Text of US SB 2357 (2023)

II 118TH CONGRESS 1ST SESSION S. 2357 To amend chapter 110 of title 18, United States Code, to prohibit gender- affirming care on minors, and for other purposes. IN THE SENATE OF THE UNITED STATES JULY 18, 2023 Mr. VANCE (for himself and Mr. TUBERVILLE) introduced the following bill; which was read twice and referred to the Committee on Finance 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 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 ‘‘Protect Children’s In- 4 nocence Act’’. 5 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 2 •S 2357 IS TITLE I—GENDER-AFFIRMING 1 CARE ON MINORS PROHIBITED 2 SEC. 101. GENDER-AFFIRMING CARE ON MINORS PROHIB- 3 ITED. 4 Chapter 110 of title 18, United States Code, is 5 amended— 6 (1) by adding at the end the following: 7 ‘‘§ 2260B. Gender-affirming care on minors 8 ‘‘(a) DEFINITIONS.—In this section: 9 ‘‘(1) BIOLOGICAL SEX.—The term ‘biological 10 sex’ means the indication of male or female sex by 11 reproductive potential or capacity, sex chromosomes, 12 naturally occurring sex hormones, gonads, or inter- 13 nal or external genitalia present at birth. 14 ‘‘(2) GENDER-AFFIRMING CARE.— 15 ‘‘(A) IN GENERAL.—Except as provided in 16 subparagraph (B), the term ‘gender-affirming 17 care’ means, with respect to an individual, any 18 of the following: 19 ‘‘(i) Performing any surgery for the 20 purpose of changing the body of the indi- 21 vidual to correspond to a sex that differs 22 from the individual’s biological sex, includ- 23 ing— 24 ‘‘(I) castration; 25 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 3 •S 2357 IS ‘‘(II) orchiectomy; 1 ‘‘(III) scrotoplasty; 2 ‘‘(IV) vasectomy; 3 ‘‘(V) hysterectomy; 4 ‘‘(VI) oophorectomy; 5 ‘‘(VII) ovariectomy; 6 ‘‘(VIII) metoidioplasty; 7 ‘‘(IX) penectomy; 8 ‘‘(X) phalloplasty; 9 ‘‘(XI) vaginoplasty; 10 ‘‘(XII) vaginectomy; 11 ‘‘(XIII) vulvoplasty; 12 ‘‘(XIV) reduction 13 thyrochondroplasty; 14 ‘‘(XV) chondrolaryngoplasty; and 15 ‘‘(XVI) mastectomy. 16 ‘‘(ii) Any plastic surgery that femi- 17 nizes or masculinizes the facial features of 18 the individual for the purposes described in 19 clause (i). 20 ‘‘(iii) Any placement of chest implants 21 in the individual to create feminine breasts 22 for the purposes described in clause (i). 23 ‘‘(iv) Any placement of fat or artificial 24 implants in the gluteal region of the indi- 25 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 4 •S 2357 IS vidual for the purposes described in clause 1 (i). 2 ‘‘(v) Administering, supplying, pre- 3 scribing, dispensing, distributing, or other- 4 wise conveying to the individual medica- 5 tions for the purposes described in clause 6 (i), including— 7 ‘‘(I) gonadotropin-releasing hor- 8 mone (commonly known as ‘GnRH’) 9 analogues or other puberty-blocking 10 drugs to stop or delay normal pu- 11 berty; 12 ‘‘(II) testosterone or other 13 androgens to a biological female at 14 doses that are supraphysiologic to the 15 female sex; and 16 ‘‘(III) estrogen to a biological 17 male at doses that are 18 supraphysiologic to the male sex. 19 ‘‘(B) EXCEPTION.—Subparagraph (A) 20 shall not apply to conduct with respect to the 21 following individuals: 22 ‘‘(i) An individual with both ovarian 23 and testicular tissue. 24 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 5 •S 2357 IS ‘‘(ii) An individual who does not have 1 normal sex chromosome structure, sex ster- 2 oid hormone production, or sex steroid hor- 3 mone action, as determined by a physician 4 through genetic or biochemical testing. 5 ‘‘(iii) An individual experiencing infec- 6 tion, disease, injury, or disorder caused or 7 exacerbated by previous gender transition 8 procedures. 9 ‘‘(iv) An individual suffering from a 10 physical disorder, physical injury, or phys- 11 ical illness that would, as certified by a 12 physician, place the individual in imminent 13 danger of death or impairment of a major 14 bodily function unless a procedure de- 15 scribed in that subparagraph is performed. 16 ‘‘(3) MINOR.—The term ‘minor’ means any in- 17 dividual under the age of 18 years. 18 ‘‘(b) PROHIBITION ON PERFORMING GENDER-AF- 19 FIRMING CARE ON MINORS.— 20 ‘‘(1) OFFENSE.—It shall be unlawful, in any 21 circumstance described in subsection (e), to know- 22 ingly perform any gender-affirming care on a minor. 