Protect Children's Innocence Act
This bill places restrictions on the provision of gender affirming care. Gender affirming care includes performing surgery, administering medication, or performing other procedures for the purpose of changing the body of an individual to correspond to a sex that differs from the individual's biological sex.
Specifically, the bill makes it a felony to perform any gender affirming care on a minor and it permits a minor on whom such care is performed to bring a civil action against each individual who provided the care.
Additionally, the bill prohibits the use of federal funds for gender affirming care or for health insurance that covers such care. Such care may not be provided in a federal health care facility or by a federal employee. The bill also prohibits qualified health plans from including coverage for gender affirming care. Further, plans that include coverage for such care are not eligible for federal subsidies.
Finally, the bill prohibits institutions of higher education from offering instruction in gender affirming care. It also makes any non-U.S. national (alien under federal law) who performs gender affirming care on a minor deportable and inadmissible to the United States.
The restrictions under this bill do not apply to the provision of care under certain circumstances such as when an individual does not have normal sex chromosome structure, sex steroid hormone production, or sex steroid hormone action.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1399 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 1399
To amend chapter 110 of title 18, United States Code, to prohibit
gender-affirming care on minors, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 7, 2023
Ms. Greene of Georgia (for herself, Mrs. Miller of Illinois, Mr. Gosar,
Mr. Gooden of Texas, Mr. Grothman, Mr. Duncan, Mrs. Luna, Mrs.
Harshbarger, Mr. Norman, Mr. Nehls, Mr. Good of Virginia, Mr. Hern, Mr.
Rosendale, Mr. Babin, Mr. Lamborn, Mr. Higgins of Louisiana, Mr.
Steube, Ms. Hageman, Mrs. Lesko, and Mr. Biggs) introduced the
following bill; which was referred to the Committee on the Judiciary,
and in addition to the Committees on Ways and Means, Energy and
Commerce, and Education and the Workforce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend chapter 110 of title 18, United States Code, to prohibit
gender-affirming care on minors, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Protect Children's Innocence Act''.
TITLE I--GENDER-AFFIRMING CARE ON MINORS PROHIBITED
SEC. 101. GENDER-AFFIRMING CARE ON MINORS PROHIBITED.
Chapter 110 of title 18, United States Code, is amended--
(1) by adding at the end the following:
``Sec. 2260B. Gender-affirming care on minors
``(a) In General.--Whoever, in any circumstance described in
subsection (e), knowingly performs any gender-affirming care on a minor
is guilty of a class C felony.
``(b) Prohibition on Prosecution of Person on Whom Intervention Is
Performed.--No person on whom the gender-affirming care under
subsection (a) is performed may be arrested or prosecuted for an
offense under this section.
``(c) Civil Action.--A person on whom gender-affirming care is
performed under this section may bring a civil action for appropriate
relief, including compensatory and punitive damages, against each
person who performed the gender-affirming care.
``(d) Definitions.--In this section:
``(1) Gender-affirming care.--
``(A) In general.--For purposes of this chapter,
except as provided in subparagraph (B), the term
`gender-affirming care' means, with respect to an
individual, any of the following:
``(i) Performing any surgery for the
purpose of changing the body of such individual
to correspond to a sex that differs from their
biological sex, including--
``(I) castration;
``(II) orchiectomy;
``(III) scrotoplasty;
``(IV) vasectomy;
``(V) hysterectomy;
``(VI) oophorectomy;
``(VII) ovariectomy;
``(VIII) metoidioplasty;
``(IX) penectomy;
``(X) phalloplasty;
``(XI) vaginoplasty;
``(XII) vaginectomy;
``(XIII) vulvoplasty;
``(XIV) reduction
thyrochondroplasty;
``(XV) chondrolaryngoplasty; and
``(XVI) mastectomy.
``(ii) Any plastic surgery that feminizes
or masculinizes the facial features for the
purposes described in clause (i).
``(iii) Any placement of chest implants to
create feminine breasts for the purposes
described in clause (i).
``(iv) Any placement of fat or artificial
implants in the gluteal region for the purposes
described in clause (i).
``(v) Administering, supplying,
prescribing, dispensing, distributing, or
otherwise conveying to an individual
medications for the purposes described in
clause (i), including--
``(I) gonadotropin-releasing
hormone (GnRH) analogues or other
puberty-blocking drugs to stop or delay
normal puberty;
``(II) testosterone or other
androgens to biological females at
doses that are supraphysiologic to the
female sex; and
``(III) estrogen to biological
males at doses that are
supraphysiologic to the male sex.
``(B) Exception.--Subparagraph (A) shall not apply
to the following individuals:
``(i) An individual with both ovarian and
testicular tissue.
