Sponsor
Joshua David Hawley
Senator · R-MO
Senator · R-MO
The bill removes elective abortion and most gender-transition coverage from ACA Exchange plans—simplifying some federal and insurer obligations and reducing taxpayer exposure—while significantly restricting access and increasing costs and health risks for affected patients, especially low-income people and minors.
Taxpayers and some Exchange enrollees will not have elective abortion covered on ACA Exchange plans (except narrow life/rape/incest exceptions), reducing perceived taxpayer exposure to elective-abortion benefits and aligning plan benefits with those restrictions.
Insurers and federal programs will no longer be expected to cover insurance-paid gender-transition interventions for minors through Exchange plans, reducing insurer exposure and clarifying coverage limits for pediatric gender-related services.
Eliminating the multi-State-plan abortion-exception requirement reduces a statutory obligation for OPM and simplifies a portion of federal multi-State plan administration.
People enrolled in Exchange plans who need abortion care for reasons other than saving the woman's life or for rape/incest will be denied coverage and face higher out-of-pocket costs, disproportionately harming low-income enrollees and people who rely on Exchange plans.
Minors with gender dysphoria will be unable to obtain insurance-covered puberty blockers, cross-sex hormones, or gender-affirming surgeries through Exchange plans, likely increasing out-of-pocket costs, delaying care, and worsening mental-health risks for affected youth and their families.
Narrow medical-exception criteria and new statutory definitions may create administrative complexity for insurers and providers, producing billing confusion, program management burdens, and potential care delays.
Based on analysis of 2 sections of legislative text.
Bars ACA Exchange plans from covering abortion except for life/rape/incest and prohibits Exchange coverage of gender-transition procedures for minors, with narrow exceptions.
Official title: Amend the Patient Protection and Affordable Care Act to exclude coverage of gender-transition procedures for minors and abortion under health plans offered through the American Health Benefits Exchanges, and for other purposes.
Introduced October 15, 2025 by Joshua David Hawley · Last progress October 15, 2025
Prohibits Affordable Care Act exchanges from offering any health plan that covers abortion services except to save the pregnant woman's life or for rape/incest, and bars exchange coverage of gender-transition procedures for minors (under 18), with narrow exceptions for treating complications or averting imminent death/major bodily-function impairment. The bill changes related statutory language, removes a current multi-State plan abortion provision, and makes the rules effective for plan years beginning on or after January 1, 2026.