Text of US SB 3011 (2025)

II 119TH CONGRESS 1ST SESSION S. 3011 To amend the Patient Protection and Affordable Care Act to exclude coverage of gender-transition procedures for minors and abortion under health plans offered through the American Health Benefits Exchanges, and for other purposes. IN THE SENATE OF THE UNITED STATES OCTOBER 15, 2025 Mr. HAWLEY introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To amend the Patient Protection and Affordable Care Act to exclude coverage of gender-transition procedures for minors and abortion under health plans offered through the American Health Benefits Exchanges, 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 ‘‘Prohibiting Abortion 4 & Transgender Procedures on the Exchanges Act’’. 5 VerDate Sep 11 2014 22:11 Oct 15, 2025 Jkt 069200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3011.IS S3011 ssavage on LAPJG3WLY3PROD with BILLS 2 •S 3011 IS SEC. 2. EXCLUSION OF GENDER-TRANSITION PROCEDURES 1 FOR MINORS AND ABORTION FROM COV- 2 ERAGE UNDER HEALTH PLANS OFFERED 3 THROUGH THE AMERICAN HEALTH BENEFITS 4 EXCHANGES. 5 (a) IN GENERAL.—Section 1303 of the Patient Pro- 6 tection and Affordable Care Act (42 U.S.C. 18023) is 7 amended— 8 (1) in subsection (a)— 9 (A) by striking paragraph (2); and 10 (B) by striking the subsection designation 11 and heading and all that follows through ‘‘A 12 State’’ in paragraph (1) and inserting the fol- 13 lowing: 14 ‘‘(a) STATE OPT-OUT OF ABORTION COVERAGE.—A 15 State’’; 16 (2) in subsection (b), by striking the subsection 17 designation and heading and all that follows through 18 ‘‘No qualified’’ in paragraph (4) and inserting the 19 following: 20 ‘‘(b) NO DISCRIMINATION ON BASIS OF PROVISION 21 OF ABORTION.—No qualified’’; 22 (3) in subsection (c)— 23 (A) in paragraph (2)— 24 (i) by striking the paragraph designa- 25 tion and heading and all that follows 26 VerDate Sep 11 2014 22:11 Oct 15, 2025 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3011.IS S3011 ssavage on LAPJG3WLY3PROD with BILLS 3 •S 3011 IS through ‘‘Nothing’’ in subparagraph (A) 1 and inserting the following: 2 ‘‘(2) NO EFFECT ON FEDERAL LAWS REGARD- 3 ING ABORTION.—Nothing’’; and 4 (ii) by redesignating clauses (i) 5 through (iii) as subparagraphs (A) through 6 (C), respectively, and adjusting the mar- 7 gins accordingly; 8 (B) by striking the subsection designation 9 and heading and all that follows through the 10 end of paragraph (1) and inserting the fol- 11 lowing: 12 ‘‘(c) APPLICATION OF FEDERAL LAWS.—’’; and 13 (C) by redesignating paragraphs (2) and 14 (3) as paragraphs (1) and (2), respectively; 15 (4) by redesignating subsections (a) through (d) 16 as subsections (b) through (e), respectively; and 17 (5) by inserting before subsection (b) (as so re- 18 designated) the following: 19 ‘‘(a) PROHIBITION ON COVERAGE OF GENDER-TRAN- 20 SITION PROCEDURES FOR MINORS AND ABORTION.— 21 ‘‘(1) IN GENERAL.—An Exchange may not 22 make available any health plan, including any health 23 plan offering excepted benefits (as defined in section 24 VerDate Sep 11 2014 22:11 Oct 15, 2025 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3011.IS S3011 ssavage on LAPJG3WLY3PROD with BILLS 4 •S 3011 IS 2791(c) of the Public Health Service Act), that pro- 1 vides coverage for— 2 ‘‘(A) abortion, except in the case where a 3 woman suffers from a physical disorder, phys- 4 ical injury, or physical illness that would, as 5 certified by a physician, place the woman in 6 danger of death unless an abortion is per- 7 formed, including a life-endangering physical 8 condition caused by or arising from the preg- 9 nancy itself, or unless the pregnancy is the re- 10 sult of an act of rape or incest; or 11 ‘‘(B) gender-transition procedures for mi- 12 nors. 13 ‘‘(2) DEFINITIONS.