I 

116TH CONGRESS 

2D SESSION H. R. 8013 

To prohibit taxpayer-funded gender reassignment medical interventions, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

AUGUST 11, 2020 

Mr. LAMALFA (for himself, Mr. NORMAN, Mr. ADERHOLT, Mr. LAMBORN, Mr. 

ALLEN, Mr. KING of Iowa, Mr. STEUBE, Mr. BABIN, Mr. FLORES, and 

Mr. HICE of Georgia) 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 2020’’. 

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

8 this Act is as follows: 


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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. 

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. 


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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 

22 virilization, 46 XY chromosomes with 

23 undervirilization, or having both ovarian and testic24 ular tissue. 

25 ‘‘(2) An individual with respect to whom a phy26 sician has determined through genetic or biochemical 


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1 testing that the individual does not have normal sex 

2 chromosome structure, sex steroid hormone produc3 tion, or sex steroid hormone action for a biological 

4 male or female. 

5 ‘‘§ 308. Gender reassignment medical intervention de6 fined 

7 ‘‘For purposes of this chapter, the term ‘gender reas8 signment medical intervention’ means— 

9 ‘‘(1) performing a surgery that sterilizes an in10 dividual, including castration, vasectomy, 

11 hysterectomy, oophorectomy, metoidioplasty, 

12 penectomy, phalloplasty, and vaginoplasty, to change 

13 the body of such individual to correspond to a sex 

14 that is discordant with biological sex; 

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

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

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

18 medications for the purpose described in paragraph 

19 (1), including— 

20 ‘‘(A) GnRH agonists or other puberty21 blocking drugs to stop or delay normal puberty; 

22 ‘‘(B) testosterone or other androgens to bi23 ological females at doses that are 

24 supraphysiologic to the female sex; and 


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

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

3 SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 

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

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

‘‘4. Prohibiting taxpayer-funded gender reassignment 

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

6 TITLE II—APPLICATION UNDER 

7 THE AFFORDABLE CARE ACT 

8 SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 

9 PREMIUM CREDITS AND COST-SHARING RE10 DUCTIONS UNDER ACA. 

11 (a) IN GENERAL.— 

12 (1) DISALLOWANCE OF REFUNDABLE CREDIT

13 AND COST-SHARING REDUCTIONS FOR COVERAGE

14 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES

15 COVERAGE FOR GENDER REASSIGNMENT MEDICAL

16 INTERVENTIONS.— 

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

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

19 of 1986 is amended by inserting before the pe20 riod at the end the following: ‘‘or any health 

21 plan that includes coverage for gender reassign22 ment medical interventions (other than any 

23 gender reassignment medical intervention or 


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1 treatment described in section 306 or 307 of 

2 title 1, United States Code)’’. 

3 (B) OPTION TO PURCHASE OR OFFER SEP4 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 subpara7 graph: 

8 ‘‘(C) SEPARATE COVERAGE OR PLAN FOR

9 GENDER REASSIGNMENT MEDICAL INTERVEN10 TIONS ALLOWED.— 

11 ‘‘(i) OPTION TO PURCHASE SEPARATE

12 COVERAGE OR PLAN.—Nothing in subpara13 graph (A) shall be construed as prohibiting 

14 any individual from purchasing separate 

15 coverage for gender reassignment medical 

16 interventions described in such subpara17 graph, or a health plan that includes such 

18 gender reassignment medical interventions, 

19 so long as no credit is allowed under this 

20 section with respect to the premiums for 

21 such coverage or plan. 

22 ‘‘(ii) OPTION TO OFFER COVERAGE OR

23 PLAN.—Nothing in subparagraph (A) shall 

24 restrict any non-Federal health insurance 

25 issuer offering a health plan from offering 


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1 separate coverage for gender reassignment 

2 medical interventions described in such 

3 subparagraph, or a plan that includes such 

4 gender reassignment medical interventions, 

5 so long as premiums for such separate cov6 erage or plan are not paid for with any 

7 amount attributable to the credit allowed 

8 under this section (or the amount of any 

9 advance payment of the credit under sec10 tion 1412 of the Patient Protection and 

11 Affordable Care Act).’’. 

12 (2) DISALLOWANCE OF SMALL EMPLOYER

13 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN

14 WHICH INCLUDES COVERAGE FOR GENDER REAS15 SIGNMENT MEDICAL INTERVENTIONS.—Subsection 

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

17 1986 is amended— 

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

19 the following: 

20 ‘‘(1) IN GENERAL.—Any term’’; and 

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

22 paragraph: 

23 ‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING

24 COVERAGE FOR GENDER REASSIGNMENT MEDICAL

25 INTERVENTIONS.— 


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

2 health plan’ does not include any health plan 

3 that includes coverage for gender reassignment 

4 medical interventions (other than any gender 

5 reassignment medical intervention or treatment 

6 described in section 306 or 307 of title 1, 

7 United States Code). 

8 ‘‘(B) SEPARATE COVERAGE OR PLAN FOR

9 GENDER REASSIGNMENT MEDICAL INTERVEN10 TIONS ALLOWED.— 

11 ‘‘(i) OPTION TO PURCHASE SEPARATE

12 COVERAGE OR PLAN.—Nothing in subpara13 graph (A) shall be construed as prohibiting 

14 any employer from purchasing for its em15 ployees separate coverage for gender reas16 signment medical interventions described 

17 in such subparagraph, or a health plan 

18 that includes such gender reassignment 

19 medical interventions, so long as no credit 

20 is allowed under this section with respect 

21 to the employer contributions for such cov22 erage or plan. 

23 ‘‘(ii) OPTION TO OFFER COVERAGE OR

24 PLAN.—Nothing in subparagraph (A) shall 

25 restrict any non-Federal health insurance 


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1 issuer offering a health plan from offering 

2 separate coverage for gender reassignment 

3 medical interventions described in such 

4 subparagraph, or a plan that includes such 

5 gender reassignment medical interventions, 

6 so long as such separate coverage or plan 

7 is not paid for with any employer contribu8 tion eligible for the credit allowed under 

9 this section.’’. 

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

11 1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 

12 amended by adding at the end the following new para13 graph: 

14 ‘‘(7) COVERAGE CONSISTENT WITH FEDERAL

15 POLICY REGARDING GENDER REASSIGNMENT MED16 ICAL INTERVENTIONS.—In entering into contracts 

17 under this subsection, the Director shall ensure that 

18 no multi-State qualified health plan offered in an 

19 Exchange provides health benefits coverage for 

20 which the expenditure of Federal funds is prohibited 

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

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

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

24 December 31, 2019, but only with respect to plan years 

25 beginning after such date, and the amendment made by 


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1 subsection (b) shall apply to plan years beginning after 

2 such date. 

Æ 


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