No Subsidies for Gender Transition Procedures Act
- Sponsor
- Sen. Marshall, Roger [R-KS]
- Committees
- Finance Committee (primary)
- Last action
- May 1, 2025
Bottom line
The bill aims to eliminate all federal financial support and tax benefits for gender transition procedures across various federal health and tax programs by defining them as outside the scope of 'medical care' or 'essential health benefits.'
What it actually does
This bill prohibits federal tax deductions for expenses related to gender transition procedures and denies federal funding for such procedures under Medicaid, the Children's Health Insurance Program (CHIP) for minors, and Medicare. It also explicitly excludes gender transition procedures from the definition of essential health benefits under the Affordable Care Act. The bill provides extensive definitions of what constitutes a 'gender transition procedure' and lists specific exclusions for medically verifiable disorders of sex development, treatment of complications, and precocious puberty.
Proponents argue
Supporters argue that federal funds and tax benefits should not be used to subsidize procedures they consider elective, experimental, or potentially harmful, particularly for minors. They contend that the bill protects taxpayer money from being used for procedures that are not universally accepted as medically necessary or appropriate, and that it upholds a specific view of biological sex.
Opponents contend
Opponents assert that the bill discriminates against transgender individuals by denying them access to medically necessary care, as recognized by major medical organizations. They argue that it interferes with patient-provider relationships, exacerbates health disparities, and could lead to worse health outcomes for transgender individuals, particularly youth.
The bill is relatively short and clearly written, making it accessible for a reader to understand its core provisions within a reasonable timeframe.
Section 2, Internal Revenue Code of 1986, Section 213(d)(12)
Denial of Medical Expense Tax Deduction for Gender Transition Procedures
This provision amends the Internal Revenue Code to explicitly state that 'gender transition procedures' are not considered 'medical care' for the purpose of tax deductions. This means individuals will no longer be able to deduct expenses related to these procedures from their federal income taxes. The section includes detailed definitions of what constitutes a 'gender transition procedure' and specific exclusions for certain medical conditions.
Supporters argue
Supporters argue this provision ensures taxpayer subsidies do not indirectly support procedures they deem non-essential or controversial. They contend it aligns tax policy with a specific moral or medical viewpoint regarding gender transition.
Critics contend
Opponents contend that denying tax deductions for medically recognized care is discriminatory and places an undue financial burden on transgender individuals. They argue it treats gender-affirming care differently from other forms of medical treatment, despite its recognition by professional medical organizations.
Tradeoffs
The provision balances the government's role in defining deductible medical expenses against the rights of individuals to access and receive financial relief for healthcare, particularly for care that is medically affirmed by some but politically contested by others.
Section 3, Social Security Act, Sections 1903(i) and 1905(kk)
Prohibition of Federal Medicaid Funding for Gender Transition Procedures
This section amends the Social Security Act to prevent federal Medicaid matching funds from being used for 'specified gender transition procedures.' States that choose to cover these procedures would be required to do so entirely with state funds, without federal reimbursement. It also includes comprehensive definitions of what constitutes a 'specified gender transition procedure' and lists specific exclusions for intersex conditions, precocious puberty, and treatment of complications.
Section 4, Social Security Act, Section 2105(c)
Prohibition of Federal CHIP Funding for Gender Transition Procedures on Minors
This section amends the Social Security Act to prohibit federal Children's Health Insurance Program (CHIP) funding from being used for 'specified gender transition procedures' for minors. This means states cannot receive federal matching funds for covering these procedures for children, nor for health benefit coverage that includes such procedures for minors. The definitions from Section 1905(kk) (Medicaid) apply here.
Section 5, Social Security Act, Section 1862(a)
Exclusion of Gender Transition Procedures from Medicare Coverage
This section amends the Social Security Act to explicitly exclude 'specified gender transition procedures' from Medicare coverage. This means Medicare will not pay for any items or services related to these procedures, using the same definitions and exclusions as provided in Section 1905(kk) (Medicaid).
Section 6, Patient Protection and Affordable Care Act, Section 1302(b)(2)
Exclusion of Gender Transition Procedures from Essential Health Benefits
This section amends the Affordable Care Act (ACA) to explicitly prohibit the Secretary of Health and Human Services from including 'gender transition procedures' (as defined in the IRS Code, Section 213(d)(12)(B)) in the definition of essential health benefits (EHBs). This means that health plans offered on ACA marketplaces would not be required to cover these procedures, potentially leading to their exclusion from many plans.
The bill provides highly detailed and exhaustive lists of what constitutes a 'gender transition procedure,' encompassing various hormonal and surgical interventions, and equally detailed exclusions for conditions like medically verifiable disorders of sex development, treatment of complications, and precocious puberty.
Section 2(a) (amending IRC 213(d)(12)(B)) and Section 3(b) (amending SSA 1905(kk))
Why it matters:This level of detail is standard legislative practice for defining terms that will have significant legal and financial implications across multiple federal programs, aiming for clarity and to prevent loopholes. However, its complexity can make it difficult to quickly grasp the full implications.
Case for: Proponents argue that precise definitions are necessary to ensure the bill's intent is clearly understood and applied consistently across different federal programs, preventing misinterpretation or unintended application. They believe it provides legal certainty.
Case against: Opponents might argue that such exhaustive lists could become quickly outdated with medical advancements or could inadvertently exclude new forms of medically necessary care. They might also contend that the specificity reflects an attempt to micromanage medical practice through legislation.
Estimated impact: These definitions are foundational to the entire bill, determining the scope of all funding denials and tax deduction exclusions. Their impact is therefore comprehensive across all affected federal programs and individuals.