23 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 6 •S 2357 IS ‘‘(2) PENALTY.—Any person who violates para- 1 graph (1) shall be fined under this title, imprisoned 2 for not more than 12 years, or both. 3 ‘‘(c) PROHIBITION ON PROSECUTION OF PERSON ON 4 WHOM INTERVENTION IS PERFORMED.—A person on 5 whom gender-affirming care is performed may not be ar- 6 rested or prosecuted for an offense under subsection (b). 7 ‘‘(d) CIVIL ACTION.—A person on whom gender-af- 8 firming care is performed in violation of subsection (b) 9 may bring a civil action in an appropriate district court 10 of the United States for appropriate relief, including com- 11 pensatory and punitive damages, against each person who 12 performed the gender-affirming care. 13 ‘‘(e) CIRCUMSTANCES DESCRIBED.—The cir- 14 cumstances referred to in subsection (b) are that— 15 ‘‘(1) the defendant or victim traveled in inter- 16 state or foreign commerce, or traveled using a 17 means, channel, facility, or instrumentality of inter- 18 state or foreign commerce, in furtherance of or in 19 connection with the conduct described in that sub- 20 section; 21 ‘‘(2) the defendant used a means, channel, fa- 22 cility, or instrumentality of interstate or foreign 23 commerce in furtherance of or in connection with 24 the conduct described in that subsection; 25 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 7 •S 2357 IS ‘‘(3) any payment of any kind was made, di- 1 rectly or indirectly, in furtherance of or in connec- 2 tion with the conduct described in that subsection 3 using any means, channel, facility, or instrumen- 4 tality of interstate or foreign commerce or in or af- 5 fecting interstate or foreign commerce; 6 ‘‘(4) the defendant transmitted in interstate or 7 foreign commerce any communication relating to or 8 in furtherance of the conduct described in that sub- 9 section— 10 ‘‘(A) using any means, channel, facility, or 11 instrumentality of interstate or foreign com- 12 merce; or 13 ‘‘(B) in or affecting interstate or foreign 14 commerce by any means or in any manner, in- 15 cluding by computer, mail, wire, or electro- 16 magnetic transmission; 17 ‘‘(5) any instrument, item, substance, or other 18 object that has traveled in interstate or foreign com- 19 merce was used to perform the conduct described in 20 that subsection; 21 ‘‘(6) the conduct described in that subsection 22 occurred in— 23 ‘‘(A) the special maritime and territorial 24 jurisdiction of the United States; or 25 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 8 •S 2357 IS ‘‘(B) a territory or possession of the 1 United States; or 2 ‘‘(7) the conduct described in that subsection 3 otherwise occurred in or affected interstate or for- 4 eign commerce. 5 ‘‘(f) RULE OF CONSTRUCTION.—Nothing in this sec- 6 tion shall be construed as prohibiting provision of the med- 7 ical services described in subsection (a)(2)(A) to address 8 legitimate health issues, such as any male or female repro- 9 ductive cancers, apart from changing the body of an indi- 10 vidual to correspond to a sex that differs from the individ- 11 ual’s biological sex.’’; and 12 (2) in the table of sections, by adding at the 13 end the following: 14 ‘‘2260B. Gender-affirming care on minors.’’. TITLE II—PROHIBITING FEDER- 15 ALLY FUNDED GENDER-AF- 16 FIRMING CARE 17 SEC. 201. PROHIBITING TAXPAYER-FUNDED GENDER-AF- 18 FIRMING CARE. 19 Title 1, United States Code, is amended by adding 20 at the end the following: 21 ‘‘CHAPTER 4—PROHIBITING TAXPAYER- 22 FUNDED GENDER-AFFIRMING CARE 23 ‘‘301. Prohibition on funding for gender-affirming care. ‘‘302. Prohibition on funding for health benefits plans that cover gender-affirm- ing care. VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6211 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 9 •S 2357 IS ‘‘303. Limitation on Federal facilities and employees, Federal land and terri- tories, and Tribal territories. ‘‘304. Effect on separate coverage. ‘‘305. Effect on use of non-Federal funds for health coverage. ‘‘306. Application to complications arising from gender-affirming care. ‘‘307. Application to individuals born with medically verifiable disorder of sex development. ‘‘308. Gender-affirming care defined. ‘‘309. Effect of chapter. ‘‘§ 301. Prohibition on