``(ii) An individual with respect to whom a
physician has determined through genetic or
biochemical testing that the individual does
not have normal sex chromosome structure, sex
steroid hormone production, or sex steroid
hormone action.
``(iii) An individual experiencing
infection, disease, injury, or disorder caused
or exacerbated by previous gender transition
procedures.
``(iv) An individual suffering from a
physical disorder, physical injury, or physical
illness that would, as certified by a
physician, place the individual in imminent
danger of death or impairment of a major bodily
function unless the procedure is performed.
``(2) Biological sex.--The term `biological sex' means the
indication of male or female sex by reproductive potential or
capacity, sex chromosomes, naturally occurring sex hormones,
gonads, or internal or external genitalia present at birth.
``(3) Minor.--The term `minor' means any person under the
age of eighteen years.
``(e) Circumstances Described.--For purposes of subsection (a), the
circumstances described in this subsection are that--
``(1) the defendant or victim traveled in interstate or
foreign commerce, or traveled using a means, channel, facility,
or instrumentality of interstate or foreign commerce, in
furtherance of or in connection with the conduct described in
subsection (a);
``(2) the defendant used a means, channel, facility, or
instrumentality of interstate or foreign commerce in
furtherance of or in connection with the conduct described in
subsection (a);
``(3) any payment of any kind was made, directly or
indirectly, in furtherance of or in connection with the conduct
described in subsection (a) using any means, channel, facility,
or instrumentality of interstate or foreign commerce or in or
affecting interstate or foreign commerce;
``(4) the defendant transmitted in interstate or foreign
commerce any communication relating to or in furtherance of the
conduct described in subsection (a) using any means, channel,
facility, or instrumentality of interstate or foreign commerce
or in or affecting interstate or foreign commerce by any means
or in manner, including by computer, mail, wire, or
electromagnetic transmission;
``(5) any instrument, item, substance, or other object that
has traveled in interstate or foreign commerce was used to
perform the conduct described in subsection (a);
``(6) the conduct described in subsection (a) occurred
within the special maritime and territorial jurisdiction of the
United States, or any territory or possession of the United
States; or
``(7) the conduct described in subsection (a) otherwise
occurred in or affected interstate or foreign commerce.
``(f) Rule of Construction.--Nothing in this section shall be
construed as prohibiting provision of the medical services described in
subsection (d)(1)(A) to address legitimate health issues, such as any
male or female reproductive cancers, apart from changing the body to
correspond to a sex that differs from one's biological sex.''; and
(2) by amending the table of sections for such chapter by
adding at the end the following:
``2260B. Gender-affirming care on minors.''.
TITLE II--PROHIBITING FEDERALLY FUNDED GENDER-AFFIRMING CARE
SEC. 201. PROHIBITING TAXPAYER-FUNDED GENDER-AFFIRMING CARE.
Title 1, United States Code, is amended by adding at the end the
following new chapter:
``CHAPTER 4--PROHIBITING TAXPAYER-FUNDED GENDER-AFFIRMING CARE
``301. Prohibition on funding for gender-affirming care.
``302. Prohibition on funding for health benefits plans that cover
gender-affirming care.
``303. Limitation on Federal facilities and employees, Federal lands
and territories, and Tribal territories.
``304. Construction relating to separate coverage.
``305. Construction relating to the use of non-Federal funds for health
coverage.
``306. Construction relating to complications arising from gender-
affirming care.
``307. Treatment of individuals born with medically verifiable disorder
of sex development.
``308. Gender-affirming care defined.
``309. Rule of construction.
``Sec. 301. Prohibition on funding for gender-affirming care
``No funds authorized or appropriated by Federal law, and none of
the funds in any trust fund to which funds are authorized or
appropriated by Federal law, including funds provided under titles
XVIII, XIX, and XXI of the Social Security Act, shall be expended for
any gender-affirming care.
``Sec. 302. Prohibition on funding for health benefits plans that cover
gender-affirming care
``No funds authorized or appropriated by Federal law, and none of
the funds in any trust fund to which funds are authorized or
appropriated by Federal law, shall be expended for health benefits
coverage that includes coverage of gender-affirming care.
``Sec. 303. Limitation on Federal facilities and employees, Federal
lands and territories, and Tribal territories
``No health care service furnished--
``(1) by or in a health care facility owned or operated by
the Federal Government, Federal land or territory, or a Tribal
territory; or
``(2) by any physician or other individual employed by the
Federal Government, Federal land or territory, or a Tribal
territory to provide health care services within the scope of
the physician's or individual's employment,
may include gender-affirming care.
