US
Us Congress House Bill HB2202

Us Congress 2025-2026 Regular Session

Us Congress House Bill HB2202 Compare Versions

Only one version of the bill is available at this time.
OldNewDifferences
11 I
22 119THCONGRESS
33 1
44 STSESSION H. R. 2202
55 To prohibit taxpayer-funded gender transition procedures, and for other
66 purposes.
77 IN THE HOUSE OF REPRESENTATIVES
88 MARCH18, 2025
99 Mr. L
1010 AMALFAintroduced the following bill; which was referred to the Com-
1111 mittee on Energy and Commerce, and in addition to the Committees on
1212 the Judiciary, and Ways and Means, for a period to be subsequently de-
1313 termined by the Speaker, in each case for consideration of such provisions
1414 as fall within the jurisdiction of the committee concerned
1515 A BILL
1616 To prohibit taxpayer-funded gender transition procedures,
1717 and for other purposes.
1818 Be it enacted by the Senate and House of Representa-1
1919 tives of the United States of America in Congress assembled, 2
2020 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3
2121 (a) S
2222 HORTTITLE.—This Act may be cited as the 4
2323 ‘‘End Taxpayer Funding of Gender Experimentation Act 5
2424 of 2025’’. 6
2525 (b) T
2626 ABLE OFCONTENTS.—The table of contents of 7
2727 this Act is as follows: 8
2828 Sec. 1. Short title; table of contents.
2929 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\H2202.IH H2202
3030 ssavage on LAPJG3WLY3PROD with BILLS 2
3131 •HR 2202 IH
3232 TITLE I—PROHIBITING FEDERALLY FUNDED GENDER
3333 TRANSITION PROCEDURES
3434 Sec. 101. Prohibiting taxpayer-funded gender transition procedures.
3535 Sec. 102. Amendment to table of chapters.
3636 TITLE II—APPLICATION UNDER THE AFFORDABLE CARE ACT
3737 Sec. 201. Clarifying application of prohibition to premium credits and cost-
3838 sharing reductions under ACA.
3939 TITLE I—PROHIBITING FEDER-1
4040 ALLY FUNDED GENDER TRAN-2
4141 SITION PROCEDURES 3
4242 SEC. 101. PROHIBITING TAXPAYER-FUNDED GENDER TRAN-4
4343 SITION PROCEDURES. 5
4444 Title 1, United States Code, is amended by adding 6
4545 at the end the following new chapter: 7
4646 ‘‘CHAPTER 4—PROHIBITING TAXPAYER- 8
4747 FUNDED GENDER TRANSITION PROCE-9
4848 DURES 10
4949 ‘‘Sec.
5050 ‘‘301. Prohibition on funding for gender transition procedures.
5151 ‘‘302. Prohibition on funding for health benefits plans that cover gender transi-
5252 tion procedures.
5353 ‘‘303. Limitation on Federal facilities and employees.
5454 ‘‘304. Construction relating to separate coverage.
5555 ‘‘305. Construction relating to the use of non-Federal funds for health coverage.
5656 ‘‘306. Construction relating to complications arising from gender transition pro-
5757 cedures.
5858 ‘‘307. Definitions.
