119-s1551

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1551 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 1551

 To deny tax deductions and other Federal funding for the costs of 
 gender transition procedures.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 May 1, 2025

 Mr. Marshall (for himself, Mr. Ricketts, Mr. Cassidy, and Mr. Lee) 
introduced the following bill; which was read twice and referred to the 
 Committee on Finance

_______________________________________________________________________

 A BILL

 To deny tax deductions and other Federal funding for the costs of 
 gender transition procedures.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``No Subsidies for Gender Transition 
Procedures Act''.

SEC. 2. DENIAL OF MEDICAL EXPENSE TAX DEDUCTION.

    (a) In General.--Subsection
            (d) of 

section 213 of the Internal 
Revenue Code of 1986 is amended by adding at the end the following new 
paragraph:
 ``

    (12) Expenses relating to gender transition.--
 ``
        (A) In general.--The term `medical care' does not 
 include any gender transition procedure.
 ``
        (B) === Definitions. ===
-For purposes of this 
 paragraph--
 ``
            (i) Gender transition procedure.--
 ``
            (I) In general.--The term `gender 
 transition procedure' means any 
 hormonal or surgical intervention for 
 the purpose of gender transition, 
 including--
 ``

    (aa) the provision of 
 gonadotropin-releasing hormone 
 agonists or other puberty-
 suppression drugs or puberty-
 blocking drugs to stop or delay 
 normally-timed puberty in an 
 individual who does not 
 identify as his or her sex,
 ``

    (bb) the provision of 
 testosterone, estrogen, 
 progesterone, or other androgen 
 blockers to an individual at 
 doses which are 
 supraphysiologic to what would 
 normally be produced 
 endogenously in a healthy 
 individual of the same age and 
 sex, with the intent to align 
 an individual's physical 
 appearance with an identity 
 that differs from his or her 
 sex,
 ``
            (cc) surgical procedures 
 that attempt to transform an 
 individual's physical 
 appearance to align with an 
 identity that differs from his 
 or her sex or that attempt to 
 alter or remove an individual's 
 sexual organs to minimize or 
 destroy their natural 
 biological functions,
 ``
            (dd) castration, 
 vasectomy, penectomy, 
 orchiectomy, vaginoplasty, 
 clitoroplasty, vulvoplasty, 
 mastectomy, hysterectomy, 
 oophorectomy, ovariectomy, 
 reconstruction of the fixed 
 part of the urethra with or 
 without metoidioplasty or 
 phalloplasty, metoidioplasty, 
 phalloplasty, vaginectomy, 
 scrotoplasty, implantation of 
 erection or testicular 
 prostheses, reduction 
 thyrochondroplasty, 
 chondrolaryngoplasty, tubal 
 ligation, sterilization, 
 augmentation mammoplasty, 
 placement of chest implants to 
 create feminine breasts, 
 placement of fat or artificial 
 implants in the gluteal region, 
 liposuction, lipofilling, voice 
 surgery, hair reconstruction, 
 pectoral implants, any plastic, 
 cosmetic, or aesthetic surgery 
 which feminizes or masculinizes 
 the facial or other 
 physiological features of an 
 individual, and any removal of 
 any otherwise healthy or non-
 diseased body part or tissue.
 ``
            (II) Exclusions.--The term 
 `gender transition procedure' does not 
 include, 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)--
 ``

    (aa) services to 
 individuals born with a 
 medically verifiable disorder 
 of sex development, including 
 an individual with external sex 
 characteristics which 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,
 ``

    (bb) services relating to 
 any other physician-diagnosed 
 disorder of sexual development 
 with respect to 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 male or female of the 
 same age,
 ``
            (cc) the treatment of any 
 infection, injury, disease, or 
 disorder caused or exacerbated 
 by the performance of gender 
 transition procedures, without 
 regard to whether the gender 
 transition procedure was 
 performed in accordance with 
 State and Federal law or 
 whether the gender transition 
 procedure is treated as medical 
 care under this section,
 ``
            (dd) 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) which 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 to 
 alleviate said physical 
 disorder, physical injury, or 
 physical illness,
 ``

    (ee) procedures to 
 restore or reconstruct the body 
 of the individual in order to 
 correspond to the individual's 
 sex after one or more previous 
 gender transition procedures, 
 which may include the removal 
 of a pseudo phallus or breast 
 augmentation,
 ``

    (ff) puberty suppression 
 or puberty-blocking 
 prescription drugs for the 
 purpose of normalizing puberty 
 for a minor experiencing 
 precocious puberty, or
 ``

    (gg) male circumcision.
 ``
            (ii) Gender transition.--The term `gender 
 transition' means the process by which an 
 individual goes from identifying with or 
 presenting as his or her sex to identifying 
 with or presenting as a self-proclaimed 
 identity which does not correspond with or is 
 different from his or her sex, and may be 
 accompanied by social, legal, or physical 
 changes.
 ``
            (iii) Sex.--The term `sex', when 
 referring to an individual's sex, means either 
 male or female, as biologically determined.
 ``
            (iv) Female.--The term `female', when 
 used to refer to a natural person, means a 
 person belonging, at conception, to the sex 
 characterized by a reproductive system with the 
 biological function of producing eggs

    (ova) .
 ``
            (v) Male.--The term `male', when used to 
 refer to a natural person, means a person 
 belonging, at conception, to the biological sex 
 characterized by a reproductive system with the 
 biological function of producing sperm.''.

