I
119THCONGRESS
1
STSESSION H. R. 2202
To prohibit taxpayer-funded gender transition procedures, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
MARCH18, 2025
Mr. L
AMALFAintroduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committees on
the Judiciary, and Ways and Means, for a period to be subsequently de-
termined 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 transition procedures,
and for other purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3
(a) S
HORTTITLE.—This Act may be cited as the 4
‘‘End Taxpayer Funding of Gender Experimentation Act 5
of 2025’’. 6
(b) T
ABLE OFCONTENTS.—The table of contents of 7
this Act is as follows: 8
Sec. 1. Short title; table of contents.
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TITLE I—PROHIBITING FEDERALLY FUNDED GENDER
TRANSITION PROCEDURES
Sec. 101. Prohibiting taxpayer-funded gender transition procedures.
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-1
ALLY FUNDED GENDER TRAN-2
SITION PROCEDURES 3
SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER TRAN-4
SITION PROCEDURES. 5
Title 1, United States Code, is amended by adding 6
at the end the following new chapter: 7
‘‘CHAPTER 4—PROHIBITING TAXPAYER- 8
FUNDED GENDER TRANSITION PROCE-9
DURES 10
‘‘Sec.
‘‘301. Prohibition on funding for gender transition procedures.
‘‘302. Prohibition on funding for health benefits plans that cover gender transi-
tion 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 pro-
cedures.
‘‘307. Definitions.
‘‘§ 301. Prohibition on funding for gender transition 11
procedures 12
‘‘No funds authorized or appropriated by Federal 13
law, and none of the funds in any trust fund to which 14
funds are authorized or appropriated by Federal law, shall 15
be expended for any gender transition procedures. 16
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‘‘§ 302. Prohibition on funding for health benefits 1
plans that cover gender transition proce-2
dures 3
‘‘No funds authorized or appropriated by Federal 4
law, and none of the funds in any trust fund to which 5
funds are authorized or appropriated by Federal law, shall 6
be expended for health benefits coverage that includes cov-7
erage of gender transition procedures. 8
‘‘§ 303. Limitation on Federal facilities and employees 9
‘‘No health care service furnished— 10
‘‘(1) by or in a health care facility owned or op-11
erated by the Federal Government; or 12
‘‘(2) by any physician or other individual em-13
ployed by the Federal Government to provide health 14
care services within the scope of the physician’s or 15
individual’s employment, 16
may include gender transition procedures. 17
‘‘§ 304. Construction relating to separate coverage 18
‘‘Nothing in this chapter shall be construed as pro-19
hibiting any individual, entity, or State or locality from 20
purchasing separate coverage for gender transition proce-21
dures or health benefits coverage that includes gender 22
transition procedures so long as such coverage is paid for 23
entirely using only funds not authorized or appropriated 24
by Federal law and such coverage shall not be purchased 25
using matching funds required for a federally subsidized 26
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program, including a State’s or locality’s contribution of 1
Medicaid matching funds. 2
‘‘§ 305. Construction relating to the use of non-Fed-3
eral funds for health coverage 4
‘‘Nothing in this chapter shall be construed as re-5
stricting the ability of any non-Federal health benefits cov-6
erage provider from offering coverage for gender transi-7
tion procedures, or the ability of a State or locality to con-8
tract separately with such a provider for such coverage, 9
so long as only funds not authorized or appropriated by 10
Federal law are used and such coverage shall not be pur-11
chased using matching funds required for a federally sub-12
sidized program, including a State’s or locality’s contribu-13
tion of Medicaid matching funds. 14
‘‘§ 306. Construction relating to complications arising 15
from gender transition procedures 16
‘‘Nothing in this chapter shall be construed to apply 17
to the treatment of any infection, injury, disease, or dis-18
order that has been caused by or exacerbated by the per-19
formance of a gender transition procedure. 20
‘‘§ 307. Definitions 21
‘‘For purposes of this chapter: 22
‘‘(1) F
EMALE.—The term ‘female’, when used 23
to refer to a natural person, means an individual 24
who naturally has, had, will have, or would have, but 25
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for a congenital anomaly, historical accident, or in-1
tentional or unintentional disruption, the reproduc-2
tive system that at some point produces, transports, 3
and utilizes eggs for fertilization. 4
‘‘(2) G
ENDER TRANSITION.—The term ‘gender 5
transition’ means the process in which an individual 6
goes from identifying with or presenting as his or 7
her sex to identifying with or presenting a self-pro-8
claimed identity that does not correspond with or is 9
