EACH Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 2234 To ensure affordable abortion coverage and care for every person, and for other purposes. IN THE HOUSE OF REPRESENTATIVES MARCH 26, 2021 Ms. LEE of California (for herself, Ms. SCHAKOWSKY, Ms. DEGETTE, Ms. PRESSLEY, Ms. MOORE of Wisconsin, Mr. WELCH, Ms. BARRAGA´N, Ms. SPEIER, Mr. CONNOLLY, Ms. VELA´ZQUEZ, Mr. LAWSON of Florida, Mr. JOHNSON of Georgia, Ms. BASS, Mr. CARSON, Mrs. BEATTY, Ms. MCCOLLUM, Ms. STEVENS, Mr. LOWENTHAL, Ms. STRICKLAND, Mr. NADLER, Ms. GARCIA of Texas, Ms. JACOBS of California, Mrs. LAW- RENCE, Mr. MCGOVERN, Mr. TRONE, Ms. NORTON, Mr. TAKANO, Mr. LEVIN of Michigan, Ms. WILD, Ms. DELBENE, Ms. MENG, Mr. GALLEGO, Ms. CASTOR of Florida, Ms. CLARKE of New York, Mr. CLEAVER, Mr. JONES, Mr. CASTEN, Ms. KAPTUR, Ms. MATSUI, Mr. NEGUSE, Mr. MORELLE, Mr. BLUMENAUER, Mr. CICILLINE, Ms. BLUNT ROCHESTER, Ms. PORTER, Ms. BUSH, Mr. PAYNE, Mr. PANETTA, Mr. TORRES of New York, Mr. ESPAILLAT, Ms. BROWNLEY, Mr. MALINOWSKI, Mr. MOULTON, Mr. DANNY K. DAVIS of Illinois, Mrs. CAROLYN B. MALONEY of New York, Ms. WILLIAMS of Georgia, Ms. PINGREE, Ms. LOIS FRANKEL of Florida, Mr. LIEU, Mr. HASTINGS, Mrs. HAYES, Ms. BONAMICI, Ms. SCHRIER, Mr. HIGGINS of New York, Mr. DEFAZIO, Ms. ROSS, Mrs. NAPOLITANO, Mr. SIRES, Mr. DEUTCH, Mr. TONKO, Mrs. TORRES of California, Ms. UNDERWOOD, Mr. PHILLIPS, Mr. COHEN, Mr. HUFFMAN, Mr. POCAN, Mrs. TRAHAN, Ms. CHU, Ms. DELAURO, Mr. CARBAJAL, Ms. CLARK of Massachusetts, Ms. KUSTER, Mrs. FLETCHER, Mr. CROW, Ms. LEGER FERNANDEZ, Ms. WASSERMAN SCHULTZ, Mr. CASE, Ms. SA´NCHEZ, Mr. SEAN PATRICK MALONEY of New York, Ms. MANNING, Mr. LEVIN of California, Mr. AUCHINCLOSS, Mr. QUIGLEY, Mr. KAHELE, Mr. GRIJALVA, Ms. LOFGREN, Mr. GOMEZ, Mrs. WATSON COLEMAN, Mr. SCHIFF, Mr. EVANS, Mr. SHERMAN, Mr. HIMES, Ms. NEWMAN, Ms. TITUS, Mr. PETERS, Mr. SMITH of Wash- ington, Mr. GARCI´A of Illinois, Mr. FOSTER, Ms. SHERRILL, Mr. MCNER- NEY, Mr. CRIST, Mr. THOMPSON of California, Ms. ADAMS, Ms. TLAIB, Mr. PALLONE, Mr. MEEKS, Mr. PRICE of North Carolina, Mr. LARSEN of Washington, Mr. RYAN, Mrs. MCBATH, Ms. JAYAPAL, Mr. KILDEE, Mr. RASKIN, Mr. DESAULNIER, Mr. BROWN, Ms. WILSON of Florida, Mr. SCHNEIDER, Mr. KEATING, Mr. BERA, Mr. CASTRO of Texas, Ms. OMAR, VerDate Sep 11 2014 02:59 May 25, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H2234.IH H2234 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 2234 IH Ms. OCASIO-CORTEZ, Mr. KILMER, Ms. JOHNSON of Texas, Mr. VARGAS, Mr. KHANNA, Ms. DEAN, Ms. WEXTON, Mr. VEASEY, Mrs. DINGELL, Mr. BEYER, Mr. CA´RDENAS, and Ms. SCANLON) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Natural Resources, Armed Services, Veterans’ Affairs, the Judiciary, Oversight and Reform, and Foreign Affairs, 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 ensure affordable abortion coverage and care for every person, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Equal Access to Abor- 4 tion Coverage in Health Insurance Act of 2021’’ or the 5 ‘‘EACH Act of 2021’’. 6 SEC. 2. FINDINGS. 7 Congress makes the following findings: 8 (1) All people should have access to abortion 9 services regardless of actual or perceived race, color, 10 ethnicity, language, ancestry, citizenship, immigra- 11 tion status, sex (including a sex stereotype; preg- 12 nancy, childbirth, or a related medical condition; 13 sexual orientation or gender identity; and sex char- 14 acteristics), age, disability, or sex work status or be- 15 havior. 16 VerDate Sep 11 2014 02:59 May 25, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2234.IH H2234 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 2234 IH (2) A person’s income level, wealth, or type of 1 insurance should not prevent them from having ac- 2 cess to a full range of pregnancy-related health care, 3 including abortion services. 4 (3) No person should have the decision to have, 5 or not to have, an abortion made for them based on 6 the ability or inability to afford the health care serv- 7 ice. 8 (4) Since 1976, the Federal Government has 9 banned the use of Federal funds to pay for abortion 10 services and allows for exceptions only in very nar- 11 row circumstances. This ban affects people of repro- 12 ductive age in the United States who are insured 13 through the Medicaid program, as well as individuals 14 who receive insurance or care through other feder- 15 ally-funded health programs and plans. 16 (5) Women make up the majority of Medicaid 17 enrollees (54 percent) and, in 2019, approximately 18 14 million women of reproductive age relied on the 19 program for care. Due to systematic barriers and 20 discrimination, a disproportionately higher number 21 of women of color and Lesbian, Gay, Bisexual, 22 Transgender, or Queer (LGBTQ) individuals are en- 23 rolled in the program. 