5959 ‘‘§ 301. Prohibition on funding for gender transition 11
6060 procedures 12
6161 ‘‘No funds authorized or appropriated by Federal 13
6262 law, and none of the funds in any trust fund to which 14
6363 funds are authorized or appropriated by Federal law, shall 15
6464 be expended for any gender transition procedures. 16
6565 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
6666 ssavage on LAPJG3WLY3PROD with BILLS 3
6767 •HR 2202 IH
6868 ‘‘§ 302. Prohibition on funding for health benefits 1
6969 plans that cover gender transition proce-2
7070 dures 3
7171 ‘‘No funds authorized or appropriated by Federal 4
7272 law, and none of the funds in any trust fund to which 5
7373 funds are authorized or appropriated by Federal law, shall 6
7474 be expended for health benefits coverage that includes cov-7
7575 erage of gender transition procedures. 8
7676 ‘‘§ 303. Limitation on Federal facilities and employees 9
7777 ‘‘No health care service furnished— 10
7878 ‘‘(1) by or in a health care facility owned or op-11
7979 erated by the Federal Government; or 12
8080 ‘‘(2) by any physician or other individual em-13
8181 ployed by the Federal Government to provide health 14
8282 care services within the scope of the physician’s or 15
8383 individual’s employment, 16
8484 may include gender transition procedures. 17
8585 ‘‘§ 304. Construction relating to separate coverage 18
8686 ‘‘Nothing in this chapter shall be construed as pro-19
8787 hibiting any individual, entity, or State or locality from 20
8888 purchasing separate coverage for gender transition proce-21
8989 dures or health benefits coverage that includes gender 22
9090 transition procedures so long as such coverage is paid for 23
9191 entirely using only funds not authorized or appropriated 24
9292 by Federal law and such coverage shall not be purchased 25
9393 using matching funds required for a federally subsidized 26
9494 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
9595 ssavage on LAPJG3WLY3PROD with BILLS 4
9696 •HR 2202 IH
9797 program, including a State’s or locality’s contribution of 1
9898 Medicaid matching funds. 2
9999 ‘‘§ 305. Construction relating to the use of non-Fed-3
100100 eral funds for health coverage 4
101101 ‘‘Nothing in this chapter shall be construed as re-5
102102 stricting the ability of any non-Federal health benefits cov-6
103103 erage provider from offering coverage for gender transi-7
104104 tion procedures, or the ability of a State or locality to con-8
105105 tract separately with such a provider for such coverage, 9
106106 so long as only funds not authorized or appropriated by 10
107107 Federal law are used and such coverage shall not be pur-11
108108 chased using matching funds required for a federally sub-12
109109 sidized program, including a State’s or locality’s contribu-13
110110 tion of Medicaid matching funds. 14
111111 ‘‘§ 306. Construction relating to complications arising 15
112112 from gender transition procedures 16
113113 ‘‘Nothing in this chapter shall be construed to apply 17
114114 to the treatment of any infection, injury, disease, or dis-18
115115 order that has been caused by or exacerbated by the per-19
116116 formance of a gender transition procedure. 20
117117 ‘‘§ 307. Definitions 21
118118 ‘‘For purposes of this chapter: 22
119119 ‘‘(1) F
120120 EMALE.—The term ‘female’, when used 23
121121 to refer to a natural person, means an individual 24
122122 who naturally has, had, will have, or would have, but 25
123123 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
124124 ssavage on LAPJG3WLY3PROD with BILLS 5
125125 •HR 2202 IH
126126 for a congenital anomaly, historical accident, or in-1
127127 tentional or unintentional disruption, the reproduc-2
128128 tive system that at some point produces, transports, 3
129129 and utilizes eggs for fertilization. 4
130130 ‘‘(2) G
131131 ENDER TRANSITION.—The term ‘gender 5
132132 transition’ means the process in which an individual 6
133133 goes from identifying with or presenting as his or 7
134134 her sex to identifying with or presenting a self-pro-8
135135 claimed identity that does not correspond with or is 9
136136 different from his or her sex, and may be accom-10
137137 panied with social, legal, or physical changes. 11
138138 ‘‘(3) G
139139 ENDER TRANSITION PROCEDURE .— 12
140140 ‘‘(A) I
141141 N GENERAL.—The term ‘gender 13
142142 transition procedure’ means any hormonal or 14
143143 surgical intervention for the purpose of gender 15
144144 transition, including— 16
145145 ‘‘(i) gonadotropin-releasing hormone 17
146146 (GnRH) agonists or any other puberty- 18
147147 blocking or suppressing drugs to stop or 19
148148 delay normal puberty; 20
149149 ‘‘(ii) testosterone, estrogen, progester-21
150150 one, or other androgens to an individual at 22
151151 doses that are supraphysiologic to what 23
152152 would normally be produced endogenously 24
153153 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
154154 ssavage on LAPJG3WLY3PROD with BILLS 6
155155 •HR 2202 IH
156156 in a healthy individual of the same age and 1
157157 sex; 2
158158 ‘‘(iii) castration; 3
159159 ‘‘(iv) orchiectomy; 4
160160 ‘‘(v) scrotoplasty; 5
