II 

117TH CONGRESS 

1ST SESSION S. 777 

To prohibit taxpayer-funded gender reassignment medical interventions, and 

for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 16, 2021 

Mr. MARSHALL (for himself, Mr. BRAUN, Mr. COTTON, Mrs. BLACKBURN, Mr. 

LEE, and Mrs. HYDE-SMITH) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

A BILL 

To prohibit taxpayer-funded gender reassignment medical 

interventions, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘End Taxpayer Funding of Gender Experimentation Act 

6 of 2021’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—PROHIBITING FEDERALLY FUNDED GENDER 

REASSIGNMENT MEDICAL INTERVENTIONS 


pamtmann on DSKBC07HB2PROD with BILLS
2 

•S 777 IS

Sec. 101. Prohibiting taxpayer-funded gender reassignment medical interventions. 

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 costsharing reductions under ACA. 

1 TITLE I—PROHIBITING FEDER2 ALLY FUNDED GENDER REAS3 SIGNMENT MEDICAL INTER4 VENTIONS 

5 SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER REAS6 SIGNMENT MEDICAL INTERVENTIONS. 

7 Title 1, United States Code, is amended by adding 

8 at the end the following new chapter: 

9 ‘‘CHAPTER 4—PROHIBITING TAXPAYER10 FUNDED GENDER REASSIGNMENT 

11 MEDICAL INTERVENTIONS 

‘‘301. Prohibition on funding for gender reassignment medical interventions. 

‘‘302. Prohibition on funding for health benefits plans that cover gender reassignment medical interventions. 

‘‘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 reassignment 

medical interventions. 

‘‘307. Treatment of individuals born with medically verifiable disorder of sex development. 

‘‘308. Gender reassignment medical intervention defined. 

12 ‘‘§ 301. Prohibition on funding for gender reassign13 ment medical interventions 

14 ‘‘No funds authorized or appropriated by Federal 

15 law, and none of the funds in any trust fund to which 

16 funds are authorized or appropriated by Federal law, shall 


pamtmann on DSKBC07HB2PROD with BILLS
3 

•S 777 IS

1 be expended for any gender reassignment medical inter2 vention. 

3 ‘‘§ 302. Prohibition on funding for health benefits 

4 plans that cover gender reassignment 

5 medical interventions 

6 ‘‘No funds authorized or appropriated by Federal 

7 law, and none of the funds in any trust fund to which 

8 funds are authorized or appropriated by Federal law, shall 

9 be expended for health benefits coverage that includes cov10 erage of gender reassignment medical interventions. 

11 ‘‘§ 303. Limitation on Federal facilities and employees 

12 ‘‘No health care service furnished— 

13 ‘‘(1) by or in a health care facility owned or op14 erated by the Federal Government; or 

15 ‘‘(2) by any physician or other individual em16 ployed by the Federal Government to provide health 

17 care services within the scope of the physician’s or 

18 individual’s employment, 

19 may include gender reassignment medical interventions. 

20 ‘‘§ 304. Construction relating to separate coverage 

21 ‘‘Nothing in this chapter shall be construed as pro22 hibiting any individual, entity, or State or locality from 

23 purchasing separate coverage for gender reassignment 

24 medical interventions or health benefits coverage that in25 cludes gender reassignment medical interventions so long 


pamtmann on DSKBC07HB2PROD with BILLS
4 

•S 777 IS

1 as such coverage is paid for entirely using only funds not 

2 authorized or appropriated by Federal law and such cov3 erage shall not be purchased using matching funds re4 quired for a federally subsidized program, including a 

5 State’s or locality’s contribution of Medicaid matching 

6 funds. 

7 ‘‘§ 305. Construction relating to the use of non-Fed8 eral funds for health coverage 

9 ‘‘Nothing in this chapter shall be construed as re10 stricting the ability of any non-Federal health benefits cov11 erage provider from offering coverage for gender reassign12 ment medical interventions, or the ability of a State or 

13 locality to contract separately with such a provider for 

14 such coverage, so long as only funds not authorized or ap15 propriated by Federal law are used and such coverage 

16 shall not be purchased using matching funds required for 

17 a federally subsidized program, including a State’s or lo18 cality’s contribution of Medicaid matching funds. 