different from his or her sex, and may be accom-10
panied with social, legal, or physical changes. 11
‘‘(3) G
ENDER TRANSITION PROCEDURE .— 12
‘‘(A) I
N GENERAL.—The term ‘gender 13
transition procedure’ means any hormonal or 14
surgical intervention for the purpose of gender 15
transition, including— 16
‘‘(i) gonadotropin-releasing hormone 17
(GnRH) agonists or any other puberty- 18
blocking or suppressing drugs to stop or 19
delay normal puberty; 20
‘‘(ii) testosterone, estrogen, progester-21
one, or other androgens to an individual at 22
doses that are supraphysiologic to what 23
would normally be produced endogenously 24
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in a healthy individual of the same age and 1
sex; 2
‘‘(iii) castration; 3
‘‘(iv) orchiectomy; 4
‘‘(v) scrotoplasty; 5
‘‘(vi) implantation of erection or tes-6
ticular prostheses; 7
‘‘(vii) vasectomy; 8
‘‘(viii) hysterectomy; 9
‘‘(ix) oophorectomy; 10
‘‘(x) ovariectomy; 11
‘‘(xi) reconstruction of the fixed part 12
of the urethra with or without a 13
metoidioplasty or a phalloplasty; 14
‘‘(xii) metoidioplasty; 15
‘‘(xiii) penectomy; 16
‘‘(xiv) phalloplasty; 17
‘‘(xv) vaginoplasty; 18
‘‘(xvi) clitoroplasty 19
‘‘(xvii) vaginectomy; 20
‘‘(xviii) vulvoplasty; 21
‘‘(xix) reduction thyrochondroplasty; 22
‘‘(xx) chondrolaryngoplasty; 23
‘‘(xxi) mastectomy; 24
‘‘(xxii) tubal ligation; 25
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‘‘(xxiii) sterilization; 1
‘‘(xxiv) any plastic, cosmetic, or aes-2
thetic surgery that feminizes or 3
masculinizes the facial or other physio-4
logical features of an individual; 5
‘‘(xxv) any placement of chest im-6
plants to create feminine breasts; 7
‘‘(xxvi) any placement of fat or artifi-8
cial implants in the gluteal region; 9
‘‘(xxvii) augmentation mammoplasty; 10
‘‘(xxviii) liposuction; 11
‘‘(xxix) lipofilling; 12
‘‘(xxx) voice surgery; 13
‘‘(xxxi) hair reconstruction; 14
‘‘(xxxii) pectoral implants; and 15
‘‘(xxxiii) the removal of any otherwise 16
healthy or non-diseased body part or tis-17
sue. 18
‘‘(B) E
XCLUSIONS.—The term ‘gender 19
transition procedure’ does not include the fol-20
lowing when furnished to an individual by a 21
health care provider with the consent of such 22
individual or, if applicable, such individual’s 23
parents or legal guardian: 24
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‘‘(i) Services to individuals born with 1
a medically verifiable disorder of sex devel-2
opment, including an individual with exter-3
nal sex characteristics that are irresolvably 4
ambiguous, such as an individual born with 5
46 XX chromosomes with virilization, an 6
individual born with 46 XY chromosomes 7
with undervirilization, or an individual 8
born having both ovarian and testicular 9
tissue. 10
‘‘(ii) Services provided when a physi-11
cian has otherwise diagnosed a disorder of 12
sexual development in which the physician 13
has determined through genetic or bio-14
chemical testing that the individual does 15
not have normal sex chromosome struc-16
ture, sex steroid hormone production, or 17
sex steroid hormone action for a healthy 18
individual of the same sex and age. 19
‘‘(iii) The treatment of any infection, 20
injury, disease, or disorder that has been 21
caused by or exacerbated by the perform-22
ance of gender transition procedures, 23
whether or not the gender transition proce-24
dure was performed in accordance with 25
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State and Federal law or whether or not 1
funding for the gender transition proce-2
dure is permissible under this section. 3
‘‘(iv) Any procedure undertaken be-4
cause the individual suffers from a physical 5
disorder, physical injury, or physical illness 6
(but not claimed mental distress) that 7
would, as certified by a physician, place 8
the individual in imminent danger of death 9
or impairment of major bodily function, 10
unless the procedure is performed. 11
‘‘(v) Puberty suppression or blocking 12
prescription drugs for the purpose of nor-13
malizing puberty for a minor experiencing 14
precocious puberty. 15
‘‘(vi) Male circumcision. 16
‘‘(4) M
ALE.—The term ‘male’, when used to 17
refer to a natural person, means an individual who 18
naturally has, had, will have, or would have, but for 19
a congenital anomaly, historical accident, or inten-20
tional or unintentional disruption, the reproductive 21
system that at some point produces, transports, and 22
utilizes sperm for fertilization. 23
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‘‘(5) SEX.—The term ‘sex’, when referring to 1
an individual’s sex, means to refer to either male or 2
female, as biologically determined.’’. 3
SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 4
The table of chapters for title 1, United States Code, 5
is amended by adding at the end the following new item: 6
‘‘4. Prohibiting taxpayer-funded gender transition pro-
cedures.......................................................................301’’.