161161 ‘‘(vi) implantation of erection or tes-6
162162 ticular prostheses; 7
163163 ‘‘(vii) vasectomy; 8
164164 ‘‘(viii) hysterectomy; 9
165165 ‘‘(ix) oophorectomy; 10
166166 ‘‘(x) ovariectomy; 11
167167 ‘‘(xi) reconstruction of the fixed part 12
168168 of the urethra with or without a 13
169169 metoidioplasty or a phalloplasty; 14
170170 ‘‘(xii) metoidioplasty; 15
171171 ‘‘(xiii) penectomy; 16
172172 ‘‘(xiv) phalloplasty; 17
173173 ‘‘(xv) vaginoplasty; 18
174174 ‘‘(xvi) clitoroplasty 19
175175 ‘‘(xvii) vaginectomy; 20
176176 ‘‘(xviii) vulvoplasty; 21
177177 ‘‘(xix) reduction thyrochondroplasty; 22
178178 ‘‘(xx) chondrolaryngoplasty; 23
179179 ‘‘(xxi) mastectomy; 24
180180 ‘‘(xxii) tubal ligation; 25
181181 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
182182 ssavage on LAPJG3WLY3PROD with BILLS 7
183183 •HR 2202 IH
184184 ‘‘(xxiii) sterilization; 1
185185 ‘‘(xxiv) any plastic, cosmetic, or aes-2
186186 thetic surgery that feminizes or 3
187187 masculinizes the facial or other physio-4
188188 logical features of an individual; 5
189189 ‘‘(xxv) any placement of chest im-6
190190 plants to create feminine breasts; 7
191191 ‘‘(xxvi) any placement of fat or artifi-8
192192 cial implants in the gluteal region; 9
193193 ‘‘(xxvii) augmentation mammoplasty; 10
194194 ‘‘(xxviii) liposuction; 11
195195 ‘‘(xxix) lipofilling; 12
196196 ‘‘(xxx) voice surgery; 13
197197 ‘‘(xxxi) hair reconstruction; 14
198198 ‘‘(xxxii) pectoral implants; and 15
199199 ‘‘(xxxiii) the removal of any otherwise 16
200200 healthy or non-diseased body part or tis-17
201201 sue. 18
202202 ‘‘(B) E
203203 XCLUSIONS.—The term ‘gender 19
204204 transition procedure’ does not include the fol-20
205205 lowing when furnished to an individual by a 21
206206 health care provider with the consent of such 22
207207 individual or, if applicable, such individual’s 23
208208 parents or legal guardian: 24
209209 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
210210 ssavage on LAPJG3WLY3PROD with BILLS 8
211211 •HR 2202 IH
212212 ‘‘(i) Services to individuals born with 1
213213 a medically verifiable disorder of sex devel-2
214214 opment, including an individual with exter-3
215215 nal sex characteristics that are irresolvably 4
216216 ambiguous, such as an individual born with 5
217217 46 XX chromosomes with virilization, an 6
218218 individual born with 46 XY chromosomes 7
219219 with undervirilization, or an individual 8
220220 born having both ovarian and testicular 9
221221 tissue. 10
222222 ‘‘(ii) Services provided when a physi-11
223223 cian has otherwise diagnosed a disorder of 12
224224 sexual development in which the physician 13
225225 has determined through genetic or bio-14
226226 chemical testing that the individual does 15
227227 not have normal sex chromosome struc-16
228228 ture, sex steroid hormone production, or 17
229229 sex steroid hormone action for a healthy 18
230230 individual of the same sex and age. 19
231231 ‘‘(iii) The treatment of any infection, 20
232232 injury, disease, or disorder that has been 21
233233 caused by or exacerbated by the perform-22
234234 ance of gender transition procedures, 23
235235 whether or not the gender transition proce-24
236236 dure was performed in accordance with 25
237237 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
238238 ssavage on LAPJG3WLY3PROD with BILLS 9
239239 •HR 2202 IH
240240 State and Federal law or whether or not 1
241241 funding for the gender transition proce-2
242242 dure is permissible under this section. 3
243243 ‘‘(iv) Any procedure undertaken be-4
244244 cause the individual suffers from a physical 5
245245 disorder, physical injury, or physical illness 6
246246 (but not claimed mental distress) that 7
247247 would, as certified by a physician, place 8
248248 the individual in imminent danger of death 9
249249 or impairment of major bodily function, 10
250250 unless the procedure is performed. 11
251251 ‘‘(v) Puberty suppression or blocking 12
252252 prescription drugs for the purpose of nor-13
253253 malizing puberty for a minor experiencing 14
254254 precocious puberty. 15
255255 ‘‘(vi) Male circumcision. 16
256256 ‘‘(4) M
257257 ALE.—The term ‘male’, when used to 17
258258 refer to a natural person, means an individual who 18
259259 naturally has, had, will have, or would have, but for 19
260260 a congenital anomaly, historical accident, or inten-20
261261 tional or unintentional disruption, the reproductive 21
262262 system that at some point produces, transports, and 22
263263 utilizes sperm for fertilization. 23
264264 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
265265 ssavage on LAPJG3WLY3PROD with BILLS 10
266266 •HR 2202 IH
267267 ‘‘(5) SEX.—The term ‘sex’, when referring to 1
268268 an individual’s sex, means to refer to either male or 2
269269 female, as biologically determined.’’. 3
270270 SEC. 102. AMENDMENT TO TABLE OF CHAPTERS. 4
271271 The table of chapters for title 1, United States Code, 5
272272 is amended by adding at the end the following new item: 6
273273 ‘‘4. Prohibiting taxpayer-funded gender transition pro-
274274 cedures.......................................................................301’’.