19 ‘‘§ 306. Construction relating to complications arising 

20 from gender reassignment medical inter21 ventions 

22 ‘‘Nothing in this chapter shall be construed to apply 

23 to the treatment of any infection, injury, disease, or dis24 order that has been caused by or exacerbated by the per25 formance of a gender reassignment medical intervention. 


pamtmann on DSKBC07HB2PROD with BILLS
5 

•S 777 IS

1 This rule of construction shall be applicable without re2 gard to whether the gender reassignment medical inter3 vention was performed in accord with Federal or State 

4 law, and without regard to whether funding for the gender 

5 reassignment medical intervention is permissible under 

6 section 307. 

7 ‘‘§ 307. Treatment of individuals born with medically 

8 verifiable disorder of sex development 

9 ‘‘The limitations established in sections 301, 302, 

10 and 303 shall not apply with respect to the following indi11 viduals: 

12 ‘‘(1) An individual with external biological sex 

13 characteristics that are irresolvably ambiguous, such 

14 as those born with 46 XX chromosomes with 

15 virilization, 46 XY chromosomes with 

16 undervirilization, or having both ovarian and testic17 ular tissue. 

18 ‘‘(2) An individual with respect to whom a phy19 sician has determined through genetic or biochemical 

20 testing that the individual does not have normal sex 

21 chromosome structure, sex steroid hormone produc22 tion, or sex steroid hormone action for a biological 

23 male or female. 


pamtmann on DSKBC07HB2PROD with BILLS
6 

•S 777 IS

1 ‘‘§ 308. Gender reassignment medical intervention de2 fined 

3 ‘‘For purposes of this chapter, the term ‘gender reas4 signment medical intervention’ means— 

5 ‘‘(1) performing a surgery that sterilizes an in6 dividual, including castration, vasectomy, 

7 hysterectomy, oophorectomy, metoidioplasty, 

8 penectomy, phalloplasty, and vaginoplasty, to change 

9 the body of such individual to correspond to a sex 

10 that is discordant with biological sex; 

11 ‘‘(2) performing a mastectomy on an individual 

12 for the purpose described in paragraph (1); and 

13 ‘‘(3) administering or supplying to an individual 

14 medications for the purpose described in paragraph 

15 (1), including— 

16 ‘‘(A) GnRH agonists or other puberty17 blocking drugs to stop or delay normal puberty; 

18 ‘‘(B) testosterone or other androgens to bi19 ological females at doses that are 

20 supraphysiologic to the female sex; and 

21 ‘‘(C) estrogen to biological males at doses 

22 that are supraphysiologic to the male sex.’’. 

23 SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 

24 The table of chapters for title 1, United States Code, 

25 is amended by adding at the end the following new item: 


pamtmann on DSKBC07HB2PROD with BILLS
7 

•S 777 IS

‘‘4. Prohibiting taxpayer-funded gender reassignment 

medical interventions .......................................... 301’’. 

1 TITLE II—APPLICATION UNDER 

2 THE AFFORDABLE CARE ACT 

3 SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 

4 PREMIUM CREDITS AND COST-SHARING RE5 DUCTIONS UNDER ACA. 

6 (a) IN GENERAL.— 

7 (1) DISALLOWANCE OF REFUNDABLE CREDIT

8 AND COST-SHARING REDUCTIONS FOR COVERAGE

9 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES

10 COVERAGE FOR GENDER REASSIGNMENT MEDICAL

11 INTERVENTIONS.— 

12 (A) IN GENERAL.—Subparagraph (A) of 

13 section 36B(c)(3) of the Internal Revenue Code 

14 of 1986 is amended by inserting before the pe15 riod at the end the following: ‘‘or any health 

16 plan that includes coverage for gender reassign17 ment medical interventions (other than any 

18 gender reassignment medical intervention or 

19 treatment described in section 306 or 307 of 

20 title 1, United States Code)’’. 

21 (B) OPTION TO PURCHASE OR OFFER SEP22 ARATE COVERAGE OR PLAN.—Paragraph (3) of 

23 section 36B(c) of such Code is amended by 


pamtmann on DSKBC07HB2PROD with BILLS
8 

•S 777 IS

1 adding at the end the following new subpara2 graph: 

3 ‘‘(C) SEPARATE COVERAGE OR PLAN FOR

4 GENDER REASSIGNMENT MEDICAL INTERVEN5 TIONS ALLOWED.— 

6 ‘‘(i) OPTION TO PURCHASE SEPARATE

7 COVERAGE OR PLAN.—Nothing in subpara8 graph (A) shall be construed as prohibiting 

9 any individual from purchasing separate 

10 coverage for gender reassignment medical 

11 interventions described in such subpara12 graph, or a health plan that includes such 

13 gender reassignment medical interventions, 

14 so long as no credit is allowed under this 

15 section with respect to the premiums for 

16 such coverage or plan. 