TITLE II—APPLICATION UNDER 7
THE AFFORDABLE CARE ACT 8
SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 9
PREMIUM CREDITS AND COST-SHARING RE-10
DUCTIONS UNDER ACA. 11
(a) I
NGENERAL.— 12
(1) D
ISALLOWANCE OF REFUNDABLE CREDIT 13
AND COST-SHARING REDUCTIONS FOR COVERAGE 14
UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 15
COVERAGE FOR GENDER PROCEDURES .— 16
(A) I
N GENERAL.—Subparagraph (A) of 17
section 36B(c)(3) of the Internal Revenue Code 18
of 1986 is amended by inserting before the pe-19
riod at the end the following: ‘‘or any health 20
plan that includes coverage for gender transi-21
tion procedures, as defined in section 307 of 22
title 1, United States Code (other than any pro-23
cedure described in section 306 of such title)’’. 24
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(B) OPTION TO PURCHASE OR OFFER SEP -1
ARATE COVERAGE OR PLAN .—Paragraph (3) of 2
section 36B(c) of such Code is amended by 3
adding at the end the following new subpara-4
graph: 5
‘‘(C) S
EPARATE COVERAGE OR PLAN FOR 6
GENDER TRANSITION PROCEDURES AL -7
LOWED.— 8
‘‘(i) O
PTION TO PURCHASE SEPARATE 9
COVERAGE OR PLAN.—Nothing in subpara-10
graph (A) shall be construed as prohibiting 11
any individual from purchasing separate 12
coverage for gender transition procedures 13
described in such subparagraph, or a 14
health plan that includes such gender tran-15
sition procedures, so long as no credit is 16
allowed under this section with respect to 17
the premiums for such coverage or plan. 18
‘‘(ii) O
PTION TO OFFER COVERAGE OR 19
PLAN.—Nothing in subparagraph (A) shall 20
restrict any non-Federal health insurance 21
issuer offering a health plan from offering 22
separate coverage for gender transition 23
procedures described in such subpara-24
graph, or a plan that includes such gender 25
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transition procedures, so long as premiums 1
for such separate coverage or plan are not 2
paid for with any amount attributable to 3
the credit allowed under this section (or 4
the amount of any advance payment of the 5
credit under section 1412 of the Patient 6
Protection and Affordable Care Act).’’. 7
(2) D
ISALLOWANCE OF SMALL EMPLOYER 8
HEALTH INSURANCE EXPENSE CREDIT FOR PLAN 9
WHICH INCLUDES COVERAGE FOR GENDER TRANSI -10
TION PROCEDURES.—Subsection (h) of section 45R 11
of the Internal Revenue Code of 1986 is amended— 12
(A) by striking ‘‘Any term’’ and inserting 13
the following: 14
‘‘(1) I
N GENERAL.—Any term’’; and 15
(B) by adding at the end the following new 16
paragraph: 17
‘‘(2) E
XCLUSION OF HEALTH PLANS INCLUDING 18
COVERAGE FOR GENDER TRANSITION PROCE -19
DURES.— 20
‘‘(A) I
N GENERAL.—In this section, the 21
term ‘qualified health plan’ does not include 22
any health plan that includes coverage for gen-23
der transition procedures, as defined in section 24
307 of title 1, United States Code (other than 25
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any procedure described in section 306 of such 1
title). 2
‘‘(B) S
EPARATE COVERAGE OR PLAN FOR 3
GENDER TRANSITION PROCEDURES AL -4
LOWED.— 5
‘‘(i) O
PTION TO PURCHASE SEPARATE 6
COVERAGE OR PLAN.—Nothing in subpara-7
graph (A) shall be construed as prohibiting 8
any employer from purchasing for its em-9
ployees separate coverage for gender tran-10
sition procedures described in such sub-11
paragraph, or a health plan that includes 12
such gender transition procedures, so long 13
as no credit is allowed under this section 14
with respect to the employer contributions 15
for such coverage or plan. 16
‘‘(ii) O
PTION TO OFFER COVERAGE OR 17
PLAN.—Nothing in subparagraph (A) shall 18
restrict any non-Federal health insurance 19
issuer offering a health plan from offering 20
separate coverage for gender transition 21
procedures described in such subpara-22
graph, or a plan that includes such gender 23
transition procedures, so long as such sep-24
arate coverage or plan is not paid for with 25
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any employer contribution eligible for the 1
credit allowed under this section.’’. 2
(b) A
PPLICATION TOMULTI-STATEPLANS.—Section 3
1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 4
amended by adding at the end the following new para-5
graph: 6
‘‘(8) C
OVERAGE CONSISTENT WITH FEDERAL 7
POLICY REGARDING GENDER TRANSITION PROCE -8
DURES.—In entering into contracts under this sub-9
section, the Director shall ensure that no multi-State 10
qualified health plan offered in an Exchange pro-11
vides health benefits coverage for which the expendi-12
ture of Federal funds is prohibited under chapter 4 13
of title 1, United States Code.’’. 14
(c) E
FFECTIVEDATE.—The amendments made by 15
subsection (a) shall apply to taxable years ending after 16
the date that is 1 year after the date of enactment of this 17
Act, but only with respect to plan years beginning after 18
such date, and the amendment made by subsection (b) 19
shall apply to plan years beginning after such date. 20
Æ
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