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 Com-
mittees on the Judiciary, and Ways and Means, for a period to be subse-
quently 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘End Taxpayer Funding of Gender Experimentation Act 
of 2020’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
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 interven-
tions. 
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 cost- 
sharing reductions under ACA. 
TITLE I—PROHIBITING FEDER-
ALLY FUNDED GENDER REAS-
SIGNMENT MEDICAL INTER-
VENTIONS 
SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER REAS-
SIGNMENT MEDICAL INTERVENTIONS. 
Title 1, United States Code, is amended by adding 
at the end the following new chapter: 
‘‘CHAPTER 
4—PROHIBITING 
TAXPAYER- 
FUNDED 
GENDER 
REASSIGNMENT 
MEDICAL INTERVENTIONS 
‘‘301. Prohibition on funding for gender reassignment medical interventions. 
‘‘302. Prohibition on funding for health benefits plans that cover gender reas-
signment 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 de-
velopment. 
‘‘308. Gender reassignment medical intervention defined. 
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‘‘§ 301. Prohibition on funding for gender reassign-
ment medical interventions 
‘‘No funds authorized or appropriated by Federal 
law, and none of the funds in any trust fund to which 
funds are authorized or appropriated by Federal law, shall 
be expended for any gender reassignment medical inter-
vention. 
‘‘§ 302. Prohibition on funding for health benefits 
plans that cover gender reassignment 
medical interventions 
‘‘No funds authorized or appropriated by Federal 
law, and none of the funds in any trust fund to which 
funds are authorized or appropriated by Federal law, shall 
be expended for health benefits coverage that includes cov-
erage of gender reassignment medical interventions. 
‘‘§ 303. Limitation on Federal facilities and employees 
‘‘No health care service furnished— 
‘‘(1) by or in a health care facility owned or op-
erated by the Federal Government; or 
‘‘(2) by any physician or other individual em-
ployed by the Federal Government to provide health 
care services within the scope of the physician’s or 
individual’s employment, 
may include gender reassignment medical interventions. 
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‘‘§ 304. Construction relating to separate coverage 
‘‘Nothing in this chapter shall be construed as pro-
hibiting any individual, entity, or State or locality from 
purchasing separate coverage for gender reassignment 
medical interventions or health benefits coverage that in-
cludes gender reassignment medical interventions so long 
as such coverage is paid for entirely using only funds not 
authorized or appropriated by Federal law and such cov-
erage shall not be purchased using matching funds re-
quired for a federally subsidized program, including a 
State’s or locality’s contribution of Medicaid matching 
funds. 
‘‘§ 305. Construction relating to the use of non-Fed-
eral funds for health coverage 
‘‘Nothing in this chapter shall be construed as re-
stricting the ability of any non-Federal health benefits cov-
erage provider from offering coverage for gender reassign-
ment medical interventions, or the ability of a State or 
locality to contract separately with such a provider for 
such coverage, so long as only funds not authorized or ap-
propriated by Federal law are used and such coverage 
shall not be purchased using matching funds required for 
a federally subsidized program, including a State’s or lo-
cality’s contribution of Medicaid matching funds. 
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‘‘§ 306. Construction relating to complications arising 
from gender reassignment medical inter-
ventions 
‘‘Nothing in this chapter shall be construed to apply 
to the treatment of any infection, injury, disease, or dis-
order that has been caused by or exacerbated by the per-
formance of a gender reassignment medical intervention. 
This rule of construction shall be applicable without re-
gard to whether the gender reassignment medical inter-
vention was performed in accord with Federal or State 
law, and without regard to whether funding for the gender 
reassignment medical intervention is permissible under 
section 307. 
‘‘§ 307. Treatment of individuals born with medically 
verifiable disorder of sex development 
‘‘The limitations established in sections 301, 302, 
and 303 shall not apply with respect to the following indi-
viduals: 
‘‘(1) An individual with external biological sex 
characteristics that are irresolvably ambiguous, such 
as those born with 46 XX chromosomes with 
virilization, 
XY 
chromosomes 
with 
undervirilization, or having both ovarian and testic-
ular tissue. 