17 ‘‘(ii) OPTION TO OFFER COVERAGE OR

18 PLAN.—Nothing in subparagraph (A) shall 

19 restrict any non-Federal health insurance 

20 issuer offering a health plan from offering 

21 separate coverage for gender reassignment 

22 medical interventions described in such 

23 subparagraph, or a plan that includes such 

24 gender reassignment medical interventions, 

25 so long as premiums for such separate covVerDate Sep 11 2014 18:17 Apr 09, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S777.IS S777

pamtmann on DSKBC07HB2PROD with BILLS
9 

•S 777 IS

1 erage or plan are not paid for with any 

2 amount attributable to the credit allowed 

3 under this section (or the amount of any 

4 advance payment of the credit under sec5 tion 1412 of the Patient Protection and 

6 Affordable Care Act).’’. 

7 (2) DISALLOWANCE OF SMALL EMPLOYER

8 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN

9 WHICH INCLUDES COVERAGE FOR GENDER REAS10 SIGNMENT MEDICAL INTERVENTIONS.—Subsection 

11 (h) of section 45R of the Internal Revenue Code of 

12 1986 is amended— 

13 (A) by striking ‘‘Any term’’ and inserting 

14 the following: 

15 ‘‘(1) IN GENERAL.—Any term’’; and 

16 (B) by adding at the end the following new 

17 paragraph: 

18 ‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING

19 COVERAGE FOR GENDER REASSIGNMENT MEDICAL

20 INTERVENTIONS.— 

21 ‘‘(A) IN GENERAL.—The term ‘qualified 

22 health plan’ does not include any health plan 

23 that includes coverage for gender reassignment 

24 medical interventions (other than any gender 

25 reassignment medical intervention or treatment 


pamtmann on DSKBC07HB2PROD with BILLS
10 

•S 777 IS

1 described in section 306 or 307 of title 1, 

2 United States Code). 

3 ‘‘(B) SEPARATE COVERAGE OR PLAN FOR

4 GENDER REASSIGNMENT MEDICAL INTERVEN5 TIONS ALLOWED.— 

6 ‘‘(i) OPTION TO PURCHASE SEPARATE

7 COVERAGE OR PLAN.—Nothing in subpara8 graph (A) shall be construed as prohibiting 

9 any employer from purchasing for its em10 ployees separate coverage for gender reas11 signment medical interventions described 

12 in such subparagraph, or a health plan 

13 that includes such gender reassignment 

14 medical interventions, so long as no credit 

15 is allowed under this section with respect 

16 to the employer contributions for such cov17 erage 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 reassignment 

23 medical interventions described in such 

24 subparagraph, or a plan that includes such 

25 gender reassignment medical interventions, 


pamtmann on DSKBC07HB2PROD with BILLS
11 

•S 777 IS

1 so long as such separate coverage or plan 

2 is not paid for with any employer contribu3 tion eligible for the credit allowed under 

4 this section.’’. 

5 (b) APPLICATION TO MULTI-STATE PLANS.—Section 

6 1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 

7 amended by adding at the end the following new para8 graph: 

9 ‘‘(8) COVERAGE CONSISTENT WITH FEDERAL

10 POLICY REGARDING GENDER REASSIGNMENT MED11 ICAL INTERVENTIONS.—In entering into contracts 

12 under this subsection, the Director shall ensure that 

13 no multi-State qualified health plan offered in an 

14 Exchange provides health benefits coverage for 

15 which the expenditure of Federal funds is prohibited 

16 under chapter 4 of title 1, United States Code.’’. 

17 (c) EFFECTIVE DATE.—The amendments made by 

18 subsection (a) shall apply to taxable years ending after 

19 the date that is one year after the date of enactment of 

20 this Act, but only with respect to plan years beginning 

21 after such date, and the amendment made by subsection 

22 (b) shall apply to plan years beginning after such date. 

Æ 


pamtmann on DSKBC07HB2PROD with BILLS