,i #aafth ,,congress #b;d ,session ,h4 ,r4 #hjac ,,in ,,the ,,house ,,of ,,representatives ,august #aa1 #bjbj,mr4 ,la,malfa 7for himself1 ,mr4 ,norman1 ,mr4 ,aderholt1 ,mr4 ,lamborn1 ,mr4 ,allen1 ,mr4 ,king of ,iowa1 ,mr4 ,steube1 ,mr4 ,babin1 ,mr4 ,flores1 and ,mr4 ,hice of ,georgia7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committees on the ,judiciary1 and ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 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 interventions1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,end ,taxpayer ,funding of ,gender ,experimentation ,act of #bjbj4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,title ,i--,prohibiting ,federally ,funded ,gender ,reassignment ,medical ,interventions,sec4 #aja4 ,prohibiting taxpayer-funded gender reassignment medical interventions4,sec4 #ajb4 ,amendment to table of chapters4,title ,,ii--,application under the ,affordable ,care ,act,sec4 #bja4 ,clarifying application of prohibition to premium credits and cost-sharing reductions under ,,aca4 ,i ,prohibiting ,federally ,funded ,gender ,reassignment ,medical ,interventions #aja4 ,prohibiting taxpayer-funded gender reassignment medical interventions ,title #a1 ,united ,states ,code1 is amended by adding at the end the following new chapter3 #d ,prohibiting taxpayer-funded gender reassignment medical interventions #cja4 ,prohibition on funding for gender reassignment medical interventions4 #cjb4 ,prohibition on funding for health benefits plans that cover gender reassignment medical interventions4 #cjc4 ,limitation on ,federal facilities and employees4 #cjd4 ,construction relating to separate coverage4 #cje4 ,construction relating to the use of non-,federal funds for health coverage4 #cjf4 ,construction relating to complications arising from gender reassignment medical interventions4 #cjg4 ,treatment of individuals born with medically verifiable disorder of sex development4 #cjh4 ,gender reassignment medical intervention defined4 #cja4 ,prohibition on funding for gender reassignment medical interventions ,no funds authorized or appropriated by ,federal law1 and none of the funds in any trust fund to which funds are authorized or appropriated by ,federal law1 shall be expended for any gender reassignment medical intervention4 #cjb4 ,prohibition on funding for health benefits plans that cover gender reassignment medical interventions ,no funds authorized or appropriated by ,federal law1 and none of the funds in any trust fund to which funds are authorized or appropriated by ,federal law1 shall be expended for health benefits coverage that includes coverage of gender reassignment medical interventions4 #cjc4 ,limitation on ,federal facilities and employees ,no health care service furnished-- 7#a7 by or in a health care facility owned or operated by the ,federal ,government2 or 7#b7 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 employment1 may include gender reassignment medical interventions4 #cjd4 ,construction relating to separate coverage ,nothing in this chapter shall be construed as prohibiting any individual1 entity1 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 program1 including a ,state's or locality's contribution of ,medicaid matching funds4 #cje4 ,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 interventions1 or the ability of a ,state or locality to contract separately with such a provider for such coverage1 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 program1 including a ,state's or locality's contribution of ,medicaid matching funds4 #cjf4 ,construction relating to complications arising from gender reassignment medical interventions ,nothing in this chapter shall be construed to apply to the treatment of any infection1 injury1 disease1 or disorder that has been caused by or exacerbated by the performance of a gender reassignment medical intervention4 ,this rule of construction shall be applicable without regard to whether the gender reassignment medical intervention was performed in accord with ,federal or ,state law1 and without regard to whether funding for the gender reassignment medical intervention is permissible under section #cjg4 #cjg4 ,treatment of individuals born with medically verifiable disorder of sex development ,the limitations established in sections #cja1 #cjb1 and #cjc shall not apply with respect to the following individuals3 7#a7 ,an individual with external biological sex characteristics that are irresolvably ambiguous1 such as those born with #df ,,xx chromosomes with virilization1 #df ,,xy chromosomes with undervirilization1 or having both ovarian and testicular tissue4 7#b7 ,an individual with respect to whom a physician has determined through genetic or biochemical testing that the individual does not have normal sex chromosome structure1 sex steroid hormone production1 or sex steroid hormone action for a biological male or female4 #cjh4 ,gender reassignment medical intervention defined ,for purposes of this chapter1 the term gender reassignment medical intervention means-- 7#a7 performing a surgery that sterilizes an individual1 including castration1 vasectomy1 hysterectomy1 oophorectomy1 metoidioplasty1 penectomy1 phalloplasty1 and vaginoplasty1 to change