TRUTH in Coverage Act of 2026
- Sponsor
- Sen. Marshall, Roger [R-KS]
- Committees
- Health, Education, Labor, and Pensions Committee (primary)
- Last action
- Jul 16, 2026
Bottom line
This bill requires health plans that cover gender-affirming care to also cover "detransition" or "reversal" care, treating it equally to other medical benefits.
What it actually does
This bill mandates that group health plans and health insurance issuers that cover "sex-rejecting procedures" must also cover "restorative care" for individuals who have undergone such procedures. This coverage must adhere to the same financial requirements and treatment limitations as other medical and surgical benefits. The bill defines "sex-rejecting procedures" broadly to include various medical and surgical interventions aimed at aligning physical appearance with an asserted identity differing from one's sex, and "restorative care" as items and services to address the harms and complications of such procedures, aiming to restore healthy human form and functioning.
Proponents argue
Supporters argue this bill ensures comprehensive care for individuals who experience adverse effects or regret after undergoing sex-rejecting procedures. They contend it promotes health equity by requiring coverage for restorative care, which they view as essential for addressing potential harms and restoring natural bodily function, without imposing additional financial burdens on those seeking such care. They emphasize the importance of transparency and uniformity in health coverage for all stages of care related to these procedures.
Opponents contend
Opponents might argue that the bill's definitions of "sex-rejecting procedures" and "sex" are politically charged and could stigmatize gender-affirming care, potentially leading to reduced access or increased administrative burdens for plans. They may also contend that mandating coverage for "restorative care" in this manner could be seen as an attempt to undermine or complicate existing coverage for gender-affirming treatments, or that it could lead to disputes over what constitutes "harms" or "restorative care" under the broad definitions.
The bill is concise and its core provisions are clearly stated, making it accessible for a reader to evaluate within a reasonable timeframe.
Section 1
Short Title
This section establishes the official short title of the Act as the "Treatment and Restoration Uniformity and Transparency in Health Coverage Act of 2026" or the "TRUTH in Coverage Act of 2026". This title provides a concise and easily referable name for the legislation.
Supporters argue
A clear and concise short title helps in public discourse and legislative tracking, reflecting the bill's intent to ensure "truth" and "uniformity" in health coverage related to these procedures.
Critics contend
No specific opposition is typically raised against short titles, though the chosen name itself ("TRUTH in Coverage") could be seen by opponents as a rhetorical framing device.
Tradeoffs
None apparent for the short title itself, beyond the inherent framing of the bill's purpose.
Section 2(a), (b), (c) amending PHSA, ERISA, and IRC
Mandate for Coverage of Restorative Care
This core provision requires group health plans and health insurance issuers that provide benefits for any "sex-rejecting procedure" to also provide benefits for "restorative care" to individuals who have received such procedures. This coverage is required regardless of whether the original procedure was covered by the plan or issuer. It also mandates that financial requirements (like deductibles, copays, out-of-pocket maximums, and aggregate lifetime/annual limits) and treatment limitations for restorative care must be no more restrictive than those applied to substantially all other medical and surgical benefits.
Section 2(c)(5), (c)(1), (c)(3) (PHSA, ERISA, IRC)
Definitions of Sex and Biological Sex
This provision explicitly defines "sex" as referring to either male or female, "as genetically determined at fertilization." It further defines "female" as an individual with a reproductive system naturally organized to produce large gametes (ova) and "male" as an individual with a reproductive system naturally organized to produce small gametes (sperm), absent disruption or congenital anomaly.
Section 2(c)(6) (PHSA, ERISA, IRC)
Broad Definition of "Sex-Rejecting Procedure"
This section provides an extensive list of medical and surgical interventions defined as "sex-rejecting procedures." This includes puberty blockers, cross-sex hormones, various surgeries (e.g., castration, hysterectomy, mastectomy, phalloplasty, vaginoplasty), and cosmetic surgeries intended to feminize or masculinize features. It explicitly states these are interventions "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 also lists exceptions for medically verifiable disorders of sex development, treatment of complications from sex-rejecting procedures, life-threatening physical disorders, precocious puberty, and male circumcision.
