Congressional Bill Would Require Insurers to Cover Detransition Care Nationwide

A bill introduced in the U.S. House by Rep. Diana Harshbarger of Tennessee would require private health insurers that cover gender transition procedures to also pay for restorative care for people seeking to reverse or treat complications from those interventions. The Treatment and Restoration Uniformity and Transparency in Health Coverage (TRUTH in Coverage) Act, which has a companion bill in the Senate from Sen. Roger Marshall of Kansas, aims to extend a requirement already in effect in Texas to the national level.

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The proposal highlights a growing debate over insurance obligations and the long-term medical needs of individuals who detransition after undergoing gender-related surgeries or hormone treatments.

The legislation follows a Texas law that compels insurers to cover rehabilitative care for those who detransition after receiving opposite-sex hormones or elective surgeries. The issue has gained attention as more young people, such as Soren Aldaco and Chloe Cole, have spoken publicly about regretting gender transition procedures and facing significant medical costs to address the resulting physical effects. Aldaco's malpractice suit against her therapist was recently allowed to proceed by the Texas Supreme Court, marking a notable legal development.

Bill Requirements and Coverage

The TRUTH in Coverage Act would require insurers that pay for what the bill terms "sex-rejecting procedures"—including opposite-sex hormones and surgeries—to also cover a wide range of restorative treatments. Covered care would include treatment for reproductive and endocrine system injuries, sexual and urinary function, bone degradation, cardiovascular disease, reconstructive surgery, physical therapy, cancer treatment, psychiatric and psychological care, and fertility services. The bill would amend the Public Health Service Act, ERISA, and the Internal Revenue Code, with requirements taking effect for plans starting on or after January 1, 2027, if enacted.

Rep. Harshbarger said in a press release, "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."

"Patients should never be abandoned after undergoing life-altering, harmful medical interventions once reality sets in."

— Rep. Diana Harshbarger, bill sponsor

Chloe Cole, a detransitioner who underwent gender transition procedures as a minor, said, "Kids suffering the harms of sex-rejecting procedures deserve financial access to medical treatments that would reverse those effects."

Transparency and Medical Coding

The bill's supporters argue that it would increase transparency about the long-term effects of gender transition procedures. Dr. Michelle Cretella, Adolescent Health Council co-chair at the American College of Pediatricians, said the law would require insurers to document the extent of harm caused by puberty blockers, cross-sex hormones, and surgeries. Cretella noted that insurance reimbursement is currently hindered by the lack of specific ICD-10 codes for detransition care, making it difficult for patients to access coverage for restorative treatments.

The advocacy group Do No Harm has recommended a new diagnosis code for "Gender Identity Disorder in Remission (Desistance)" to the Centers for Disease Control and Prevention, which could make detransitioners more visible in health records and insurance billing. Cretella said both Do No Harm and ACPeds are "cautiously optimistic" that the CDC will add the code.

Industry and Policy Response

Insurance companies have faced criticism from detransitioners and some lawmakers for covering gender transition procedures but not the subsequent care needed by those who regret or suffer complications from them. Harshbarger, a pharmacist by training, said, "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."

Sen. Roger Marshall, the Senate sponsor, stated, "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."

Supporters of gender-affirming care, including some medical organizations and state officials, argue that such procedures are safe and effective for those who need them. The Federalist reports that these groups have not addressed the specific insurance coverage issues raised by detransitioners or responded to the new legislation.

Broader Context and Next Steps

The bill comes amid ongoing legal and policy battles over gender medicine in the U.S., with some judges blocking efforts to restrict transition procedures for minors and the Justice Department securing agreements with clinics to offer detransition care. The TRUTH in Coverage Act represents a new legislative approach focused on insurance coverage for those seeking to reverse or treat complications from gender procedures. If passed, the law would take effect for insurance plans beginning in 2027.