    (b) Effective Date.--The amendment made by this section shall apply 
to taxable years beginning after the date of the enactment of this Act.

SEC. 3. PROHIBITING FEDERAL MEDICAID FUNDING FOR GENDER TRANSITION 
 PROCEDURES.

    (a) In General.--

Section 1903
            (i) of the Social Security Act (42 
U.S.C. 1396b
            (i) ) is amended--

    (1) in paragraph

    (26) , by striking ``; or'' and inserting a 
 semicolon;

    (2) in paragraph

    (27) , by striking the period at the end 
 and inserting ``; or'';

    (3) by inserting after paragraph

    (27) the following new 
 paragraph:
 ``

    (28) with respect to any amounts expended for any 
 specified gender transition procedure (as defined in 

section 1905

    (kk) ) to an individual enrolled in a State plan under this 
 title (or a waiver of such plan), including any amounts 
 expended for the administration of a State program that 
 furnishes any such procedure.''; and

    (4) in the flush left matter at the end, by striking ``and

    (18) ,'' and inserting ``

    (18) , and

    (28) ''.

    (b) Prohibiting Federal Medicaid Funding for Gender Transition 
Procedures.--

Section 1905 of the Social Security Act (42 U.S.C. 1396d) 
is amended by adding at the end the following new subsection:
 ``

    (kk) Prohibiting Federal Medicaid Funding for Specified Gender 
Transition Procedures.--
 ``

    (1) Specified gender transition procedures defined.--For 
 purposes of 

section 1903
            (i) (28) , except as provided in 
 paragraph

    (2) , the term `specified gender transition procedure' 
 means, with respect to an individual, any hormonal or surgical 
 intervention for the purpose of gender transition, including--
 ``
        (A) the provision of gonadotropin-releasing 
 hormone agonists or other puberty suppression drugs or 
 puberty-blocking drugs to stop or delay normally timed 
 puberty in an individual who does not identify as his 
 or her sex;
 ``
        (B) the provision of testosterone, estrogen, 
 progesterone, or other androgen blockers to an 
 individual at doses which are supraphysiologic to what 
 would normally be produced endogenously in a healthy 
 individual of the same age and sex, with the intent to 
 align an individual's physical appearance with an 
 identity that differs from his or her sex;
 ``
            (C) surgical procedures that attempt to transform 
 an individual's physical appearance to align with an 
 identity that differs from his or her sex or that 
 attempt to alter or remove an individual's sexual 
 organs to minimize or destroy their natural biological 
 functions; or
 ``
            (D) castration, vasectomy, penectomy, 
 orchiectomy, vaginoplasty, clitoroplasty, vulvoplasty, 
 mastectomy, hysterectomy, oophorectomy, ovariectomy, 
 reconstruction of the fixed part of the urethra with or 
 without metoidioplasty or phalloplasty, metoidioplasty, 
 phalloplasty, vaginectomy, scrotoplasty, implantation 
 of erection or testicular prostheses, reduction 
 thyrochondroplasty, chondrolaryngoplasty, tubal 
 ligation, sterilization, augmentation mammoplasty, 
 placement of chest implants to create feminine breasts, 
 placement of fat or artificial implants in the gluteal 
 region, liposuction, lipofilling, voice surgery, hair 
 reconstruction, pectoral implants, any plastic, 
 cosmetic, or aesthetic surgery which feminizes or 
 masculinizes the facial or other physiological features 
 of an individual, and any removal of any otherwise 
 healthy or non-diseased body part or tissue.
 ``

