S977-119

1. Short title; table of contents This Act may be cited as the End Taxpayer Funding of Gender Experimentation Act of 2025. The table of contents of this Act is as follows:

101. Prohibiting taxpayer-funded gender transition procedures Title 1, United States Code, is amended by adding at the end the following new chapter: 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 transition procedures. 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 transition procedures. No health care service furnished— by or in a health care facility owned or operated by the Federal Government; or 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, Nothing in this chapter shall be construed as prohibiting any individual, entity, or State or locality from purchasing separate coverage for gender transition procedures or health benefits coverage that includes gender transition procedures 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. Nothing in this chapter shall be construed as restricting the ability of any non-Federal health benefits coverage provider from offering coverage for gender transition procedures, 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. 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 transition procedure. For purposes of this chapter: The term female, when used to refer to a natural person, means an individual who naturally has, had, will have, or would have, but for a congenital anomaly, historical accident, or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes eggs for fertilization. The term gender transition means the process in which an individual goes from identifying with or presenting as his or her sex to identifying with or presenting a self-proclaimed identity that does not correspond with or is different from his or her sex, and may be accompanied with social, legal, or physical changes. The term gender transition procedure means any hormonal or surgical intervention for the purpose of gender transition, including— gonadotropin-releasing hormone (GnRH) agonists or other puberty-blocking or suppressing drugs to stop or delay normal puberty; testosterone, estrogen, progesterone, or other androgens to an individual at doses that are supraphysiologic to what would normally be produced endogenously in a healthy individual of the same age and sex; castration; orchiectomy; scrotoplasty; implantation of erection or testicular prostheses; vasectomy; hysterectomy; oophorectomy; ovariectomy; reconstruction of the fixed part of the urethra with or without a metoidioplasty or a phalloplasty; metoidioplasty; penectomy; phalloplasty; vaginoplasty; clitoroplasty vaginectomy; vulvoplasty; reduction thyrochondroplasty; chondrolaryngoplasty; mastectomy; tubal ligation; sterilization; any plastic, cosmetic, or aesthetic surgery that feminizes or masculinizes the facial or other physiological features of an individual; any placement of chest implants to create feminine breasts; any placement of fat or artificial implants in the gluteal region; augmentation mammoplasty; liposuction; lipofilling; voice surgery; hair reconstruction; pectoral implants; and the removal of any otherwise healthy or non-diseased body part or tissue. The term gender transition procedure does not include the following when furnished to an individual by a health care provider with the consent of such individual or, if applicable, such individual’s parents or legal guardian: Services to individuals born with a medically verifiable disorder of sex development, including an individual with external sex characteristics that are irresolvably ambiguous, such as an individual born with 46 XX chromosomes with virilization, an individual born with 46 XY chromosomes with undervirilization, or an individual born having both ovarian and testicular tissue. Services provided when a physician has otherwise diagnosed a disorder of sexual development in which the 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 healthy individual of the same sex and age. The treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures, whether or not the gender transition procedure was performed in accordance with State and Federal law or whether or not funding for the gender transition procedure is permissible under this section. Any procedure undertaken because the individual suffers from a physical disorder, physical injury, or physical illness (but not mental, behavioral, or emotional distress or a mental, behavioral, or emotional disorder) that would, as certified by a physician, place the individual in imminent danger of death or impairment of major bodily function, unless the procedure is performed. Puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty. Male circumcision. The term male, when used to refer to a natural person, means an individual who naturally has, had, will have, or would have, but for a congenital anomaly, historical accident, or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes sperm for fertilization. The term sex, when referring to an individual’s sex, means to refer to either male or female, as biologically determined. 4Prohibiting taxpayer-funded gender transition proceduresSec. 301. Prohibition on funding for gender transition procedures. 302. Prohibition on funding for health benefits plans that cover gender transition procedures. 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 transition procedures. 