funding for gender-affirming 1 care 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, in- 5 cluding funds provided under titles XVIII, XIX, and XXI 6 of the Social Security Act, shall be expended for any gen- 7 der-affirming care. 8 ‘‘§ 302. Prohibition on funding for health benefits 9 plans that cover gender-affirming care 10 ‘‘No funds authorized or appropriated by Federal 11 law, and none of the funds in any trust fund to which 12 funds are authorized or appropriated by Federal law, shall 13 be expended for health benefits coverage that includes cov- 14 erage of gender-affirming care. 15 ‘‘§ 303. Limitation on Federal facilities and employ- 16 ees, Federal land and territories, and 17 Tribal territories 18 ‘‘Gender-affirming care may not be included in any 19 health care service furnished by— 20 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 10 •S 2357 IS ‘‘(1) a health care facility owned or operated by 1 the Federal Government; 2 ‘‘(2) a health care facility operated on Federal 3 land, in a territory, or in a Tribal territory; or 4 ‘‘(3) any physician or other individual providing 5 health care services within the scope of the physi- 6 cian’s or individual’s employment who is— 7 ‘‘(A) employed by the Federal Government; 8 or 9 ‘‘(B) employed by a health care facility op- 10 erated on Federal land, in a territory, or in a 11 Tribal territory. 12 ‘‘§ 304. Effect on separate coverage 13 ‘‘Nothing in this chapter prohibits any individual, en- 14 tity, or State or locality from purchasing separate cov- 15 erage for gender-affirming care or health benefits coverage 16 that includes gender-affirming care, on the condition that 17 such coverage— 18 ‘‘(1) is paid for entirely using funds— 19 ‘‘(A) not authorized or appropriated by 20 Federal law; or 21 ‘‘(B) not received from Federal programs, 22 platforms, or infrastructure; 23 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 11 •S 2357 IS ‘‘(2) does not cover any practice that would be 1 subject to penalty under section 2260B of title 18; 2 and 3 ‘‘(3) is not purchased using matching funds re- 4 quired for a federally subsidized program, including 5 a State’s or locality’s contribution of Medicaid 6 matching funds. 7 ‘‘§ 305. Effect on use of non-Federal funds for health 8 coverage 9 ‘‘Nothing in this chapter restricts the ability of any 10 non-Federal health benefits coverage provider from offer- 11 ing coverage for gender-affirming care, or the ability of 12 a State or locality to contract separately with such a pro- 13 vider for such coverage, on the condition that such cov- 14 erage— 15 ‘‘(1) is paid for entirely using funds— 16 ‘‘(A) not authorized or appropriated by 17 Federal law; or 18 ‘‘(B) not received from Federal programs, 19 platforms, or infrastructure; 20 ‘‘(2) does not cover any practice that would be 21 subject to penalty under section 2260B of title 18; 22 and 23 ‘‘(3) is not purchased using matching funds re- 24 quired for a federally subsidized program, including 25 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 12 •S 2357 IS a State’s or locality’s contribution of Medicaid 1 matching funds. 2 ‘‘§ 306. Application to complications arising from gen- 3 der-affirming care 4 ‘‘Nothing in this chapter applies to the treatment of 5 any infection, injury, disease, or disorder that has been 6 caused or exacerbated by the performance of a gender- 7 affirming care, regardless of whether— 8 ‘‘(1) the gender-affirming care was performed 9 in accordance with Federal or State law; or 10 ‘‘(2) funding for the gender-affirming care is 11 permissible under section 307. 12 ‘‘§ 307. Application to individuals born with medi- 13 cally verifiable disorder of sex develop- 14 ment 15 ‘‘The prohibitions and limitations described in sec- 16 tions 301, 302, and 303 shall not apply to conduct with 17 respect to an individual described in section 18 2260B(a)(2)(B) of title 18. 19 ‘‘§ 308. Gender-affirming care defined 20 ‘‘For purposes of this chapter, the term ‘gender-af- 21 firming care’ has the meaning given such term in section 22 2260B of title 18. 