24 VerDate Sep 11 2014 02:59 May 25, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2234.IH H2234 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 2234 IH (6) Women of color are more likely to be in- 1 sured by the Medicaid program. Nationwide, 29 per- 2 cent of Black women and 25 percent of Hispanic 3 women aged 15–49 were enrolled in Medicaid in 4 2018 , compared with 15 percent of white women. 5 (7) In the aggregate, nearly one-fifth (19 per- 6 cent) of Asian American and Pacific Islander women 7 are enrolled in the Medicaid program, while enroll- 8 ment rates for certain Asian ethnic subgroups are 9 much higher (at 62 percent of Bhutanese women, 43 10 percent of Hmong women and 32 percent of Paki- 11 stani women). 12 (8) Medicaid also provides coverage to more 13 than one in four (27 percent) nonelderly American 14 Indian and Alaska Native (AIAN) adults and half of 15 AIAN children. 16 (9) In a 2014 nationwide survey of LGBT peo- 17 ple with incomes less than 400 percent Federal Pov- 18 erty Level (FPL), 61 percent of all respondents had 19 incomes in the Medicaid expansion range—up to 20 138 percent of the FPL—including 73 percent of 21 African-American respondents, 67 percent of Latino 22 respondents, and 53 percent of white respondents. 23 Another survey found that 32 percent of Asian and 24 VerDate Sep 11 2014 02:59 May 25, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2234.IH H2234 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 2234 IH Native Hawaiian/Pacific Islander transgender people 1 were living in poverty. 2 (10) Of women aged 15–44 enrolled in Med- 3 icaid in 2018, 55 percent lived in the 34 States and 4 the District of Columbia where Medicaid does not 5 cover abortion services except in limited cir- 6 cumstances. This amounted to 7.2 million women of 7 reproductive age, including 3 million women living 8 below the FPL. Of this population, Black, Indige- 9 nous, and other People of Color (BIPOC) women ac- 10 counted for 51 percent of those enrolled. 11 (11) The Indian Health Service (IHS) is the 12 federally funded health program for American Indi- 13 ans and Alaska Natives. The IHS serves a popu- 14 lation of approximately 2.56 million and as a feder- 15 ally funded system, since 1988, it has been barred 16 from providing abortion services except for very lim- 17 ited cases. American Indians and Alaska Natives 18 often face higher levels of poverty and limited access 19 to health care for a number of intersecting oppres- 20 sions thus leaving them without recourse for the fed- 21 eral ban on abortion services. 22 (12) Moreover, 26 States also prohibit coverage 23 of abortion services in the marketplaces and 11 pro- 24 hibit coverage in private health insurance plans 25 VerDate Sep 11 2014 02:59 May 25, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2234.IH H2234 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 2234 IH under the Patient Protection and Affordable Care 1 Act of 2010 (Public Law 111–148). 2 (13) A recent report details how restrictions on 3 abortion services coverage interfere with a person’s 4 individual decision-making, with their health and 5 well-being, with their economic security, with their 6 vulnerability to intimate partner violence, and with 7 their constitutionally protected right to a safe and 8 normal health care service. 9 (14) About 25 percent of women covered by 10 Medicaid seeking abortion services must carry their 11 pregnancies to term because they are unable to ob- 12 tain funds for their care. Government-imposed bar- 13 riers to abortion services restrict people’s decisions 14 on if, when, and how to parent, and have long-last- 15 ing and life-altering harmful effects on the pregnant 16 person, their families and their communities. Those 17 who seek and are denied abortion services are more 18 likely to remain in or fall into poverty than those 19 who access the care they need. 20 (15) Restrictions on abortion service coverage 21 have a disproportionately harmful impact on women 22 with low incomes, women of color, immigrant 23 women, LGBTQ people, and young women. Addi- 24 tionally, numerous state-imposed barriers make it 25 VerDate Sep 11 2014 02:59 May 25, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2234.IH H2234 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 2234 IH disparately difficult for low-income people, people of 1 color, immigrants, LGBTQ people, and young people 2 to access the health care and resources necessary to 3 prevent unintended pregnancy or to assure that they 4 are able to carry healthy pregnancies to term. Fur- 5 thermore, young people of reproductive age (15–24) 6 are more likely to have a lower income than those 7 older than that, and this income gap is greater for 8 young BIPOC. More than 40 percent of youth and 9 children under age 