‘‘(2) An individual with respect to whom a phy-
sician has determined through genetic or biochemical 
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testing that the individual does not have normal sex 
chromosome structure, sex steroid hormone produc-
tion, or sex steroid hormone action for a biological 
male or female. 
‘‘§ 308. Gender reassignment medical intervention de-
fined 
‘‘For purposes of this chapter, the term ‘gender reas-
signment medical intervention’ means— 
‘‘(1) performing a surgery that sterilizes an in-
dividual, 
including 
castration, 
vasectomy, 
hysterectomy, 
oophorectomy, 
metoidioplasty, 
penectomy, phalloplasty, and vaginoplasty, to change 
the body of such individual to correspond to a sex 
that is discordant with biological sex; 
‘‘(2) performing a mastectomy on an individual 
for the purpose described in paragraph (1); and 
‘‘(3) administering or supplying to an individual 
medications for the purpose described in paragraph 
(1), including— 
‘‘(A) GnRH agonists or other puberty- 
blocking drugs to stop or delay normal puberty; 
‘‘(B) testosterone or other androgens to bi-
ological 
females 
at 
doses 
that 
are 
supraphysiologic to the female sex; and 
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‘‘(C) estrogen to biological males at doses 
that are supraphysiologic to the male sex.’’. 
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 reassignment 
medical interventions ..........................................
301’’. 
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
REASSIGNMENT
MEDICAL 
INTERVENTIONS.— 
(A) IN
GENERAL.—Subparagraph (A) of 
section 36B(c)(3) of the Internal Revenue Code 
of 1986 is amended by inserting before the pe-
riod at the end the following: ‘‘or any health 
plan that includes coverage for gender reassign-
ment medical interventions (other than any 
gender reassignment medical intervention or 
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treatment described in section 306 or 307 of 
title 1, United States Code)’’. 
(B) OPTION TO PURCHASE OR OFFER SEP-
ARATE COVERAGE OR PLAN.—Paragraph (3) of 
section 36B(c) of such Code is amended by 
adding at the end the following new subpara-
graph: 
‘‘(C) SEPARATE COVERAGE OR PLAN FOR 
GENDER
REASSIGNMENT
MEDICAL
INTERVEN-
TIONS ALLOWED.— 
‘‘(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 reassignment medical 
interventions described in such subpara-
graph, or a health plan that includes such 
gender reassignment medical interventions, 
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 
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separate coverage for gender reassignment 
medical interventions described in such 
subparagraph, or a plan that includes such 
gender reassignment medical interventions, 
so long as premiums for such separate cov-
erage 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 sec-
tion 1412 of the Patient Protection and 
Affordable Care Act).’’. 
(2) DISALLOWANCE
OF
SMALL
EMPLOYER 
HEALTH
INSURANCE
EXPENSE
CREDIT
FOR
PLAN 
WHICH
INCLUDES
COVERAGE
FOR
GENDER
REAS-
SIGNMENT
MEDICAL
INTERVENTIONS.—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
REASSIGNMENT
MEDICAL 
INTERVENTIONS.— 
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‘‘(A) IN
GENERAL.—The term ‘qualified 
health plan’ does not include any health plan 
that includes coverage for gender reassignment 
medical interventions (other than any gender 
reassignment medical intervention or treatment 
described in section 306 or 307 of title 1, 
United States Code). 
‘‘(B) SEPARATE COVERAGE OR PLAN FOR 
GENDER
REASSIGNMENT
MEDICAL
INTERVEN-
TIONS ALLOWED.— 
‘‘(i) OPTION TO PURCHASE SEPARATE 
COVERAGE OR PLAN.—Nothing in subpara-
graph (A) shall be construed as prohibiting 
any employer from purchasing for its em-
ployees separate coverage for gender reas-
signment medical interventions described 
in such subparagraph, or a health plan 
that includes such gender reassignment 
medical interventions, so long as no credit 
is allowed under this section with respect 
to the employer contributions for such cov-
erage or plan. 
‘‘(ii) OPTION TO OFFER COVERAGE OR 
PLAN.—Nothing in subparagraph (A) shall 
restrict any non-Federal health insurance 
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