23 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 13 •S 2357 IS ‘‘§ 309. Effect of chapter 1 ‘‘Nothing in this chapter prohibits the provision of 2 the medical services described in section 2260B(a)(2)(B) 3 of title 18, to address any male or female reproductive 4 cancers (other than medical services to change the body 5 of an individual to correspond to a sex that differs from 6 the individual’s biological sex).’’. 7 SEC. 202. AMENDMENT TO TABLE OF CHAPTERS. 8 The table of chapters for title 1, United States Code, 9 is amended by adding at the end the following: 10 ‘‘4. Prohibiting taxpayer-funded gender-affirming care ... 301’’. TITLE III—APPLICATION UNDER 11 THE AFFORDABLE CARE ACT 12 SEC. 301. CLARIFYING APPLICATION OF PROHIBITION TO 13 PREMIUM CREDITS AND COST-SHARING RE- 14 DUCTIONS UNDER ACA. 15 (a) IN GENERAL.— 16 (1) DISALLOWANCE OF REFUNDABLE CREDIT 17 AND COST-SHARING REDUCTIONS FOR COVERAGE 18 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 19 COVERAGE FOR GENDER-AFFIRMING CARE.— 20 (A) IN GENERAL.—Subparagraph (A) of 21 section 36B(c)(3) of the Internal Revenue Code 22 of 1986 is amended by inserting before the pe- 23 riod at the end the following: ‘‘or any health 24 plan that includes coverage for gender-affirming 25 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 14 •S 2357 IS care (other than any gender-affirming care or 1 treatment described in section 306 or 307 of 2 title 1, United States Code)’’. 3 (B) OPTION TO PURCHASE OR OFFER SEP- 4 ARATE COVERAGE OR PLAN.—Paragraph (3) of 5 section 36B(c) of such Code is amended by 6 adding at the end the following new subpara- 7 graph: 8 ‘‘(C) SEPARATE COVERAGE OR PLAN FOR 9 GENDER-AFFIRMING CARE ALLOWED.— 10 ‘‘(i) OPTION TO PURCHASE SEPARATE 11 COVERAGE OR PLAN.—Nothing in subpara- 12 graph (A) shall be construed as prohibiting 13 any individual from purchasing separate 14 coverage for gender-affirming care de- 15 scribed in such subparagraph, or a health 16 plan that includes such gender-affirming 17 care, so long as no credit is allowed under 18 this section with respect to the premiums 19 for such coverage or plan and such cov- 20 erage or plan does not cover any practice 21 that would be subject to penalty under sec- 22 tion 2260B of title 18, United States 23 Code. 24 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 15 •S 2357 IS ‘‘(ii) OPTION TO OFFER COVERAGE OR 1 PLAN.—Nothing in subparagraph (A) shall 2 restrict any non-Federal health insurance 3 issuer offering a health plan from offering 4 separate coverage for gender-affirming 5 care described in such subparagraph, or a 6 plan that includes such gender-affirming 7 care, so long as premiums for such sepa- 8 rate coverage or plan are not paid for with 9 any amount attributable to the credit al- 10 lowed under this section (or the amount of 11 any advance payment of the credit under 12 section 1412 of the Patient Protection and 13 Affordable Care Act) and such coverage or 14 plan does not cover any practice that 15 would be subject to penalty under section 16 2260B of title 18, United States Code.’’. 17 (2) DISALLOWANCE OF SMALL EMPLOYER 18 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN 19 WHICH INCLUDES COVERAGE FOR GENDER-AFFIRM- 20 ING CARE.—Subsection (h) of section 45R of the In- 21 ternal Revenue Code of 1986 is amended— 22 (A) by striking ‘‘Any term’’ and inserting 23 the following: 24 ‘‘(1) IN GENERAL.—Any term’’; and 25 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 16 •S 2357 IS (B) by adding at the end the following new 1 paragraph: 2 ‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING 3 COVERAGE FOR GENDER-AFFIRMING CARE.— 4 ‘‘(A) IN GENERAL.—The term ‘qualified 5 health plan’ does not include any health plan 6 that includes coverage for gender-affirming care 7 (other than any gender-affirming care or treat- 8 ment described in section 306 or 307 of title 1, 9 United States Code). 10 ‘‘(B) SEPARATE COVERAGE OR PLAN FOR 11 GENDER-AFFIRMING CARE ALLOWED.— 12 ‘‘(i) OPTION TO PURCHASE SEPARATE 13 COVERAGE OR PLAN.—Nothing in subpara- 14 graph (A) shall be construed as prohibiting 15 any employer from purchasing for its em- 16 ployees separate coverage for gender-af- 17 firming care described in such subpara- 18 graph, or a health plan that includes such 19 gender-affirming care, so long as no credit 20 is allowed under this section with respect 21 to the employer contributions for such cov- 22 erage or plan and such coverage does not 23 cover any practice that would be subject to 24 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 17 •S 2357 IS penalty under section 2260B of title 18, 1 United States Code. 2 ‘‘(ii) OPTION TO OFFER COVERAGE OR 3 PLAN.