``Sec. 304. Construction relating to separate coverage
``Nothing in this chapter shall be construed as prohibiting any
individual, entity, or State or locality from purchasing separate
coverage for gender-affirming care or health benefits coverage that
includes gender-affirming care so long as such coverage is paid for
entirely using only funds not authorized or appropriated by Federal
law, federal programs, platforms, or infrastructure, such coverage does
not cover any practice that would be subject to penalty under section
2260B of title 18, United States Code, and such coverage shall not be
purchased using matching funds required for a federally subsidized
program, including a State's or locality's contribution of Medicaid
matching funds.
``Sec. 305. Construction relating to the use of non-Federal funds for
health coverage
``Nothing in this chapter shall be construed as restricting the
ability of any non-Federal health benefits coverage provider from
offering coverage for gender-affirming care, or the ability of a State
or locality to contract separately with such a provider for such
coverage, so long as only funds not authorized or appropriated by
Federal law are used, such coverage does not cover any practice that
would be subject to penalty under section 2260B of title 18, United
States Code, and such coverage shall not be purchased using matching
funds required for a federally subsidized program, including a State's
or locality's contribution of Medicaid matching funds.
``Sec. 306. Construction relating to complications arising from gender-
affirming care
``Nothing in this chapter shall be construed to apply to the
treatment of any infection, injury, disease, or disorder that has been
caused by or exacerbated by the performance of a gender-affirming care.
This rule of construction shall be applicable without regard to whether
the gender-affirming care was performed in accord with Federal or State
law, and without regard to whether funding for the gender-affirming
care is permissible under section 307.
``Sec. 307. Treatment of individuals born with medically verifiable
disorder of sex development
``The limitations established in sections 301, 302, and 303 shall
not apply with respect to an individual described in section
2260B(d)(1)(B) of title 18, United States Code.
``Sec. 308. Gender-affirming care defined
``For purposes of this chapter, the term `gender-affirming care'
has the meaning given such term in section 2260B(d)(1) of title 18,
United States Code.
``Sec. 309. Rule of construction
``Nothing in this chapter shall be construed as prohibiting
provision of the medical services described in section 2260B(d)(1)(A)
of title 18, United States Code, to address any male or female
reproductive cancers, apart from changing the body to correspond to a
sex that differs from one's biological sex.''.
SEC. 202. AMENDMENT TO TABLE OF CHAPTERS.
The table of chapters for title 1, United States Code, is amended
by adding at the end the following new item:
``4. Prohibiting taxpayer-funded gender-affirming care...... 301''.
TITLE III--APPLICATION UNDER THE AFFORDABLE CARE ACT
SEC. 301. CLARIFYING APPLICATION OF PROHIBITION TO PREMIUM CREDITS AND
COST-SHARING REDUCTIONS UNDER ACA.
(a) In General.--
(1) Disallowance of refundable credit and cost-sharing
reductions for coverage under qualified health plan which
provides coverage for gender-affirming care.--
(A) In general.--Subparagraph (A) of section
36B(c)(3) of the Internal Revenue Code of 1986 is
amended by inserting before the period at the end the
following: ``or any health plan that includes coverage
for gender-affirming care (other than any gender-
affirming care or treatment described in section 306 or
307 of title 1, United States Code)''.
(B) Option to purchase or offer separate coverage
or plan.--Paragraph (3) of section 36B(c) of such Code
is amended by adding at the end the following new
subparagraph:
``(C) Separate coverage or plan for gender-
affirming care allowed.--
``(i) Option to purchase separate coverage
or plan.--Nothing in subparagraph (A) shall be
construed as prohibiting any individual from
purchasing separate coverage for gender-
affirming care described in such subparagraph,
or a health plan that includes such gender-
affirming care, so long as no credit is allowed
under this section with respect to the premiums
for such coverage or plan and such coverage or
plan does not cover any practice that would be
subject to penalty under section 2260B of title
18, United States Code.
``(ii) Option to offer coverage or plan.--
Nothing in subparagraph (A) shall restrict any
non-Federal health insurance issuer offering a
health plan from offering separate coverage for
gender-affirming care described in such
subparagraph, or a plan that includes such
gender-affirming care, so long as premiums for
such separate coverage or plan are not paid for
with any amount attributable to the credit
allowed under this section (or the amount of
any advance payment of the credit under section
1412 of the Patient Protection and Affordable
Care Act) and such coverage or plan does not
cover any practice that would be subject to
penalty under section 2260B of title 18, United
States Code.''.
(2) Disallowance of small employer health insurance expense
credit for plan which includes coverage for gender-affirming
care.--Subsection (h) of section 45R of the Internal Revenue
Code of 1986 is amended--
(A) by striking ``Any term'' and inserting the
following:
``(1) In general.--Any term''; and
(B) by adding at the end the following new
paragraph:
``(2) Exclusion of health plans including coverage for
gender-affirming care.--
``(A) In general.--The term `qualified health plan'
does not include any health plan that includes coverage
for gender-affirming care (other than any gender-
affirming care or treatment described in section 306 or
307 of title 1, United States Code).