the body of such individual to correspond to a sex that is discordant with biological sex2 7#b7 performing a mastectomy on an individual for the purpose described in paragraph 7#a72 and 7#c7 administering or supplying to an individual medications for the purpose described in paragraph 7#a71 including-- 7,a7 ,gn,r,h agonists or other puberty-blocking drugs to stop or delay normal puberty2 7,b7 testosterone or other androgens to biological females at doses that are supraphysiologic to the female sex2 and 7,c7 estrogen to biological males at doses that are supraphysiologic to the male sex4 4 #ajb4 ,amendment to table of chapters ,the table of chapters for title #a1 ,united ,states ,code1 is amended by adding at the end the following new item3 #d4,prohibiting taxpayer-funded gender reassignment medical interventions#cja 4 ,,ii ,application under the ,affordable ,care ,act #bja4 ,clarifying application of prohibition to premium credits and cost-sharing reductions under ,,aca 7a7 ,in general 7#a7 ,disallowance of refundable credit and cost-sharing reductions for coverage under qualified health plan which provides coverage for gender reassignment medical interventions 7,a7 ,in general ,subparagraph 7,a7 of section #cf;,b7c77#c7 of the ,internal ,revenue ,code of #aihf is amended by inserting before the period at the end the following3 or any health plan that includes coverage for gender reassignment medical interventions 7other than any gender reassignment medical intervention or treatment described in section #cjf or #cjg of title #a1 ,united ,states ,code74 7,b7 ,option to purchase or offer separate coverage or plan ,paragraph 7#c7 of section #cf;,b7c7 of such ,code is amended by adding at the end the following new subparagraph3 7,c7 ,separate coverage or plan for gender reassignment medical interventions allowed 7i7 ,option to purchase separate coverage or plan ,nothing in subparagraph 7,a7 shall be construed as prohibiting any individual from purchasing separate coverage for gender reassignment medical interventions described in such subparagraph1 or a health plan that includes such gender reassignment medical interventions1 so long as no credit is allowed under this section with respect to the premiums for such coverage or plan4 7ii7 ,option to offer coverage or plan ,nothing in subparagraph 7,a7 shall restrict any non-,federal health insurance issuer offering a health plan from offering separate coverage for gender reassignment medical interventions described in such subparagraph1 or a plan that includes such gender reassignment medical interventions1 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 7or the amount of any advance payment of the credit under section #adab of the ,patient ,protection and ,affordable ,care ,act74 4 7#b7 ,disallowance of small employer health insurance expense credit for plan which includes coverage for gender reassignment medical interventions ,subsection 7h7 of section #de,r of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 by striking ,any term and inserting the following3 7#a7 ,in general ,any term 2 and 7,b7 by adding at the end the following new paragraph3 7#b7 ,exclusion of health plans including coverage for gender reassignment medical interventions 7,a7 ,in general ,the term qualified health plan does not include any health plan that includes coverage for gender reassignment medical interventions 7other than any gender reassignment medical intervention or treatment described in section #cjf or #cjg of title #a1 ,united ,states ,code74 7,b7 ,separate coverage or plan for gender reassignment medical interventions allowed 7i7 ,option to purchase separate coverage or plan ,nothing in subparagraph 7,a7 shall be construed as prohibiting any employer from purchasing for its employees separate coverage for gender reassignment medical interventions described in such subparagraph1 or a health plan that includes such gender reassignment medical interventions1 so long as no credit is allowed under this section with respect to the employer contributions for such coverage or plan4 7ii7 ,option to offer coverage or plan ,nothing in subparagraph 7,a7 shall restrict any non-,federal health insurance issuer offering a health plan from offering separate coverage for gender reassignment medical interventions described in such subparagraph1 or a plan that includes such gender reassignment medical interventions1 so long as such separate coverage or plan is not paid for with any employer contribution eligible for the credit allowed under this section4 4 7b7 ,application to multi-,state plans ,section #accd7;a7 of ,public ,law #aaa-adh 7#db ,u4,s4,c4 #ahjed7;a77 is amended by adding at the end the following new paragraph3 7#g7 ,coverage consistent with ,federal policy regarding gender reassignment medical interventions ,in entering into contracts under this subsection1 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 #d of title #a1 ,united ,states ,code4 4 7c7 ,effective date ,the amendments made by subsection 7a7 shall apply to taxable years ending after ,december #ca1 #bjai1 but only with respect to plan years beginning after such date1 and the amendment made by subsection 7b7 shall apply to plan years beginning after such date4