—Nothing in subparagraph (A) shall 4 restrict any non-Federal health insurance 5 issuer offering a health plan from offering 6 separate coverage for gender-affirming 7 care described in such subparagraph, or a 8 plan that includes such gender-affirming 9 care, so long as such separate coverage or 10 plan is not paid for with any employer con- 11 tribution eligible for the credit allowed 12 under this section and such coverage or 13 plan does not cover any practice that 14 would be subject to penalty under section 15 2260B of title 18, United States Code.’’. 16 (b) APPLICATION TO MULTI-STATE PLANS.—Section 17 1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 18 amended by adding at the end the following: 19 ‘‘(8) COVERAGE CONSISTENT WITH FEDERAL 20 POLICY REGARDING GENDER-AFFIRMING CARE.—In 21 entering into contracts under this subsection, the 22 Director shall ensure that no multi-State qualified 23 health plan offered in an Exchange provides health 24 benefits coverage for which the expenditure of Fed- 25 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 18 •S 2357 IS eral funds is prohibited under chapter 4 of title 1, 1 United States Code.’’. 2 (c) EFFECTIVE DATE.—The amendments made by 3 subsection (a) shall apply to taxable years ending after 4 the date that is one year after the date of enactment of 5 this Act, but only with respect to plan years beginning 6 after such date, and the amendment made by subsection 7 (b) shall apply to plan years beginning after such date. 8 TITLE IV—ADDITIONAL 9 PROVISIONS 10 SEC. 401. PROHIBITION ON INSTITUTIONS OF HIGHER EDU- 11 CATION AND ACCREDITING AGENCIES OR AS- 12 SOCIATIONS. 13 (a) PROHIBITION ON INSTITUTIONS OF HIGHER 14 EDUCATION.—Section 487(a) of the Higher Education 15 Act of 1965 (20 U.S.C. 1094(a)) is amended by adding 16 at the end the following: 17 ‘‘(30) The institution will not offer instruction 18 in gender-affirming care (as defined in section 19 2260B of title 18, United States Code).’’. 20 (b) PROHIBITION ON ACCREDITING AGENCIES OR AS- 21 SOCIATIONS.—Section 496(a) of the Higher Education 22 Act of 1965 (20 U.S.C. 1099b(a)) is amended— 23 (1) by striking ‘‘and’’ at the end of paragraph 24 (7); 25 VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 19 •S 2357 IS (2) by striking the period at the end of para- 1 graph (8) and inserting ‘‘; and’’; and 2 (3) by adding at the end the following: 3 ‘‘(9) such agency or association does not ac- 4 credit any institution that offers instruction in gen- 5 der-affirming care (as defined in section 2260B of 6 title 18, United States Code).’’. 7 SEC. 402. IMMIGRATION CONSEQUENCES WITH RESPECT 8 TO PROVIDING GENDER-AFFIRMING CARE. 9 (a) DEFINITION OF GENDER-AFFIRMING CARE.— 10 Section 101(a) of the Immigration and Nationality Act (8 11 U.S.C. 1101(a)) is amended by adding at the end the fol- 12 lowing: 13 ‘‘(53) The term ‘gender-affirming care’ shall 14 have the meaning given such term in section 2260B 15 of title 18, United States Code.’’. 16 (b) CLASSES OF ALIENS INELIGIBLE FOR VISAS OR 17 ADMISSION.—Section 212(a)(1)(A) of the Immigration 18 and Nationality Act (8 U.S.C. 1182(a)(1)(A)) is amend- 19 ed— 20 (1) in clause (iii)(II), by striking ‘‘or’’ at the 21 end; 22 (2) in clause (iv), by striking the comma at the 23 end and inserting ‘‘, or’’; and 24 (3) by inserting after clause (iv) the following: 25 VerDate Sep 11 2014 20:55 Aug 05, 2023 Jkt 039200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS 20 •S 2357 IS ‘‘(v) who is determined to have per- 1 formed gender-affirming care on a child 2 that has not attained the age of 18 years 3 old,’’. 4 (c) CLASSES OF DEPORTABLE ALIENS.—Section 5 237(a) of the Immigration and Nationality Act (8 U.S.C. 6 1227(a)) is amended by adding at the end the following: 7 ‘‘(8) GENDER-AFFIRMING CARE.—Any alien 8 who has performed gender-affirming care on a child 9 who has not attained the age of 18 years old is de- 10 portable.’’. 11 Æ VerDate Sep 11 2014 23:54 Aug 04, 2023 Jkt 039200 PO 00000 Frm 00020 Fmt 6652 Sfmt 6301 E:\BILLS\S2357.IS S2357 kjohnson on DSK79L0C42PROD with BILLS