275275 TITLE II—APPLICATION UNDER 7
276276 THE AFFORDABLE CARE ACT 8
277277 SEC. 201. CLARIFYING APPLICATION OF PROHIBITION TO 9
278278 PREMIUM CREDITS AND COST-SHARING RE-10
279279 DUCTIONS UNDER ACA. 11
280280 (a) I
281281 NGENERAL.— 12
282282 (1) D
283283 ISALLOWANCE OF REFUNDABLE CREDIT 13
284284 AND COST-SHARING REDUCTIONS FOR COVERAGE 14
285285 UNDER QUALIFIED HEALTH PLAN WHICH PROVIDES 15
286286 COVERAGE FOR GENDER PROCEDURES .— 16
287287 (A) I
288288 N GENERAL.—Subparagraph (A) of 17
289289 section 36B(c)(3) of the Internal Revenue Code 18
290290 of 1986 is amended by inserting before the pe-19
291291 riod at the end the following: ‘‘or any health 20
292292 plan that includes coverage for gender transi-21
293293 tion procedures, as defined in section 307 of 22
294294 title 1, United States Code (other than any pro-23
295295 cedure described in section 306 of such title)’’. 24
296296 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
297297 ssavage on LAPJG3WLY3PROD with BILLS 11
298298 •HR 2202 IH
299299 (B) OPTION TO PURCHASE OR OFFER SEP -1
300300 ARATE COVERAGE OR PLAN .—Paragraph (3) of 2
301301 section 36B(c) of such Code is amended by 3
302302 adding at the end the following new subpara-4
303303 graph: 5
304304 ‘‘(C) S
305305 EPARATE COVERAGE OR PLAN FOR 6
306306 GENDER TRANSITION PROCEDURES AL -7
307307 LOWED.— 8
308308 ‘‘(i) O
309309 PTION TO PURCHASE SEPARATE 9
310310 COVERAGE OR PLAN.—Nothing in subpara-10
311311 graph (A) shall be construed as prohibiting 11
312312 any individual from purchasing separate 12
313313 coverage for gender transition procedures 13
314314 described in such subparagraph, or a 14
315315 health plan that includes such gender tran-15
316316 sition procedures, so long as no credit is 16
317317 allowed under this section with respect to 17
318318 the premiums for such coverage or plan. 18
319319 ‘‘(ii) O
320320 PTION TO OFFER COVERAGE OR 19
321321 PLAN.—Nothing in subparagraph (A) shall 20
322322 restrict any non-Federal health insurance 21
323323 issuer offering a health plan from offering 22
324324 separate coverage for gender transition 23
325325 procedures described in such subpara-24
326326 graph, or a plan that includes such gender 25
327327 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
328328 ssavage on LAPJG3WLY3PROD with BILLS 12
329329 •HR 2202 IH
330330 transition procedures, so long as premiums 1
331331 for such separate coverage or plan are not 2
332332 paid for with any amount attributable to 3
333333 the credit allowed under this section (or 4
334334 the amount of any advance payment of the 5
335335 credit under section 1412 of the Patient 6
336336 Protection and Affordable Care Act).’’. 7
337337 (2) D
338338 ISALLOWANCE OF SMALL EMPLOYER 8
339339 HEALTH INSURANCE EXPENSE CREDIT FOR PLAN 9
340340 WHICH INCLUDES COVERAGE FOR GENDER TRANSI -10
341341 TION PROCEDURES.—Subsection (h) of section 45R 11
342342 of the Internal Revenue Code of 1986 is amended— 12
343343 (A) by striking ‘‘Any term’’ and inserting 13
344344 the following: 14
345345 ‘‘(1) I
346346 N GENERAL.—Any term’’; and 15
347347 (B) by adding at the end the following new 16
348348 paragraph: 17
349349 ‘‘(2) E
