TRUTH in Coverage Act of 2026
- Sponsor
- Rep. Harshbarger, Diana [R-TN-1]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Jul 16, 2026
Bottom line
The TRUTH in Coverage Act of 2026 requires health plans that cover gender-affirming care to also cover a broad range of services aimed at reversing or mitigating the effects of such care, defining sex as genetically determined at fertilization.
What it actually does
This bill mandates that group health plans and health insurance issuers providing coverage for "sex-rejecting procedures" must also cover "restorative care" to address harms caused by such procedures. It defines "sex-rejecting procedures" as medical or surgical interventions to align physical appearance with an asserted identity differing from an individual's sex, and "restorative care" as services to mitigate or reverse harms and restore healthy form and functioning, regardless of whether the initial procedure was covered.
Proponents argue
Supporters argue this bill ensures comprehensive care for individuals who have undergone gender-affirming procedures and later seek to reverse or address complications from those procedures. They contend it promotes patient safety and choice by guaranteeing coverage for "detransition" or "reversal" care, which they believe is often overlooked or inadequately covered, ensuring individuals can restore their natural form and function to the greatest extent practicable.
Opponents contend
Opponents would likely argue that this bill is an attempt to restrict access to gender-affirming care by imposing burdensome requirements on health plans and stigmatizing such procedures. They may contend that the bill's definitions of "sex-rejecting procedure" and "restorative care" are overly broad and politically motivated, potentially interfering with medical autonomy and established standards of care for transgender and gender non-conforming individuals.
The bill is moderately complex due to its extensive definitions and amendments to multiple acts, requiring careful reading to understand its full scope.
Section 2(a) (PHSA), 2(b) (ERISA), 2(c) (IRC)
Mandated Coverage for Harms of Sex-Rejecting Procedures
This provision requires group health plans and health insurance issuers to provide benefits for items and services that address the harms, complications, and adverse effects of "sex-rejecting procedures." This coverage is mandatory if the plan covers any sex-rejecting procedure, even if the individual's specific procedure was not covered by that plan or issuer, or if the individual received benefits for the initial procedure elsewhere.
Supporters argue
Supporters argue this ensures that individuals who regret or experience complications from gender-affirming care are not left without financial support for necessary medical interventions to restore their health and well-being. They emphasize the importance of comprehensive care throughout an individual's health journey.
Critics contend
Opponents may argue that this provision is designed to create a financial disincentive for health plans to cover gender-affirming care in the first place, as covering any such procedure would trigger a broad, potentially costly, and vaguely defined "restorative care" mandate. They might also contend it imposes an undue burden on plans.
Tradeoffs
The bill balances the desire to ensure coverage for individuals seeking to reverse or mitigate the effects of prior procedures against the potential for increased costs and administrative complexities for health plans, and the broader implications for coverage of gender-affirming care.
Section 2(a) (PHSA) subsection (b), 2(b) (ERISA) subsection (b), 2(c) (IRC) subsection (b)
Parity for Restorative Care Benefits
This provision mandates that financial requirements (like deductibles, copayments, out-of-pocket maximums, aggregate lifetime limits, and annual limits) and treatment limitations (like frequency, duration, or scope of treatment) for "restorative care" cannot be more restrictive than those applied to substantially all other medical and surgical benefits covered by the plan. It also prohibits separate cost-sharing or treatment limitations solely for restorative care.
The bill defines "sex-rejecting procedure" broadly to include any medical or surgical intervention "for the purpose of attempting to align an individual's physical appearance or body with an asserted identity that differs from the individual's sex." It then lists 33 specific procedures, ranging from puberty blockers and cross-sex hormones to various surgeries (e.g., mastectomy, hysterectomy, phalloplasty, vaginoplasty) and cosmetic procedures (e.g., facial feminization/masculinization surgery, breast implants, liposuction, voice surgery). It explicitly defines "sex" as genetically determined at fertilization.