Section 2(c)(4) (PHSA, ERISA, IRC)
Comprehensive Definition of "Restorative Care"
This section defines "restorative care" as items and services furnished to an individual who has received any "sex-rejecting procedure" to address, mitigate, monitor, treat, or reverse the harms, complications, and adverse effects of such procedure, with the goal of restoring healthy human form and functioning. It provides an extensive list of specific conditions and services covered, including reproductive, endocrine, sexual, urinary, vocal, and skeletal dysfunctions; cardiovascular and metabolic complications; surgical complications; loss or impairment of healthy tissues; reconstructive surgeries; rehabilitation services; psychiatric/psychological conditions; diagnostic testing; and fertility services that "cooperate with, or restore the healthy physiology and anatomy of, the human reproductive system."
Section 2(d)
Effective Date
This section states that the amendments made by this Act will apply with respect to plan years beginning on or after January 1, 2027. This provides a clear timeline for when the new coverage mandates will take effect.
The bill explicitly defines "sex" as referring to either male or female, "as genetically determined at fertilization," and provides specific biological definitions for "female" and "male."
Section 2(c)(5) (PHSA, ERISA, IRC)
Why it matters:While definitions are typically placed in such sections, the highly specific and ideologically charged nature of these definitions, which are foundational to the bill's intent, makes their placement here potentially evasive of immediate scrutiny.
Case for: Supporters argue these definitions provide a clear, objective, and scientifically grounded basis for the bill's provisions, ensuring that "restorative care" aligns with natural biological form and functioning.
Case against: Opponents contend these definitions are exclusionary and do not acknowledge contemporary understandings of gender identity, potentially leading to discrimination against transgender individuals.
Estimated impact: This definition sets the fundamental biological framework for the entire bill, influencing how all other provisions related to "sex-rejecting procedures" and "restorative care" are interpreted and applied.
The definition of "restorative care" includes "fertility services that seek to cooperate with, or restore the healthy physiology and anatomy of, the human reproductive system, without the use of methods that circumvent natural human functions, such as any treatments or procedures that involve the handling of a human egg or embryo outside the body."
Section 2(c)(4)(O) (PHSA, ERISA, IRC)
Why it matters:This level of detail is common in legislative definitions, but the specific phrasing regarding "circumvent natural human functions" and "handling of a human egg or embryo outside the body" is a subtle but significant policy choice that could be overlooked.
Case for: Supporters would argue this ensures that fertility services covered under "restorative care" align with a naturalistic view of human reproduction, consistent with the bill's broader biological definitions.
Case against: Opponents might argue this language implicitly excludes common assisted reproductive technologies like in vitro fertilization (IVF), thereby limiting options for individuals seeking to restore fertility after "sex-rejecting procedures."
Estimated impact: This provision could significantly restrict the types of fertility treatments available under "restorative care" coverage, potentially impacting individuals' ability to conceive after certain procedures.
The bill mandates coverage for "restorative care" "regardless of whether... such individual received benefits with respect to the sex-rejecting procedure under the individual's plan or coverage; or... such plan or issuer provides benefits under the individual's plan or coverage for the sex-rejecting procedure."
Section 2(a) (PHSA, ERISA, IRC)
Why it matters:This is a standard legislative drafting technique, but the implication of this clause is highly significant and could be missed by a reader focusing on the primary mandate.
Case for: Supporters argue this ensures that individuals are not penalized for prior medical decisions or for changes in their insurance coverage, guaranteeing access to necessary restorative care regardless of past circumstances.
Case against: Opponents might argue this creates an unusual mandate, forcing plans to cover the consequences of procedures they did not initially cover or approve, potentially increasing their financial burden without corresponding control over the initial procedure.
Estimated impact: This provision significantly broadens the scope of the mandate, requiring plans that cover any "sex-rejecting procedure" to cover restorative care, even if they explicitly do not cover gender-affirming care itself. This could lead to increased costs for plans and expand access to care for individuals who previously had no coverage for their initial procedures.