED GENDER TRANSITION PROCEDURES.— 21 ‘‘(1) SPECIFIED GENDER TRANSITION PROCE- 22 DURES DEFINED.—For purposes of section 23 1903(i)(28), except as provided in paragraph (2), 24 the term ‘specified gender transition procedure’ 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 10 •S 1551 IS means, with respect to an individual, any hormonal 1 or surgical intervention for the purpose of gender 2 transition, including— 3 ‘‘(A) the provision of gonadotropin-releas- 4 ing hormone agonists or other puberty suppres- 5 sion drugs or puberty-blocking drugs to stop or 6 delay normally timed puberty in an individual 7 who does not identify as his or her sex; 8 ‘‘(B) the provision of testosterone, estro- 9 gen, progesterone, or other androgen blockers 10 to an individual at doses which are 11 supraphysiologic to what would normally be 12 produced endogenously in a healthy individual 13 of the same age and sex, with the intent to 14 align an individual’s physical appearance with 15 an identity that differs from his or her sex; 16 ‘‘(C) surgical procedures that attempt to 17 transform an individual’s physical appearance 18 to align with an identity that differs from his 19 or her sex or that attempt to alter or remove 20 an individual’s sexual organs to minimize or de- 21 stroy their natural biological functions; or 22 ‘‘(D) castration, vasectomy, penectomy, 23 orchiectomy, vaginoplasty, clitoroplasty, 24 vulvoplasty, mastectomy, hysterectomy, 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 11 •S 1551 IS oophorectomy, ovariectomy, reconstruction of 1 the fixed part of the urethra with or without 2 metoidioplasty or phalloplasty, metoidioplasty, 3 phalloplasty, vaginectomy, scrotoplasty, implan- 4 tation of erection or testicular prostheses, re- 5 duction thyrochondroplasty, 6 chondrolaryngoplasty, tubal ligation, steriliza- 7 tion, augmentation mammoplasty, placement of 8 chest implants to create feminine breasts, place- 9 ment of fat or artificial implants in the gluteal 10 region, liposuction, lipofilling, voice surgery, 11 hair reconstruction, pectoral implants, any plas- 12 tic, cosmetic, or aesthetic surgery which femi- 13 nizes or masculinizes the facial or other physio- 14 logical features of an individual, and any re- 15 moval of any otherwise healthy or non-diseased 16 body part or tissue. 17 ‘‘(2) EXCLUSIONS.—The term ‘specified gender 18 transition procedure’ shall not include, when fur- 19 nished to an individual by a health care provider 20 with the consent of such individual (or, if applicable, 21 the parents or legal guardian of such individual)— 22 ‘‘(A) services to individuals born with a 23 medically verifiable disorder of sex development, 24 including an individual with external sex char- 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 12 •S 1551 IS acteristics which are irresolvably ambiguous, 1 such as an individual born with 46 XX chro- 2 mosomes with virilization, an individual born 3 with 46 XY chromosomes with undervirilization, 4 or an individual born having both ovarian and 5 testicular tissue; 6 ‘‘(B) services relating to any other physi- 7 cian-diagnosed disorder of sexual development 8 with respect to which the physician has deter- 9 mined through genetic or biochemical testing 10 that the individual does not have normal sex 11 chromosome structure, sex steroid hormone pro- 12 duction, or sex steroid hormone action for a 13 healthy male or female of the same age; 14 ‘‘(C) the treatment of any infection, injury, 15 disease, or disorder caused or exacerbated by 16 the performance of gender transition proce- 17 dures, without regard to whether the gender 18 transition procedure was performed in accord- 19 ance with State and Federal law or whether the 20 gender transition procedure is treated as med- 21 ical care under this section; 22 ‘‘(D) any procedure undertaken because 23 the individual suffers from a physical disorder, 24 physical injury, or physical illness (but not 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 13 •S 1551 IS mental, behavioral, or emotional distress or a 1 mental, behavioral, or emotional disorder) which 2 would, as certified by a physician, place the in- 3 dividual in imminent danger of death or impair- 4 ment of major bodily function unless the proce- 5 dure is performed to alleviate said physical dis- 6 order, physical injury, or physical illness; 7 ‘‘(E) any procedure to restore or recon- 8 struct the body of the individual in order to cor- 9 respond to the individual’s sex after 1 or more 10 previous gender transition procedures, which 11 may include the removal of a pseudo phallus or 12 breast augmentation; 13 ‘‘(F) puberty suppression or puberty-block- 14 ing prescription drugs for the purpose of nor- 15 malizing puberty for an individual experiencing 16 precocious puberty; or 17 ‘‘(G) male circumcision. 