End Taxpayer Funding of Gender Experimentation Act of 2021
Bill: S.777 | Sponsor: Sen. Marshall, Roger (R-KS)
Policy area: Health

Summary:
End Taxpayer Funding of Gender Experimentation Act of 2021
This bill modifies provisions relating to federal funding for, and health insurance coverage of, gender reassignment medical interventions, which include surgical remedies and hormone therapy arising from a conflict between an individual's gender identity and the sex the individual has or was identified as having at birth. Specifically, the bill prohibits the use of federal funds for gender reassignment medical interventions or for health coverage that includes such interventions. Additionally, such interventions may not be provided in a federal health care facility or by a federal employee. Under current law, coverage of these interventions through Medicare and Medicaid is generally determined at the state level.
The bill's restrictions regarding the use of federal funds do not apply to treatment of individuals with medically verifiable disorders of sex development, such as individuals born with atypical development of chromosomal, gonadal, or anatomical sex.
The bill also prohibits qualified health plans from including coverage for gender reassignment medical interventions. Further, plans that include coverage for such interventions are not eligible for federal subsidies.

To prohibit taxpayer-funded gender reassignment medical interventions, 
                        and for other purposes.

    Be it enacted by the Senate and House of Representatives 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 2021''.
    (b) Table of Contents.--The table of contents of 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 
                            cost-sharing reductions under ACA.

   TITLE I--PROHIBITING FEDERALLY FUNDED GENDER REASSIGNMENT MEDICAL 
                             INTERVENTIONS

SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER REASSIGNMENT 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 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.
``Sec. 301. Prohibition on funding for 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 any gender 
reassignment medical intervention.
``Sec. 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 coverage of gender reassignment medical 
interventions.
``Sec. 303. Limitation on Federal facilities and employees
    ``No health care service furnished--
            ``(1) by or in a health care facility owned or operated by 
        the Federal Government; or
            ``(2) by any physician or other individual employed 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.
``Sec. 304. Construction relating to separate coverage
    ``Nothing in this chapter shall be construed as prohibiting any 
individual, entity, or State or locality from purchasing separate 
coverage for gender reassignment medical interventions or health 
benefits coverage that includes 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 coverage 
shall not be purchased using matching funds required for a federally 
subsidized program, including a State's or locality's contribution of 
Medicaid matching funds.
``Sec. 305. Construction relating to the use of non-Federal funds for 
              health coverage
    ``Nothing in this chapter shall be construed as restricting the 
ability of any non-Federal health benefits coverage provider from 
offering coverage for gender reassignment 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 
appropriated 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 locality's contribution of Medicaid 
matching funds.
``Sec. 306. Construction relating to complications arising from gender 
              reassignment medical interventions
    ``Nothing in this chapter shall be construed to apply to the 
treatment of any infection, injury, disease, or disorder that has been 
caused by or exacerbated by the performance of a gender reassignment 
medical intervention. This rule of construction shall be applicable 
without regard to whether the gender reassignment medical intervention 
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.
``Sec. 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 individuals:
            ``(1) An individual with external biological sex 
        characteristics that are irresolvably ambiguous, such as those 
        born with 46 XX chromosomes with virilization, 46 XY 
        chromosomes with undervirilization, or having both ovarian and 
        testicular tissue.
            ``(2) An individual with respect to whom a physician has 
        determined through genetic or biochemical testing that the 
        individual does not have normal sex chromosome structure, sex 
        steroid hormone production, or sex steroid hormone action for a 
        biological male or female.
``Sec. 308. Gender reassignment medical intervention defined
    ``For purposes of this chapter, the term `gender reassignment 
medical intervention' means--
            ``(1) performing a surgery that sterilizes an individual, 
        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 biological 
                females at doses that are supraphysiologic to the 
                female sex; and
                    ``(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     301''.
                            interventions.

          TITLE II--APPLICATION UNDER THE AFFORDABLE CARE ACT

SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO PREMIUM CREDITS AND 
              COST-SHARING REDUCTIONS 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 period at the end the 
                following: ``or 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) Option to purchase or offer separate coverage 
                or plan.--Paragraph (3) of section 36B(c) of such Code 
                is amended by adding at the end the following new 
                subparagraph:
                    ``(C) Separate coverage or plan for gender 
                reassignment medical interventions allowed.--
                            ``(i) Option to purchase separate coverage 
                        or plan.--Nothing in subparagraph (A) shall be 
                        construed as prohibiting any individual from 
                        purchasing separate coverage for gender 
                        reassignment 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 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 reassignment medical interventions 
                        described in such subparagraph, or a plan that 
                        includes such gender reassignment medical 
                        interventions, 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).''.
            (2) Disallowance of small employer health insurance expense 
        credit for plan which includes coverage for gender reassignment 
        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.--
                    ``(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 interventions allowed.--
                            ``(i) Option to purchase separate coverage 
                        or plan.--Nothing in subparagraph (A) shall be 
                        construed as prohibiting any employer from 
                        purchasing for its employees separate coverage 
                        for gender reassignment 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 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 reassignment medical interventions 
                        described in such subparagraph, or a plan that 
                        includes such gender reassignment medical 
                        interventions, so long as such separate 
                        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 Public 
Law 111-148 (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 reassignment medical interventions.--In entering into 
        contracts under this subsection, the Director shall ensure that 
        no multi-State qualified health plan offered in an Exchange 
        provides health benefits coverage for which the expenditure of 
        Federal funds is prohibited under chapter 4 of title 1, United 
        States Code.''.
    (c) Effective Date.--The amendments made by subsection (a) shall 
apply to taxable years ending after the date that is one year after the 
date of enactment of this Act, but only with respect to plan years 
beginning after such date, and the amendment made by subsection (b) 
shall apply to plan years beginning after such date.
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