Sponsors (14)
The bill trades reduced federal spending on and federal subsidies for gender transition procedures and clearer restrictions on federally funded plans for reduced access and higher costs for transgender people, greater burdens on some employers and low-income enrollees, and legal and administrative uncertainty.
Taxpayers and the federal budget: the bill prevents federal funds and premium tax credits from subsidizing gender transition procedures, reducing federal spending tied to those services.
People and small employers who object to subsidizing gender transition care: individuals who oppose such funding will not have their premium tax credits used to subsidize those services, and employers can structure separate plans to avoid losing the small-employer credit.
Federal oversight of multi-State exchange plans: the bill directs the responsible official to prevent federally funded exchange plans from covering services barred by law, maintaining a clear federal funding boundary for those plans.
Transgender people (including federal employees) who need gender transition–related care: the bill would reduce or eliminate federal coverage and subsidies for medically recommended transition procedures, increasing out-of-pocket costs and barriers to access.
Low-income individuals choosing plans that cover gender transition procedures: those enrollees would be ineligible for premium tax credits for those plans, making coverage significantly more expensive or effectively unaffordable.
Legal and civil-rights risks for transgender people: prohibiting federal funding for transition care may limit medical decision-making and invite litigation on discrimination and equal-protection grounds.
Based on analysis of 4 sections of legislative text.
Disallows ACA premium tax credits and the small-employer tax credit for plans that cover gender transition procedures, requires multi-State Exchange plans to exclude federally prohibited coverage, and allows separate unsubsidized plans.
Introduced March 12, 2025 by Roger Wayne Marshall · Last progress March 12, 2025
Prohibits use of federal funds for gender transition procedures by adding a new chapter to Title 1 of the U.S. Code (the text of the prohibition is not included in the provided summary). It also changes tax and health-plan rules so that premium tax credits under the Affordable Care Act and the small-employer health insurance credit cannot be used for qualified health plans that cover gender transition procedures. Allows people or employers to buy—and issuers to offer—separate plans or separate coverage that include gender transition procedures, but those separate plans cannot be paid for with the disallowed tax credits or advance credit payments. The bill also directs the administrator of multi-State Exchange plans to ensure no multi-State qualified health plan includes coverage barred by the new Title 1 chapter. The tax and plan changes take effect for taxable years and plan years beginning more than one year after enactment (with precise timing tied to taxable year/plan year language).