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Prohibits the use of federal funds to pay for gender transition procedures and disqualifies health plans that cover those procedures from receiving certain Affordable Care Act (ACA) subsidies and credits. It also directs multi-State plans sold through an Exchange to follow that federal policy, while allowing separate unsubsidized coverage for those procedures. The changes apply to plan years beginning more than one year after enactment and include corresponding taxable-year adjustments.
Adds a new chapter to Title 1, United States Code, that prohibits taxpayer-funded (federally funded) gender transition procedures.
Amends the table of chapters for Title 1, United States Code, by adding an item for the new chapter created above.
Disallow refundable premium tax credit and cost-sharing reductions for coverage under a qualified health plan that provides coverage for gender transition procedures. This amends subparagraph (A) of section 36B(c)(3) of the Internal Revenue Code of 1986 to remove allowance of the credit and cost-sharing reductions for such coverage.
Allows individuals to purchase separate coverage or a health plan that includes gender transition procedures, but specifies that no premium tax credit under section 36B (or advance payments under section 1412 of the Patient Protection and Affordable Care Act) may be allowed with respect to the premiums for such separate coverage. It also allows non-Federal health insurance issuers to offer separate coverage or plans including such procedures, provided premiums are not paid with amounts attributable to the credit or advance payment.
Exclude from eligibility for the small employer health insurance expense credit any health plan that includes coverage for gender transition procedures. This amends subsection (h) of section 45R of the Internal Revenue Code of 1986 to state that the term (for purposes of the credit) does not include any health plan that includes such coverage, as defined in section 307 of title 1, United States Code (other than procedures described in section 306 of that title).
Who is affected and how:
Transgender people: Most directly affected. If their health plan is a qualified Exchange plan or otherwise relies on federal premium tax credits or cost-sharing reductions, coverage for gender transition procedures would not be funded by federal subsidies and could be removed from subsidized plans. That may increase out-of-pocket costs or limit access unless separate, unsubsidized coverage is purchased.
Qualified Exchange enrollees and private insured consumers: Enrollees in plans that would otherwise include gender transition procedures may lose subsidy-eligible coverage for those services, making those plans more expensive for lower- and moderate-income enrollees or prompting plan design changes (exclusions or separate riders).
Insurers and plan issuers (including multi-State plan issuers): Will need to adjust plan offerings, accounting, and compliance to avoid losing eligibility for federal subsidies; they may exclude gender transition procedures from subsidized plans or offer unsubsidized add-ons.
Small employers: Employers claiming the small employer health insurance expense credit could lose that credit if their plan covers gender transition procedures; this may influence employer decisions on plan design and benefits.
Health care providers: Providers who deliver gender transition procedures could see changes in payer mix, reimbursement, and patient demand depending on how insurers restructure coverage and whether patients can purchase separate unsubsidized benefits.
Exchanges and regulators: Federal Exchanges and regulators must implement and enforce the subsidy ineligibility and may need to issue guidance to carriers and consumers; multi-State plans must align with the federal policy.
Potential downstream effects:
Overall, the legislation changes who bears the cost of gender transition procedures (shifting costs away from federal funding and subsidies) and prompts insurers, employers, and Exchanges to alter plan designs or offer separate, unsubsidized coverage options.
Adds a new paragraph (8) to subsection (a) requiring that, in entering into contracts under this subsection, the Director 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.
Adds a new chapter to Title 1, United States Code that prohibits taxpayer-funded gender transition procedures.
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Read twice and referred to the Committee on Finance.
Introduced March 12, 2025 by Roger Wayne Marshall · Last progress March 12, 2025
Read twice and referred to the Committee on Finance.
Introduced in Senate