Rep. Diana Harshbarger of Tennessee has introduced legislation that would require private insurance companies nationwide to cover medical treatments for individuals seeking to reverse the effects of gender transition procedures, marking a significant expansion of requirements first enacted in Texas last year.
The Treatment and Restoration Uniformity and Transparency in Health Coverage (TRUTH in Coverage) Act, which has a companion bill in the Senate introduced by Sen. Roger Marshall of Kansas, would mandate that insurers offering coverage for gender transition procedures also pay for what the bill terms “restorative care” for those who detransition.
“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,” Harshbarger said in a press release announcing the proposal. “Patients should never be abandoned after undergoing life-altering, harmful medical interventions once reality sets in.”
Texas Law Serves as Model
The federal proposal follows landmark Texas legislation passed last year that established similar insurance coverage requirements at the state level. That law requires insurers that cover transition procedures to also cover rehabilitative care for individuals who detransition after receiving cross-sex hormones and surgeries.
The federal bill would amend the Public Health Service Act, the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code. If passed, the law would take effect for insurance plans starting on or after January 1, 2027.
Under the proposed legislation, covered restorative care would include treatment for impaired reproductive and endocrine systems, sexual and urinary function injuries, effects of cross-sex hormones on physiology, bone degradation, cardiovascular disease, reconstructive surgery, physical therapy, cancer treatment, psychiatric and psychological treatment, testing, and fertility care. The bill specifies that these coverage requirements would include copayments and deductibles.
Detransitioners Support Effort
The legislation has drawn support from individuals who underwent gender transition procedures as minors and later reversed course. Soren Aldaco, who had a double mastectomy at age 19 on the recommendation of a therapist and later sued for malpractice in a case the Texas Supreme Court allowed to proceed, called the expense of post-transition medical care “too often overlooked.”
Chloe Cole, another detransitioner who underwent medical transition as a minor, also endorsed the bill. “Kids suffering the harms of sex-rejecting procedures deserve financial access to medical treatments that would reverse those effects,” Cole said.
Insurance Coding Challenges
A major obstacle for detransitioners seeking medical care has been the absence of standardized diagnosis codes in the insurance reimbursement system. Insurance coverage relies heavily on ICD-10 codes — standardized diagnosis numbers created by the World Health Organization and managed by the Centers for Disease Control and Prevention.
While approved diagnosis codes supporting gender transition procedures exist in the system, codes specifically for detransition do not currently exist, creating difficulties for healthcare providers seeking reimbursement for restorative treatments.
In response, the organization Do No Harm has recommended a new code for “Gender Identity Disorder in Remission (Desistance)” to the CDC. According to Dr. Michelle Cretella, Adolescent Health Council co-chair at the American College of Pediatricians, implementing such a code would make detransitioners visible in health care records, insurance billing, and research. Cretella said Do No Harm and the American College of Pediatricians are “cautiously optimistic” the CDC will adopt the change.
Medical Protocols Still Developing
The medical challenges facing detransitioners extend beyond insurance coverage. Specific clinical guidelines for tapering patients off cross-sex hormone regimens do not yet exist, and developing comprehensive treatment protocols would require coordination among healthcare professionals across multiple specialties, according to Cretella.
The legislation notably exempts legitimate medical treatments for rare sexual development disorders “determined through genetic or biochemical testing” from its definition of “sex-rejecting procedures.”
Broader Policy Context
The TRUTH in Coverage Act represents a new approach in ongoing policy debates over gender transition procedures. While some federal judges have recently blocked attempts to end transgender surgeries for minors through administrative action, this legislative approach would create financial incentives for insurers to carefully evaluate coverage of transition procedures, given the potential liability for long-term restorative care.
Cretella described the bill as providing “long-overdue justice” and argued it would create “an unprecedented level of transparency” regarding the medical effects of transition procedures. She contended that insurance companies have overlooked systemic harm “across multiple organ systems” caused by puberty blockers, cross-sex hormones, and surgeries for more than a decade.
The legislation’s prospects in Congress remain uncertain, but it signals a shift in the policy debate from solely restricting access to transition procedures toward establishing requirements for long-term medical support for those who reverse course.
Source: thefederalist.com — https://thefederalist.com/2026/08/03/bill-would-make-insurance-cover-body-acceptance-treatments-for-trans-desisters/