—In this subsection: 14 ‘‘(A) GENDER-TRANSITION PROCEDURE.— 15 ‘‘(i) IN GENERAL.—Except as pro- 16 vided in clause (ii), the term ‘gender-tran- 17 sition procedure’ means— 18 ‘‘(I) the prescription or adminis- 19 tration of gonadotropin-releasing hor- 20 mone agonists or any other puberty- 21 blocking drugs for the purpose of 22 changing the body of an individual so 23 that it conforms to the subjective 24 sense of identity of the individual, in 25 VerDate Sep 11 2014 22:11 Oct 15, 2025 Jkt 069200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3011.IS S3011 ssavage on LAPJG3WLY3PROD with BILLS 5 •S 3011 IS the case such identity is at odds with 1 the individual’s biological sex of male 2 or female; 3 ‘‘(II) the prescription or adminis- 4 tration of testosterone (when pre- 5 scribed to a female) or estrogen (when 6 prescribed to a male) for the purpose 7 of changing the body of an individual 8 so that it conforms to the subjective 9 sense of identity of the individual, in 10 the case such identity is at odds with 11 the individual’s biological sex of male 12 or female; or 13 ‘‘(III) a surgery to change the 14 body of an individual so that it con- 15 forms to the subjective sense of iden- 16 tity of the individual, in the case such 17 identity is at odds with the individ- 18 ual’s biological sex of male or female. 19 ‘‘(ii) EXCEPTION.—The term ‘gender- 20 transition procedure’ does not include— 21 ‘‘(I) an intervention described in 22 clause (i) that is performed on— 23 ‘‘(aa) an individual with bio- 24 logical sex characteristics that 25 VerDate Sep 11 2014 22:11 Oct 15, 2025 Jkt 069200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3011.IS S3011 ssavage on LAPJG3WLY3PROD with BILLS 6 •S 3011 IS are inherently ambiguous, such 1 as those born with 46 XX chro- 2 mosomes with virilization, 46 XY 3 chromosomes with 4 undervirilization, or having both 5 ovarian and testicular tissue; or 6 ‘‘(bb) an individual with re- 7 spect to whom a physician has 8 determined through genetic or 9 biochemical testing that the indi- 10 vidual does not have normal sex 11 chromosome structure, sex ster- 12 oid hormone production, or sex 13 steroid hormone action, for a bio- 14 logical male or biological female; 15 ‘‘(II) the treatment of any infec- 16 tion, injury, disease, or disorder that 17 has been caused or exacerbated by the 18 performance of an intervention de- 19 scribed in clause (i) without regard to 20 whether the intervention was per- 21 formed in accordance with State or 22 Federal law; or 23 ‘‘(III) any procedure undertaken 24 because the individual suffers from a 25 VerDate Sep 11 2014 22:11 Oct 15, 2025 Jkt 069200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3011.IS S3011 ssavage on LAPJG3WLY3PROD with BILLS 7 •S 3011 IS physical disorder, physical injury, or 1 physical illness that would, as certified 2 by a physician, place the individual in 3 imminent danger of death or impair- 4 ment of major bodily function unless 5 the procedure is performed. 6 ‘‘(B) MINOR.—The term ‘minor’ means an 7 individual who has not yet reached 18 years of 8 age.’’. 9 (b) CONFORMING AMENDMENT.—Section 1334(a) 10 (42 U.S.C. 18054(a)) is amended— 11 (1) by striking paragraph (6); and 12 (2) by redesignating paragraph (7) as para- 13 graph (6). 14 (c) EFFECTIVE DATE.—The amendments made by 15 this section shall apply with respect to plan years begin- 16 ning on or after January 1, 2026. 17 Æ VerDate Sep 11 2014 22:11 Oct 15, 2025 Jkt 069200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\S3011.IS S3011 ssavage on LAPJG3WLY3PROD with BILLS