19 and almost a quarter of 10 young people age 19 to 25 have health insurance 11 through government programs. Without insurance 12 coverage for abortion services, young people are at 13 greater risk of not having the economic means to af- 14 ford care outside of insurance. Young people face 15 disproportionate access barriers to abortion includ- 16 ing parental involvement requirement (notification 17 and consent) and cost, in addition to barriers to con- 18 traception and inadequate and incomplete sexual(ity) 19 education. These challenges, which are magnified for 20 BIPOC and queer, trans, and nonbinary youth, can 21 cause significant delays in access to needed care, 22 and could ultimately harm the life of the young per- 23 son seeking abortion services. These institutionalized 24 barriers deny young people’s right to bodily auton- 25 VerDate Sep 11 2014 02:59 May 25, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2234.IH H2234 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 2234 IH omy and can force young people to encounter an 1 abusive parent or guardian, ignores trusted relation- 2 ships young people may have with adults other than 3 a parent or legal guardian, and in the case of the 4 judicial bypass process, may force young BIPOC to 5 interact with a legal system that has historically tar- 6 geted and caused harm to communities of color. 7 (16) These and other government-created and 8 government-institutionalized barriers—including the 9 restriction on funding for abortion services in Fed- 10 eral programs—exacerbate and create poverty and 11 racial inequality in income, wealth-generation, and 12 access to services. 13 (17) Access to health care, including abortion 14 services, promotes the general welfare of people liv- 15 ing in the United States. Singling out abortion serv- 16 ices for funding restrictions in health care programs 17 otherwise designed to promote the health and 18 wellbeing of people in the United States has cost 19 pregnant people their lives, their livelihoods, their 20 ability to obtain or maintain economic security for 21 themselves and their families, their ability to meet 22 their family’s basic needs, their ability to continue 23 their education without disruption, and their ability 24 to break free of abusive relationships. 25 VerDate Sep 11 2014 02:59 May 25, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2234.IH H2234 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 2234 IH (18) Like other health care and health insur- 1 ance markets in the United States, abortion services 2 and public insurance programs are commercial ac- 3 tivities that affect interstate commerce. Providers 4 and patients travel across state lines, and otherwise 5 engage in interstate commerce, to provide and access 6 abortion services. Material goods, services, and fed- 7 erally-regulated medications used in abortion serv- 8 ices circulate in interstate commerce. 9 (19) Congress has the authority to enact this 10 Act to ensure affordable coverage of abortion and 11 other services pursuant to— 12 (A) its powers under the necessary and 13 proper clause of Section 8, Article I of the Con- 14 stitution of the United States; 15 (B) its powers under the commerce clause 16 of Section 8, Article 1 of the Constitution of the 17 United States; 18 (C) its powers to tax and spend for the 19 general welfare under Section 8, Article 1 of 20 the Constitution of the United States; and 21 (D) its powers to enforce section 1 of the 22 Fourteenth Amendment under Section 5 of the 23 Fourteenth Amendment to the Constitution of 24 the United States. 25 VerDate Sep 11 2014 02:59 May 25, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2234.IH H2234 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 2234 IH (20) Congress has exercised these constitutional 1 powers to create, expand, and insure health care ac- 2 cess for people in the United States for decades. 3 Pursuant to this constitutional authority, Congress 4 has enacted, and subsequently reauthorized, numer- 5 ous health care programs including but not limited 6 to title XVIII of the Social Security Act of 1965 7 (Medicare); title XIX of the Social Security Act of 8 1965 (Medicaid); and title XXI of the Social Secu- 9 rity Act (Children’s Health Insurance Program, en- 10 acted in 1997). 11 SEC. 3. DEFINITIONS. 12 For purposes of this Act: 13 (1) ABORTION SERVICES.—The term ‘‘abortion 14 services’’ means an abortion and any services related 15 to and provided in conjunction with an abortion, 16 whether or not provided at the same time or on the 17 same day as the abortion. 18 (2) HEALTH PROGRAM OR PLAN.—The term 19 ‘‘health program or plan’’ means the following 20 health programs or plans that pay the cost o [Text truncated for display. Full text available on Congress.gov.]