350350 XCLUSION OF HEALTH PLANS INCLUDING 18
351351 COVERAGE FOR GENDER TRANSITION PROCE -19
352352 DURES.— 20
353353 ‘‘(A) I
354354 N GENERAL.—In this section, the 21
355355 term ‘qualified health plan’ does not include 22
356356 any health plan that includes coverage for gen-23
357357 der transition procedures, as defined in section 24
358358 307 of title 1, United States Code (other than 25
359359 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
360360 ssavage on LAPJG3WLY3PROD with BILLS 13
361361 •HR 2202 IH
362362 any procedure described in section 306 of such 1
363363 title). 2
364364 ‘‘(B) S
365365 EPARATE COVERAGE OR PLAN FOR 3
366366 GENDER TRANSITION PROCEDURES AL -4
367367 LOWED.— 5
368368 ‘‘(i) O
369369 PTION TO PURCHASE SEPARATE 6
370370 COVERAGE OR PLAN.—Nothing in subpara-7
371371 graph (A) shall be construed as prohibiting 8
372372 any employer from purchasing for its em-9
373373 ployees separate coverage for gender tran-10
374374 sition procedures described in such sub-11
375375 paragraph, or a health plan that includes 12
376376 such gender transition procedures, so long 13
377377 as no credit is allowed under this section 14
378378 with respect to the employer contributions 15
379379 for such coverage or plan. 16
380380 ‘‘(ii) O
381381 PTION TO OFFER COVERAGE OR 17
382382 PLAN.—Nothing in subparagraph (A) shall 18
383383 restrict any non-Federal health insurance 19
384384 issuer offering a health plan from offering 20
385385 separate coverage for gender transition 21
386386 procedures described in such subpara-22
387387 graph, or a plan that includes such gender 23
388388 transition procedures, so long as such sep-24
389389 arate coverage or plan is not paid for with 25
390390 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H2202.IH H2202
391391 ssavage on LAPJG3WLY3PROD with BILLS 14
392392 •HR 2202 IH
393393 any employer contribution eligible for the 1
394394 credit allowed under this section.’’. 2
395395 (b) A
396396 PPLICATION TOMULTI-STATEPLANS.—Section 3
397397 1334(a) of Public Law 111–148 (42 U.S.C. 18054(a)) is 4
398398 amended by adding at the end the following new para-5
399399 graph: 6
400400 ‘‘(8) C
401401 OVERAGE CONSISTENT WITH FEDERAL 7
402402 POLICY REGARDING GENDER TRANSITION PROCE -8
403403 DURES.—In entering into contracts under this sub-9
404404 section, the Director shall ensure that no multi-State 10
405405 qualified health plan offered in an Exchange pro-11
406406 vides health benefits coverage for which the expendi-12
407407 ture of Federal funds is prohibited under chapter 4 13
408408 of title 1, United States Code.’’. 14
409409 (c) E
410410 FFECTIVEDATE.—The amendments made by 15
411411 subsection (a) shall apply to taxable years ending after 16
412412 the date that is 1 year after the date of enactment of this 17
413413 Act, but only with respect to plan years beginning after 18
414414 such date, and the amendment made by subsection (b) 19
415415 shall apply to plan years beginning after such date. 20
416416 Æ
417417 VerDate Sep 11 2014 17:14 Mar 31, 2025 Jkt 059200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6301 E:\BILLS\H2202.IH H2202
418418 ssavage on LAPJG3WLY3PROD with BILLS