I 

117TH CONGRESS 

1ST SESSION H. R. 1927 

To prohibit taxpayer-funded gender reassignment medical interventions, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 16, 2021 

Mr. LAMALFA (for himself, Mr. NORMAN, Mr. ALLEN, Mr. GROTHMAN, Mr. 

DUNCAN, Mr. LAMBORN, Mr. HICE of Georgia, Mrs. MILLER of Illinois, 

Mr. STEUBE, Mr. KELLY of Mississippi, Mr. JORDAN, Mr. BANKS, Mr. 

WEBER of Texas, Mr. ADERHOLT, Mr. BABIN, and Mr. GOOD of Virginia) introduced the following bill; which was referred to the Committee 

on Energy 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 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’’. 


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

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—PROHIBITING FEDERALLY FUNDED GENDER 

REASSIGNMENT MEDICAL INTERVENTIONS 

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. 

3 TITLE I—PROHIBITING FEDER4 ALLY FUNDED GENDER REAS5 SIGNMENT MEDICAL INTER6 VENTIONS 

7 SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER REAS8 SIGNMENT MEDICAL INTERVENTIONS. 

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

10 at the end the following new chapter: 

11 ‘‘CHAPTER 4—PROHIBITING TAXPAYER12 FUNDED GENDER REASSIGNMENT 

13 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. 


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1 ‘‘§ 301. Prohibition on funding for gender reassign2 ment medical interventions 

3 ‘‘No funds authorized or appropriated by Federal 

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

5 funds are authorized or appropriated by Federal law, shall 

6 be expended for any gender reassignment medical inter7 vention. 

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

9 plans that cover gender reassignment 

10 medical interventions 

11 ‘‘No funds authorized or appropriated by Federal 

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

13 funds are authorized or appropriated by Federal law, shall 

14 be expended for health benefits coverage that includes cov15 erage of gender reassignment medical interventions. 

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

17 ‘‘No health care service furnished— 

18 ‘‘(1) by or in a health care facility owned or op19 erated by the Federal Government; or 

20 ‘‘(2) by any physician or other individual em21 ployed by the Federal Government to provide health 

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

23 individual’s employment, 

24 may include gender reassignment medical interventions. 


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1 ‘‘§ 304. Construction relating to separate coverage 

2 ‘‘Nothing in this chapter shall be construed as pro3 hibiting any individual, entity, or State or locality from 

4 purchasing separate coverage for gender reassignment 

5 medical interventions or health benefits coverage that in6 cludes gender reassignment medical interventions so long 

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

8 authorized or appropriated by Federal law and such cov9 erage shall not be purchased using matching funds re10 quired for a federally subsidized program, including a 

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

12 funds. 

13 ‘‘§ 305. Construction relating to the use of non-Fed14 eral funds for health coverage 

15 ‘‘Nothing in this chapter shall be construed as re16 stricting the ability of any non-Federal health benefits cov17 erage provider from offering coverage for gender reassign18 ment medical interventions, or the ability of a State or 

19 locality to contract separately with such a provider for 

20 such coverage, so long as only funds not authorized or ap21 propriated by Federal law are used and such coverage 

22 shall not be purchased using matching funds required for 

23 a federally subsidized program, including a State’s or lo24 cality’s contribution of Medicaid matching funds. 


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1 ‘‘§ 306. Construction relating to complications arising 

2 from gender reassignment medical inter3 ventions 

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

5 to the treatment of any infection, injury, disease, or dis6 order that has been caused by or exacerbated by the per7 formance of a gender reassignment medical intervention. 

8 This rule of construction shall be applicable without re9 gard to whether the gender reassignment medical inter10 vention was performed in accord with Federal or State 

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

12 reassignment medical intervention is permissible under 

13 section 307. 

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

15 verifiable disorder of sex development 

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

17 and 303 shall not apply with respect to the following indi18 viduals: 

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

20 characteristics that are irresolvably ambiguous, such 

21 as those born with 46 XX chromosomes with viriliza22 tion, 46 XY chromosomes with undervirilization, or 

23 having both ovarian and testicular tissue. 

24 ‘‘(2) An individual with respect to whom a phy25 sician has determined through genetic or biochemical 

26 testing that the individual does not have normal sex 


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1 chromosome structure, sex steroid hormone produc2 tion, or sex steroid hormone action for a biological 

3 male or female. 

