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Prohibits health plans offered through the ACA Exchanges from covering most abortions (allowing only life-saving care and rape/incest exceptions) and bars Exchange plans from covering specified gender-transition procedures for people under 18. Defines "gender-transition procedure" to include puberty blockers, cross-sex hormones, and surgeries, with narrow medical exceptions, and makes the changes effective for plan years beginning on or after January 1, 2026.
The bill aligns Exchange plan coverage with purchasers' and parents' preferences by excluding elective abortion and certain gender-transition services, at the cost of reduced access to care for pregnant people and transgender minors, greater out-of-pocket and state costs, and added administrative and legal burdens.
People who oppose elective abortion coverage will not find Exchange plans that include elective abortion services, aligning plan options with those purchasers' preferences.
Parents of minors who oppose gender-transition procedures will not have Exchange plans that cover puberty blockers, cross-sex hormones, or gender-affirming surgery for their children, reflecting parental preferences.
Pregnant people seeking abortion care for reasons other than life endangerment, rape, or incest will be denied Exchange coverage, increasing out-of-pocket costs and creating access barriers.
Removing abortion and certain gender-related care from Exchange plans will shift costs onto individuals, families, or state programs, reducing comprehensiveness of coverage and potentially increasing uncompensated care.
Minors who need puberty blockers, cross-sex hormones, or gender-affirming surgery will be excluded from Exchange plan coverage, limiting access to medically recommended care and increasing financial burdens on families.
Introduced October 15, 2025 by Joshua David Hawley · Last progress October 15, 2025