307. Definitions. 301.Prohibition on funding for gender transition proceduresNo 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 transition procedures.302.Prohibition on funding for health benefits plans that cover gender transition proceduresNo 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 transition procedures.303.Limitation on Federal facilities and employeesNo 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 transition procedures. 304.Construction relating to separate coverageNothing in this chapter shall be construed as prohibiting any individual, entity, or State or locality from purchasing separate coverage for gender transition procedures or health benefits coverage that includes gender transition procedures 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.305.Construction relating to the use of non-Federal funds for health coverageNothing in this chapter shall be construed as restricting the ability of any non-Federal health benefits coverage provider from offering coverage for gender transition procedures, 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.306.Construction relating to complications arising from gender transition proceduresNothing 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 transition procedure. 307.DefinitionsFor purposes of this chapter:(1)FemaleThe term female, when used to refer to a natural person, means an individual who naturally has, had, will have, or would have, but for a congenital anomaly, historical accident, or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes eggs for fertilization. (2)Gender transitionThe term gender transition means the process in which an individual goes from identifying with or presenting as his or her sex to identifying with or presenting a self-proclaimed identity that does not correspond with or is different from his or her sex, and may be accompanied with social, legal, or physical changes. (3)Gender transition procedure(A)In generalThe term gender transition procedure means any hormonal or surgical intervention for the purpose of gender transition, including— (i)gonadotropin-releasing hormone (GnRH) agonists or other puberty-blocking or suppressing drugs to stop or delay normal puberty; (ii)testosterone, estrogen, progesterone, or other androgens to an individual at doses that are supraphysiologic to what would normally be produced endogenously in a healthy individual of the same age and sex;(iii)castration;(iv)orchiectomy;(v)scrotoplasty;(vi)implantation of erection or testicular prostheses;(vii)vasectomy;(viii)hysterectomy;(ix)oophorectomy;(x)ovariectomy;(xi)reconstruction of the fixed part of the urethra with or without a metoidioplasty or a phalloplasty;(xii)metoidioplasty;(xiii)penectomy;(xiv)phalloplasty;(xv)vaginoplasty;(xvi)clitoroplasty(xvii)vaginectomy;(xviii)vulvoplasty;(xix)reduction thyrochondroplasty;(xx)chondrolaryngoplasty;(xxi)mastectomy;(xxii)tubal ligation;(xxiii)sterilization;(xxiv)any plastic, cosmetic, or aesthetic surgery that feminizes or masculinizes the facial or other physiological features of an individual;(xxv)any placement of chest implants to create feminine breasts;(xxvi)any placement of fat or artificial implants in the gluteal region;(xxvii)augmentation mammoplasty;(xxviii)liposuction; (xxix)lipofilling;(xxx)voice surgery;(xxxi)hair reconstruction;(xxxii)pectoral implants; and(xxxiii)the removal of any otherwise healthy or non-diseased body part or tissue. (B)ExclusionsThe term gender transition procedure does not include the following when furnished to an individual by a health care provider with the consent of such individual or, if applicable, such individual’s parents or legal guardian:(i)Services to individuals born with a medically verifiable disorder of sex development, including an individual with external sex characteristics that are irresolvably ambiguous, such as an individual born with 46 XX chromosomes with virilization, an individual born with 46 XY chromosomes with undervirilization, or an individual born having both ovarian and testicular tissue.(ii)Services provided when a physician has otherwise diagnosed a disorder of sexual development in which the 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 healthy individual of the same sex and age.(iii)The treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures, whether or not the gender transition procedure was performed in accordance with State and Federal law or whether or not funding for the gender transition procedure is permissible under this section.(iv)Any procedure undertaken because the individual suffers from a physical disorder, physical injury, or physical illness (but not mental, behavioral, or emotional distress or a mental, behavioral, or emotional disorder) that would, as certified by a physician, place the individual in imminent danger of death or impairment of major bodily function, unless the procedure is performed. (v)Puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty.(vi)Male circumcision.(4)MaleThe term male, when used to refer to a natural person, means an individual who naturally has, had, will have, or would have, but for a congenital anomaly, historical accident, or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes sperm for fertilization. (5)SexThe term sex, when referring to an individual’s sex, means to refer to either male or female, as biologically determined..