    (2) Exclusions.--The term `specified gender transition 
 procedure' shall not include, when furnished to an individual 
 by a health care provider with the consent of such individual 
 (or, if applicable, the parents or legal guardian of such 
 individual)--
 ``
        (A) services to individuals born with a medically 
 verifiable disorder of sex development, including an 
 individual with external sex characteristics which 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;
 ``
        (B) services relating to any other physician-
 diagnosed disorder of sexual development with respect 
 to 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 male or female of the same age;
 ``
            (C) the treatment of any infection, injury, 
 disease, or disorder caused or exacerbated by the 
 performance of gender transition procedures, without 
 regard to whether the gender transition procedure was 
 performed in accordance with State and Federal law or 
 whether the gender transition procedure is treated as 
 medical care under this section;
 ``
            (D) 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) which 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 to alleviate 
 said physical disorder, physical injury, or physical 
 illness;
 ``
        (E) any procedure to restore or reconstruct the 
 body of the individual in order to correspond to the 
 individual's sex after 1 or more previous gender 
 transition procedures, which may include the removal of 
 a pseudo phallus or breast augmentation;
 ``
        (F) puberty suppression or puberty-blocking 
 prescription drugs for the purpose of normalizing 
 puberty for an individual experiencing precocious 
 puberty; or
 ``
        (G) male circumcision.
 ``

    (3) Additional 

=== definitions. ===
-For purposes of this 
 subsection:
 ``
        (A) Gender transition.--The term `gender 
 transition' means the process by which an individual 
 goes from identifying with or presenting as his or her 
 sex to identifying with or presenting as a self-
 proclaimed identity which does not correspond with or 
 is different from his or her sex, and may be 
 accompanied by social, legal, or physical changes.
 ``
        (B) Sex.--The term `sex', when referring to an 
 individual's sex, means either male or female, as 
 biologically determined, including as described in 
 subparagraphs
            (C) and
            (D) .
 ``
            (C) Female.--The term `female', when used to 
 refer to a natural person, means an individual 
 belonging, at conception, to the sex characterized by a 
 reproductive system with the biological function of 
 producing eggs

    (ova) .
 ``
            (D) Male.--The term `male', when used to refer to 
 a natural person, means an individual belonging, at 
 conception, to the biological sex characterized by a 
 reproductive system with the biological function of 
 producing sperm.''.
            (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the date of the enactment of 
this Act.

SEC. 4. PROHIBITING FEDERAL CHILDREN'S HEALTH INSURANCE PROGRAM FUNDING 
 FOR GENDER TRANSITION PROCEDURES ON MINORS.

    (a) In General.--

Section 2105
            (c) of the Social Security Act (42 
U.S.C. 1397ee
            (c) ) is amended by adding at the end the following new 
paragraph:
 ``

    (13) Limitation on payment for specified gender 
 transition procedures for minors.--Payment shall not be made to 
 a State under this section for any amount expended under the 
 State plan to pay for specified gender transition procedures 
 (as defined in 

section 1905

    (kk) ) or to assist in the purchase, 
 in whole or in part, of health benefit coverage that includes 
 coverage of any such procedure.''.

    (b) Conforming Amendment.--

Section 2107

    (e)

    (1)
        (N) of the Social 
Security Act (42 U.S.C. 1397gg

    (e)

    (1)
        (N) ) is amended by striking ``and

    (17) '' and inserting ``

    (17) , and

    (28) ''.
            (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after the date of the enactment of 
this Act.

SEC. 5. PROHIBITING FEDERAL MEDICARE FUNDING FOR GENDER TRANSITION 
 PROCEDURES.

    (a) In General.--

Section 1862

    (a) of the Social Security Act (42 
U.S.C. 1395y

    (a) ) is amended--

    (1) in paragraph

    (24) , by striking ``or'' at the end;

    (2) in paragraph

    (25) , by striking the period at the end 
 and inserting ``; or''; and

    (3) by inserting after paragraph

    (25) the following new 
 paragraph:
 ``

    (26) which are specified gender transition procedures (as 
 defined in 

section 1905

    (kk) ).''.

    (b) Effective Date.--The amendments made by subsection

    (a) shall 
apply to items and services furnished on or after the date of the 
enactment of this Act.

SEC. 6. EXCLUSION OF GENDER TRANSITION PROCEDURES FROM ESSENTIAL HEALTH 
 BENEFITS.

 

Section 1302

    (b)

    (2) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18022

    (b)

    (2) ) is amended--

    (1) in the paragraph heading, by striking ``Limitation'' 
 and inserting ``Limitations'';

    (2) by redesignating subparagraph
        (B) as subparagraph
            (C) ;

    (3) by inserting after subparagraph
        (A) the following:
 ``
        (B) Exclusions.--In defining the essential health 
 benefits under paragraph

    (1) , or in revising essential 
 health benefits under paragraph

    (4)
        (H) , the Secretary 
 shall not include the category of gender transition 
 procedures (as defined in 

section 213
            (d) (12)
        (B) of the 
 Internal Revenue Code of 1986) or any items or services 
 covered within such a category.''; and

    (4) in subparagraph
            (C) (as so redesignated), by striking 
 ``paragraph

    (2) '' and inserting ``subparagraph
        (A) ''.
 <all>