Section 2(a) (PHSA) subsection (c)(6), 2(b) (ERISA) subsection (c)(6), 2(c) (IRC) subsection (c)(6)
Why it matters:This is standard legislative practice for defining key terms, but the sheer breadth and specificity of the list, coupled with the foundational definition of sex, make it highly consequential.
Case for: Proponents would argue that a clear and comprehensive definition is necessary to prevent ambiguity and ensure that health plans understand precisely which procedures trigger the "restorative care" mandate. They believe defining "sex" genetically provides a clear, objective standard.
Case against: Opponents would contend that the definition is intentionally broad and politically charged, encompassing a wide range of medically accepted gender-affirming care under a pejorative term "sex-rejecting." They would argue that defining "sex" solely by genetic determination at fertilization ignores the complexities of gender identity and medical consensus on gender dysphoria treatment.
Estimated impact: This definition dictates the entire scope of the bill's mandate, determining which procedures trigger the requirement for restorative care coverage. It could significantly impact the availability and nature of gender-affirming care coverage.
The bill defines "restorative care" as items and services to "address, mitigate, monitor, treat, or reverse the harms, complications, and adverse effects" of sex-rejecting procedures, "including interventions intended to restore, to the greatest extent practicable, healthy human form and functioning." It lists 17 specific categories of care, including reproductive system injury, endocrine dysfunction, sexual dysfunction, urinary dysfunction, vocal cord damage, secondary-sex-characteristic changes, skeletal disorders, cardiovascular/metabolic complications, surgical complications, loss/alteration of healthy tissues, reconstructive/regenerative surgeries, rehabilitation services, psychiatric/psychological conditions, diagnostic testing/monitoring, and specific fertility services.
Section 2(a) (PHSA) subsection (c)(4), 2(b) (ERISA) subsection (c)(4), 2(c) (IRC) subsection (c)(4)
Why it matters:Standard definition practice, but its breadth is highly significant.
Case for: Proponents argue that this comprehensive definition ensures that individuals seeking to reverse or address complications from prior procedures receive all necessary medical, psychological, and rehabilitative support to regain their health and natural bodily functions.
Case against: Opponents might argue that the definition is so broad and encompassing that it could lead to significant and unpredictable costs for health plans. They might also contend that some listed "harms" are subjective or not universally recognized as direct consequences of gender-affirming care, or that the concept of "restoring healthy human form and functioning" is open to interpretation and could be used to deny other forms of care.
Estimated impact: This definition determines the range of services that health plans must cover, potentially leading to substantial new costs for plans.
The bill explicitly excludes six categories of procedures from the definition of "sex-rejecting procedure": (i) services for individuals with medically verifiable disorders of sex development (intersex conditions), (ii) services for diagnosed disorders of sex development based on genetic/biochemical testing, (iii) treatment of infections/injuries caused or exacerbated by sex-rejecting procedures, (iv) procedures for physical disorders/injuries/illnesses posing imminent danger of death or major bodily function impairment (excluding mental distress), (v) puberty suppression for precocious puberty, and (vi) male circumcision.
Section 2(a) (PHSA) subsection (c)(6)(B), 2(b) (ERISA) subsection (c)(6)(B), 2(c) (IRC) subsection (c)(6)(B)
Why it matters:Standard practice for defining scope, but these exceptions are significant for clarifying the bill's intent and avoiding unintended consequences for other medical conditions.
Case for: Proponents would argue these exceptions demonstrate the bill's careful targeting, ensuring that legitimate medical interventions for intersex conditions, precocious puberty, or life-threatening physical conditions are not inadvertently classified as "sex-rejecting" and that complications from any procedure are treatable.
Case against: Opponents might argue that these exceptions highlight the bill's discriminatory nature by specifically targeting gender-affirming care while carving out other, sometimes analogous, medical interventions. They might also contend that the exclusion of "mental distress" as a justification for certain procedures is problematic.
Estimated impact: These exceptions narrow the scope of the bill, ensuring that certain medical conditions and procedures are not negatively impacted by the new mandates.