HARSHBARGER INTRODUCES LEGISLATION TO HOLD INSURANCE COMPANIES ACCOUNTABLE FOR SEX-REJECTING PROCEDURE HARMS

The following information was released by the office of Tennessee Rep. Diana Harshbarger:

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Washington, D.C. Congresswoman Diana Harshbarger (R-TN) today introduced the Treatment and Restoration Uniformity and Transparency in Health Coverage (TRUTH in Coverage) Act, legislation requiring health insurance plans that cover sex-rejecting procedures to also cover restorative care for patients who suffer complications, adverse outcomes, or seek to restore healthy bodily function. Sen. Roger Marshall (R-KS) introduced companion legislation in the Senate.

"It's outrageous that a health plan can cover sex-rejecting procedures but refuse to cover the restorative care patients need to address the harm they cause. That's not a fair deal for patients who want to restore healthy bodily function," said Congresswoman Diana Harshbarger. "Patients should never be abandoned after undergoing life-altering, harmful medical interventions once reality sets in. As a pharmacist, I've seen insurance companies find every excuse in the book to avoid paying for the care patients actually need. My TRUTH in Coverage Act restores fairness, promotes transparency, and ensures patients aren't left paying the price for care their insurance should cover."

"As physicians, we take an oath to first do no harm. Unfortunately, too many Americans have undergone irreversible gender transition procedures only to be left with life-changing complications and nowhere to turn," said Senator Roger Marshall. "Insurance companies have been more than willing to profit by covering these procedures, but when patients need care to treat complications and restore healthy human function, they're often left on their own. That's wrong. Patients deserve transparency before making life-altering medical decisions, and insurance companies should be consistent in their coverage when those decisions result in lifelong complications."

Across the country, many private health insurance companies have profited handsomely by covering sex-rejecting procedures that aim to alter a person's biological and anatomical characteristics. Yet patients who later experience complications, adverse medical outcomes, or seek restorative treatment often discover that while their insurance covered the original sex-rejecting procedures, it refuses to cover the care needed to treat resulting injuries or restore healthy bodily function.

The TRUTH in Coverage Act establishes a uniform federal coverage standard across private insurance markets by amending the Public Health Service Act, the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code (IRC). The legislation applies not only to state-regulated health insurance plans but also to self-funded employer health plans governed by ERISA, ensuring protections for patients nationwide.

Under the bill, any health plan that elects to cover sex-rejecting procedures or is required to cover them by state or local law or regulation, must provide coverage for restorative care under terms that are no more restrictive than those applied to the original procedures. This includes deductibles, copayments, coinsurance, prior authorization requirements, and other treatment limitations.

The legislation does not require any health plan to cover sex-rejecting procedures. Rather, it ensures that if a plan provides such coverage, it must also cover healthcare to address the harm caused by these procedures, and to restore healthy human form and functioning, to the greatest extent practicable. The requirements would take effect for plan years beginning on or after January 1, 2027.

Reps. Brian Babin (R-TX), Sheri Biggs (R-SC), Earl L. "Buddy" Carter (R-GA), "Judge" John Carter (R-TX), Juan Ciscomani (R-AZ), Clay Fuller (R-GA), Abe Hamadeh (R-AZ), Mike Kennedy (R-UT), John McGuire (R-VA), Mary Miller (R-IL), Marlin Stutzman (R-IN), and Matt Van Epps (R-TN) join as original cosponsors. Sen. Lummis (R-WY) is an original cosponsor in the Senate.

KEY PROVISIONS:

Requires health plans that cover sex-rejecting procedures to also cover restorative care addressing resulting harms, regardless of when the original procedure occurred or which plan covered it.

Prohibits insurers from imposing separate, more restrictive cost-sharing or treatment limitations on restorative care than those applicable to the original procedures.

Defines restorative care broadly to include treatment for reproductive injury, endocrine dysfunction, cardiovascular and metabolic complications, surgical complications, mental health conditions, and other harms tied to sex-rejecting procedures.

Preserves exceptions for treatment of documented disorders of sex development, emergency medical care, treatment of precocious puberty, and male circumcision.

Establishes a uniform federal standard applicable to both state-regulated health insurance markets and ERISA self-funded employer health plans.