neous 
mastectomy, 
voice 
surgery, 
liposuction, 
lipofilling, pectoral implants, or other aesthetic pro-
cedures for biologically female patients, when per-
formed for the purpose of assisting an individual 
with a gender transition. 
‘‘(9) PUBERTY-BLOCKING
DRUGS.—The term 
‘puberty-blocking drugs’ means— 
‘‘(A) 
Gonadotropin-releasing 
hormone 
(GnRH) analogues or other synthetic drugs 
used in biological males to stop luteinizing hor-
mone secretion and therefore testosterone secre-
tion; 
‘‘(B) synthetic drugs used in biological fe-
males that stop the production of estrogen; and 
‘‘(C) progesterone when used to delay or 
suppress pubertal development in children for 
the purpose of assisting an individual with a 
gender transition.’’. 
SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 
The table of chapters for title 1, United States Code, 
is amended by adding at the end the following new item: 
‘‘4. Prohibiting taxpayer-funded gender transition pro-
cedures .......................................................................
301’’. 
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TITLE II—APPLICATION UNDER 
THE AFFORDABLE CARE ACT 
SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 
PREMIUM CREDITS AND COST-SHARING RE-
DUCTIONS UNDER ACA. 
(a) IN GENERAL.— 
(1) DISALLOWANCE OF REFUNDABLE CREDIT 
AND
COST-SHARING
REDUCTIONS
FOR
COVERAGE 
UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 
COVERAGE
FOR
GENDER
TRANSITION
PROCE-
DURES.— 
(A) IN
GENERAL.—Section 36B(c)(3)(A) 
of the Internal Revenue Code of 1986 is 
amended by inserting before the period at the 
end the following: ‘‘or any health plan that in-
cludes coverage for gender transition procedures 
(other than any procedure described in section 
306 or 307 of title 1, United States Code)’’. 
(B) OPTION TO PURCHASE OR OFFER SEP-
ARATE COVERAGE OR PLAN.—Section 36B(c)(3) 
of such Code is amended by adding at the end 
the following new subparagraph: 
‘‘(C) SEPARATE COVERAGE OR PLAN FOR 
GENDER
TRANSITION
PROCEDURES
AL-
LOWED.— 
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‘‘(i) OPTION TO PURCHASE SEPARATE 
COVERAGE OR PLAN.—Nothing in subpara-
graph (A) shall be construed as prohibiting 
any individual from purchasing separate 
coverage for gender transition procedures 
described in such subparagraph, or a 
health plan that includes such gender tran-
sition procedures, so long as no credit is 
allowed under this section with respect to 
the premiums for such coverage or plan. 
‘‘(ii) OPTION TO OFFER COVERAGE OR 
PLAN.—Nothing in subparagraph (A) shall 
restrict any non-Federal health insurance 
issuer offering a health plan from offering 
separate coverage for gender transition 
procedures described in such subpara-
graph, or a plan that includes such gender 
transition procedures, so long as premiums 
for such separate coverage or plan are not 
paid for with any amount attributable to 
the credit allowed under this section (or 
the amount of any advance payment of the 
credit under section 1412 of the Patient 
Protection and Affordable Care Act).’’. 
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(2) DISALLOWANCE
OF
SMALL
EMPLOYER 
HEALTH
INSURANCE
EXPENSE
CREDIT
FOR
PLAN 
WHICH INCLUDES COVERAGE FOR GENDER TRANSI-
TION PROCEDURES.—Subsection (h) of section 45R 
of the Internal Revenue Code of 1986 is amended— 
(A) by striking ‘‘Any term’’ and inserting 
the following: 
‘‘(1) IN GENERAL.—Any term’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING 
COVERAGE
FOR
GENDER
TRANSITION
PROCE-
DURES.— 
‘‘(A) IN
GENERAL.—The term ‘qualified 
health plan’ does not include any health plan 
that includes coverage for gender transition 
procedures (other than a procedure described in 
section 306 or 307 of title 1, United States 
Code). 
‘‘(B) SEPARATE COVERAGE OR PLAN FOR 
GENDER
TRANSITION
PROCEDURES
AL-
LOWED.— 
‘‘(i) OPTION TO PURCHASE SEPARATE 
COVERAGE OR PLAN.—Nothing in subpara-
graph (A) shall be construed as prohibiting 
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any employer from purchasing for its em-
ployees separate coverage for gender tran-
sition procedures described in such sub-
paragraph, or a health plan that includes 
such gender transition procedures, so long 
as no credit is allowed under this section 
with respect to the employer contributions 
for such coverage or plan. 
‘‘(ii) OPTION TO OFFER COVERAGE OR 
PLAN.—Nothing in subparagraph (A) shall 
restrict any non-Federal health insurance 
issuer offering a health plan from offering 
separate coverage for gender transition 
procedures described in such subpara-
graph, or a plan that includes such gender 
transition procedures, so long as such sep-
arate coverage or plan is not paid for with 
any employer contribution eligible for the 
credit allowed under this section.’’. 
(b) APPLICATION TO MULTI-STATE PLANS.—Section 
1334(a) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18054(a)) is amended by adding at the end 
the following new paragraph: 
‘‘(8) COVERAGE
CONSISTENT
WITH
FEDERAL 
POLICY
REGARDING
GENDER
TRANSITION
PROCE-
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DURES.—In entering into contracts under this sub-
section, the Director shall ensure that no multi-State 
qualified health plan offered in an Exchange pro-
vides health benefits coverage for which the expendi-
ture of Federal funds is prohibited under chapter 4 
of title 1, United States Code.’’. 
(c) EFFECTIVE DATE.— 
(1) EFFECTIVE DATE WITH RESPECT TO PRE-
MIUM CREDITS AND COST SHARING REDUCTIONS.— 
The amendments made by subsection (a) shall apply 
to taxable years after the date that is one year after 
the date of enactment of this Act, but only with re-
spect to plan years beginning after such date. 
(2) EFFECTIVE
DATE
FOR
APPLICATION
TO 
MULTI-STATE
PLANS.—The amendment made by 
subsection (b) shall apply to plan years beginning on 
the date that is one year after the date of enactment 
of this Act. 
Æ 
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