``(B) Separate coverage or plan for gender-
affirming care allowed.--
``(i) Option to purchase separate coverage
or plan.--Nothing in subparagraph (A) shall be
construed as prohibiting any employer from
purchasing for its employees separate coverage
for gender-affirming care described in such
subparagraph, or a health plan that includes
such gender-affirming care, so long as no
credit is allowed under this section with
respect to the employer contributions for such
coverage or plan and such coverage does not
cover any practice that would be subject to
penalty under section 2260B of title 18, United
States Code.
``(ii) Option to offer coverage or plan.--
Nothing in subparagraph (A) shall restrict any
non-Federal health insurance issuer offering a
health plan from offering separate coverage for
gender-affirming care described in such
subparagraph, or a plan that includes such
gender-affirming care, so long as such separate
coverage or plan is not paid for with any
employer contribution eligible for the credit
allowed under this section and such coverage or
plan does not cover any practice that would be
subject to penalty under section 2260B of title
18, United States Code.''.
(b) Application to Multi-State Plans.--Section 1334(a) of Public
Law 111-148 (42 U.S.C. 18054(a)) is amended by adding at the end the
following new paragraph:
``(8) Coverage consistent with federal policy regarding
gender-affirming care.--In entering into contracts under this
subsection, the Director shall ensure that no multi-State
qualified health plan offered in an Exchange provides health
benefits coverage for which the expenditure of Federal funds is
prohibited under chapter 4 of title 1, United States Code.''.
(c) Effective Date.--The amendments made by subsection (a) shall
apply to taxable years ending after the date that is one year after the
date of enactment of this Act, but only with respect to plan years
beginning after such date, and the amendment made by subsection (b)
shall apply to plan years beginning after such date.
TITLE IV--ADDITIONAL PROVISIONS
SEC. 401. PROHIBITION ON INSTITUTIONS OF HIGHER EDUCATION AND
ACCREDITING AGENCIES OR ASSOCIATIONS.
(a) Prohibition on Institutions of Higher Education.--Section
487(a) of the Higher Education Act of 1965 (20 U.S.C. 1094(a)) is
amended by adding at the end the following:
``(30) The institution will not offer instruction in
gender-affirming care (as defined in section 2260B(d) of title
18, United States Code).''.
(b) Prohibition on Accrediting Agencies or Associations.--Section
496(a) of the Higher Education Act of 1965 (20 U.S.C. 1099b(a)) is
amended--
(1) by striking ``and'' at the end of paragraph (7);
(2) by striking the period at the end of paragraph (8) and
inserting ``; and''; and
(3) by adding at the end the following:
``(9) such agency or association does not accredit any
institution that offers instruction in gender-affirming care
(as defined in section 2260B(d) of title 18, United States
Code).''.
SEC. 402. IMMIGRATION CONSEQUENCES WITH RESPECT TO PROVIDING GENDER-
AFFIRMING CARE.
(a) Definitions.--Section 101(a) of the Immigration and Nationality
Act (8 U.S.C. 1101(a)) is amended by adding at the end the following:
``(53) The term `gender-affirming care' shall have the
meaning given such term in section 2260B(d) of title 18, United
States Code.''.
(b) Classes of Aliens Ineligible for Visas or Admission.--Section
212(a)(1)(A) of the Immigration and Nationality Act (8 U.S.C.
1182(a)(1)(A)) is amended--
(1) in clause (iii)(II), strike ``or'' at the end;
(2) in clause (iv), strike the comma at the end and insert
``, or''; and
(3) by adding at the end the following:
``(v) who is determined to have performed
gender-affirming care on a child that has not
attained the age of 18 years old,''.
(c) Classes of Deportable Aliens.--Section 237(a) of the
Immigration and Nationality Act (8 U.S.C. 1227(a)) is amended by adding
at the end the following:
``(8) Gender-affirming care.--Any alien who has performed
gender-affirming care on a child that has not attained the age
of 18 years old is deportable.''.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR H1119-1120)
Referred to the Committee on the Judiciary, and in addition to the Committees on Ways and Means, Energy and Commerce, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on the Judiciary, and in addition to the Committees on Ways and Means, Energy and Commerce, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on the Judiciary, and in addition to the Committees on Ways and Means, Energy and Commerce, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on the Judiciary, and in addition to the Committees on Ways and Means, Energy and Commerce, and Education and the Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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Referred to the Subcommittee on Health.