4 ‘‘§ 308. Gender reassignment medical intervention de5 fined 

6 ‘‘For purposes of this chapter, the term ‘gender reas7 signment medical intervention’ means— 

8 ‘‘(1) performing a surgery that sterilizes an in9 dividual, including castration, vasectomy, hysterecto10 my, oophorectomy, metoidioplasty, penectomy, phal11 loplasty, and vaginoplasty, to change the body of 

12 such individual to correspond to a sex that is dis13 cordant with biological sex; 

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

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

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

17 medications for the purpose described in paragraph 

18 (1), including— 

19 ‘‘(A) GnRH agonists or other puberty20 blocking drugs to stop or delay normal puberty; 

21 ‘‘(B) testosterone or other androgens to bi22 ological females at doses that are supraphysio23 logic to the female sex; and 

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

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


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1 SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 

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

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

‘‘4. Prohibiting taxpayer-funded gender reassignment 

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

4 TITLE II—APPLICATION UNDER 

5 THE AFFORDABLE CARE ACT 

6 SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 

7 PREMIUM CREDITS AND COST-SHARING RE8 DUCTIONS UNDER ACA. 

9 (a) IN GENERAL.— 

10 (1) DISALLOWANCE OF REFUNDABLE CREDIT

11 AND COST-SHARING REDUCTIONS FOR COVERAGE

12 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES

13 COVERAGE FOR GENDER REASSIGNMENT MEDICAL

14 INTERVENTIONS.— 

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

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

17 of 1986 is amended by inserting before the pe18 riod at the end the following: ‘‘or any health 

19 plan that includes coverage for gender reassign20 ment medical interventions (other than any 

21 gender reassignment medical intervention or 

22 treatment described in section 306 or 307 of 

23 title 1, United States Code)’’. 


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1 (B) OPTION TO PURCHASE OR OFFER SEP2 ARATE COVERAGE OR PLAN.—Paragraph (3) of 

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

4 adding at the end the following new subpara5 graph: 

6 ‘‘(C) SEPARATE COVERAGE OR PLAN FOR

7 GENDER REASSIGNMENT MEDICAL INTERVEN8 TIONS ALLOWED.— 

9 ‘‘(i) OPTION TO PURCHASE SEPARATE

10 COVERAGE OR PLAN.—Nothing in subpara11 graph (A) shall be construed as prohibiting 

12 any individual from purchasing separate 

13 coverage for gender reassignment medical 

14 interventions described in such subpara15 graph, or a health plan that includes such 

16 gender reassignment medical interventions, 

17 so long as no credit is allowed under this 

18 section with respect to the premiums for 

19 such coverage or plan. 

20 ‘‘(ii) OPTION TO OFFER COVERAGE OR

21 PLAN.—Nothing in subparagraph (A) shall 

22 restrict any non-Federal health insurance 

23 issuer offering a health plan from offering 

24 separate coverage for gender reassignment 

25 medical interventions described in such 


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1 subparagraph, or a plan that includes such 

2 gender reassignment medical interventions, 

3 so long as premiums for such separate cov4 erage or plan are not paid for with any 

5 amount attributable to the credit allowed 

6 under this section (or the amount of any 

7 advance payment of the credit under sec8 tion 1412 of the Patient Protection and 

9 Affordable Care Act).’’. 

10 (2) DISALLOWANCE OF SMALL EMPLOYER

11 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN

12 WHICH INCLUDES COVERAGE FOR GENDER REAS13 SIGNMENT MEDICAL INTERVENTIONS.—Subsection 

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

15 1986 is amended— 

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

17 the following: 

18 ‘‘(1) IN GENERAL.—Any term’’; and 

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

20 paragraph: 

21 ‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING

22 COVERAGE FOR GENDER REASSIGNMENT MEDICAL

23 INTERVENTIONS.— 

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

25 health plan’ does not include any health plan 


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1 that includes coverage for gender reassignment 

2 medical interventions (other than any gender 

3 reassignment medical intervention or treatment 

4 described in section 306 or 307 of title 1, 

5 United States Code). 

6 ‘‘(B) SEPARATE COVERAGE OR PLAN FOR

7 GENDER REASSIGNMENT MEDICAL INTERVEN8 TIONS ALLOWED.— 

9 ‘‘(i) OPTION TO PURCHASE SEPARATE

10 COVERAGE OR PLAN.—Nothing in subpara11 graph (A) shall be construed as prohibiting 

12 any employer from purchasing for its em13 ployees separate coverage for gender reas14 signment medical interventions described 

15 in such subparagraph, or a health plan 

16 that includes such gender reassignment 

17 medical interventions, so long as no credit 

18 is allowed under this section with respect 

19 to the employer contributions for such cov20 erage or plan. 

21 ‘‘(ii) OPTION TO OFFER COVERAGE OR

22 PLAN.—Nothing in subparagraph (A) shall 

23 restrict any non-Federal health insurance 

24 issuer offering a health plan from offering 

25 separate coverage for gender reassignment 


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1 medical interventions described in such 

2 subparagraph, or a plan that includes such 

3 gender reassignment medical interventions, 

4 so long as such separate coverage or plan 

5 is not paid for with any employer contribu6 tion eligible for the credit allowed under 

7 this section.’’. 

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

9 1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 

10 amended by adding at the end the following new para11 graph: 

12 ‘‘(7) COVERAGE CONSISTENT WITH FEDERAL

13 POLICY REGARDING GENDER REASSIGNMENT MED14 ICAL INTERVENTIONS.—In entering into contracts 

15 under this subsection, the Director shall ensure that 

16 no multi-State qualified health plan offered in an 

17 Exchange provides health benefits coverage for 

18 which the expenditure of Federal funds is prohibited 

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

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

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

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

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


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1 after such date, and the amendment made by subsection 

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

Æ 


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