301. Prohibition on funding for gender transition procedures 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 transition procedures.

302. Prohibition on funding for health benefits plans that cover gender transition procedures 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 transition procedures.

303. Limitation on Federal facilities and employees No health care service furnished— by or in a health care facility owned or operated by the Federal Government; or 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,

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 transition procedures or health benefits coverage that includes gender transition procedures 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.

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 transition procedures, 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.

306. Construction relating to complications arising from gender transition procedures 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 transition procedure.

307. Definitions For purposes of this chapter: The term female, when used to refer to a natural person, means an individual who naturally has, had, will have, or would have, but for a congenital anomaly, historical accident, or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes eggs for fertilization. The term gender transition means the process in which an individual goes from identifying with or presenting as his or her sex to identifying with or presenting a self-proclaimed identity that does not correspond with or is different from his or her sex, and may be accompanied with social, legal, or physical changes. The term gender transition procedure means any hormonal or surgical intervention for the purpose of gender transition, including— gonadotropin-releasing hormone (GnRH) agonists or other puberty-blocking or suppressing drugs to stop or delay normal puberty; testosterone, estrogen, progesterone, or other androgens to an individual at doses that are supraphysiologic to what would normally be produced endogenously in a healthy individual of the same age and sex; castration; orchiectomy; scrotoplasty; implantation of erection or testicular prostheses; vasectomy; hysterectomy; oophorectomy; ovariectomy; reconstruction of the fixed part of the urethra with or without a metoidioplasty or a phalloplasty; metoidioplasty; penectomy; phalloplasty; vaginoplasty; clitoroplasty vaginectomy; vulvoplasty; reduction thyrochondroplasty; chondrolaryngoplasty; mastectomy; tubal ligation; sterilization; any plastic, cosmetic, or aesthetic surgery that feminizes or masculinizes the facial or other physiological features of an individual; any placement of chest implants to create feminine breasts; any placement of fat or artificial implants in the gluteal region; augmentation mammoplasty; liposuction; lipofilling; voice surgery; hair reconstruction; pectoral implants; and the removal of any otherwise healthy or non-diseased body part or tissue. The term gender transition procedure does not include the following when furnished to an individual by a health care provider with the consent of such individual or, if applicable, such individual’s parents or legal guardian: Services to individuals born with a medically verifiable disorder of sex development, including an individual with external sex characteristics that are irresolvably ambiguous, such as an individual born with 46 XX chromosomes with virilization, an individual born with 46 XY chromosomes with undervirilization, or an individual born having both ovarian and testicular tissue. Services provided when a physician has otherwise diagnosed a disorder of sexual development in which the 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 healthy individual of the same sex and age. The treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by the performance of gender transition procedures, whether or not the gender transition procedure was performed in accordance with State and Federal law or whether or not funding for the gender transition procedure is permissible under this section. Any procedure undertaken because the individual suffers from a physical disorder, physical injury, or physical illness (but not mental, behavioral, or emotional distress or a mental, behavioral, or emotional disorder) that would, as certified by a physician, place the individual in imminent danger of death or impairment of major bodily function, unless the procedure is performed. Puberty suppression or blocking prescription drugs for the purpose of normalizing puberty for a minor experiencing precocious puberty. Male circumcision. The term male, when used to refer to a natural person, means an individual who naturally has, had, will have, or would have, but for a congenital anomaly, historical accident, or intentional or unintentional disruption, the reproductive system that at some point produces, transports, and utilizes sperm for fertilization. The term sex, when referring to an individual’s sex, means to refer to either male or female, as biologically determined.

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 procedures301.

201. Clarifying application of prohibition to premium credits and cost-sharing reductions under ACA 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 transition procedures, as defined in section 307 of title 1, United States Code (other than any procedure described in section 306 of such title). Paragraph (3) of section 36B(c) of such Code is amended by adding at the end the following new subparagraph: Nothing in subparagraph (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 transition procedures, so long as no credit is allowed under this section with respect to the premiums for such 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 subparagraph, 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). Subsection (h) of section 45R of the Internal Revenue Code of 1986 is amended— by striking Any term and inserting the following: Any term by adding at the end the following new paragraph: In this section, the term qualified health plan does not include any health plan that includes coverage for gender transition procedures, as defined in section 307 of title 1, United States Code (other than any procedure described in section 306 of such title). Nothing in subparagraph (A) shall be construed as prohibiting any employer from purchasing for its employees separate coverage for gender transition procedures described in such subparagraph, 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. 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 subparagraph, or a plan that includes such gender transition procedures, so long as such separate coverage or plan is not paid for with any employer contribution eligible for the credit allowed under this section. 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: 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. The amendments made by subsection (a) shall apply to taxable years ending after the date that is 1 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. (C)Separate coverage or plan for gender transition procedures allowed(i)Option to purchase separate coverage or planNothing in subparagraph (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 transition 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 planNothing 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 subparagraph, 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).. (1)In generalAny term; and (2)Exclusion of health plans including coverage for gender transition procedures(A)In generalIn this section, the term qualified health plan does not include any health plan that includes coverage for gender transition procedures, as defined in section 307 of title 1, United States Code (other than any procedure described in section 306 of such title).(B)Separate coverage or plan for gender transition procedures allowed(i)Option to purchase separate coverage or planNothing in subparagraph (A) shall be construed as prohibiting any employer from purchasing for its employees separate coverage for gender transition procedures described in such subparagraph, 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 planNothing 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 subparagraph, or a plan that includes such gender transition procedures, so long as such separate coverage or plan is not paid for with any employer contribution eligible for the credit allowed under this section.. (8)Coverage consistent with Federal policy regarding gender transition proceduresIn 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..