18 ‘‘(3) ADDITIONAL DEFINITIONS.—For purposes 19 of this subsection: 20 ‘‘(A) GENDER TRANSITION.—The term 21 ‘gender transition’ means the process by which 22 an individual goes from identifying with or pre- 23 senting as his or her sex to identifying with or 24 presenting as a self-proclaimed identity which 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 14 •S 1551 IS does not correspond with or is different from 1 his or her sex, and may be accompanied by so- 2 cial, legal, or physical changes. 3 ‘‘(B) SEX.—The term ‘sex’, when referring 4 to an individual’s sex, means either male or fe- 5 male, as biologically determined, including as 6 described in subparagraphs (C) and (D). 7 ‘‘(C) FEMALE.—The term ‘female’, when 8 used to refer to a natural person, means an in- 9 dividual belonging, at conception, to the sex 10 characterized by a reproductive system with the 11 biological function of producing eggs (ova). 12 ‘‘(D) MALE.—The term ‘male’, when used 13 to refer to a natural person, means an indi- 14 vidual belonging, at conception, to the biological 15 sex characterized by a reproductive system with 16 the biological function of producing sperm.’’. 17 (c) EFFECTIVE DATE.—The amendments made by 18 this section shall apply to services furnished on or after 19 the date of the enactment of this Act. 20 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 15 •S 1551 IS SEC. 4. PROHIBITING FEDERAL CHILDREN’S HEALTH IN- 1 SURANCE PROGRAM FUNDING FOR GENDER 2 TRANSITION PROCEDURES ON MINORS. 3 (a) IN GENERAL.—Section 2105(c) of the Social Se- 4 curity Act (42 U.S.C. 1397ee(c)) is amended by adding 5 at the end the following new paragraph: 6 ‘‘(13) LIMITATION ON PAYMENT FOR SPECIFIED 7 GENDER TRANSITION PROCEDURES FOR MINORS.— 8 Payment shall not be made to a State under this 9 section for any amount expended under the State 10 plan to pay for specified gender transition proce- 11 dures (as defined in section 1905(kk)) or to assist 12 in the purchase, in whole or in part, of health ben- 13 efit coverage that includes coverage of any such pro- 14 cedure.’’. 15 (b) CONFORMING AMENDMENT.—Section 16 2107(e)(1)(N) of the Social Security Act (42 U.S.C. 17 1397gg(e)(1)(N)) is amended by striking ‘‘and (17)’’ and 18 inserting ‘‘(17), and (28)’’. 19 (c) EFFECTIVE DATE.—The amendments made by 20 this section shall apply to services furnished on or after 21 the date of the enactment of this Act. 22 SEC. 5. PROHIBITING FEDERAL MEDICARE FUNDING FOR 23 GENDER TRANSITION PROCEDURES. 24 (a) IN GENERAL.—Section 1862(a) of the Social Se- 25 curity Act (42 U.S.C. 1395y(a)) is amended— 26 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 16 •S 1551 IS (1) in paragraph (24), by striking ‘‘or’’ at the 1 end; 2 (2) in paragraph (25), by striking the period at 3 the end and inserting ‘‘; or’’; and 4 (3) by inserting after paragraph (25) the fol- 5 lowing new paragraph: 6 ‘‘(26) which are specified gender transition pro- 7 cedures (as defined in section 1905(kk)).’’. 8 (b) EFFECTIVE DATE.—The amendments made by 9 subsection (a) shall apply to items and services furnished 10 on or after the date of the enactment of this Act. 11 SEC. 6. EXCLUSION OF GENDER TRANSITION PROCEDURES 12 FROM ESSENTIAL HEALTH BENEFITS. 13 Section 1302(b)(2) of the Patient Protection and Af- 14 fordable Care Act (42 U.S.C. 18022(b)(2)) is amended— 15 (1) in the paragraph heading, by striking ‘‘LIM- 16 ITATION’’ and inserting ‘‘LIMITATIONS’’; 17 (2) by redesignating subparagraph (B) as sub- 18 paragraph (C); 19 (3) by inserting after subparagraph (A) the fol- 20 lowing: 21 ‘‘(B) EXCLUSIONS.—In defining the essen- 22 tial health benefits under paragraph (1), or in 23 revising essential health benefits under para- 24 graph (4)(H), the Secretary shall not include 25 VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB 17 •S 1551 IS the category of gender transition procedures (as 1 defined in section 213(d)(12)(B) of the Internal 2 Revenue Code of 1986) or any items or services 3 covered within such a category.’’; and 4 (4) in subparagraph (C) (as so redesignated), 5 by striking ‘‘paragraph (2)’’ and inserting ‘‘subpara- 6 graph (A)’’. 7 Æ VerDate Sep 11 2014 04:08 May 09, 2025 Jkt 059200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6301 E:\BILLS\S1551.IS S1551 kjohnson on DSK7ZCZBW3PROD with $$_JOB