EACH Act of 2023

I 118TH CONGRESS 1ST SESSION H. R. 561 To ensure affordable abortion coverage and care for every person, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JANUARY 26, 2023 Ms. LEE of California (for herself, Ms. DEGETTE, Ms. SCHAKOWSKY, Ms. PRESSLEY, Mr. SCHIFF, Mr. SMITH of Washington, Mr. ESPAILLAT, Mr. GREEN of Texas, Ms. ADAMS, Mr. BERA, Mr. CARSON, Ms. SALINAS, Mr. KIM of New Jersey, Ms. CRAIG, Ms. KUSTER, Ms. BALINT, Ms. MCCOL- LUM, Mr. FOSTER, Mrs. WATSON COLEMAN, Mr. SCHNEIDER, Mr. SHER- MAN, Mr. HIGGINS of New York, Ms. PETTERSEN, Mr. RUPPERSBERGER, Ms. PINGREE, Mr. DELUZIO, Mr. PAPPAS, Mr. ALLRED, Ms. BUSH, Mr. GOLDMAN of New York, Mr. KILDEE, Mr. DAVIS of Illinois, Mr. SOTO, Mr. CICILLINE, Mr. TRONE, Mr. PHILLIPS, Mrs. DINGELL, Ms. WASSERMAN SCHULTZ, Ms. ROSS, Mr. KILMER, Ms. TITUS, Mr. PAYNE, Mr. BEYER, Ms. MATSUI, Mr. EVANS, Mr. BLUMENAUER, Mr. CASE, Ms. NORTON, Mr. CLEAVER, Mr. SWALWELL, Mr. PALLONE, Ms. WILSON of Florida, Mr. CONNOLLY, Mrs. NAPOLITANO, Ms. MENG, Mr. CASAR, Mr. STANTON, Mr. MEEKS, Ms. MOORE of Wisconsin, Ms. STEVENS, Mr. JOHNSON of Georgia, Ms. SCHOLTEN, Ms. OMAR, Mr. CORREA, Mrs. HAYES, Mr. AUCHINCLOSS, Mr. BOWMAN, Mr. MCGOVERN, Mr. HUFFMAN, Mr. MOSKOWITZ, Ms. CROCKETT, Mr. CROW, Mr. JACKSON of North Carolina, Ms. WEXTON, Mr. NADLER, Mr. GARCI´A of Illinois, Ms. TOKUDA, Mr. HIMES, Mr. GOMEZ, Mr. PANETTA, Mr. CASTRO of Texas, Mr. NEGUSE, Mr. LARSON of Connecticut, Mr. GARAMENDI, Mr. SARBANES, Mr. MORELLE, Mr. GOTTHEIMER, Mrs. BEATTY, Mr. VARGAS, Ms. CHU, Ms. BROWNLEY, Ms. CASTOR of Florida, Ms. MAN- NING, Ms. PORTER, Mr. MULLIN, Ms. SCHRIER, Mr. MFUME, Ms. UNDERWOOD, Ms. SA´NCHEZ, Ms. BLUNT ROCHESTER, Mrs. FLETCHER, Mr. DOGGETT, Ms. LOIS FRANKEL of Florida, Mrs. TRAHAN, Mrs. MCBATH, Ms. DEAN of Pennsylvania, Mr. VEASEY, Ms. KAPTUR, Ms. STRICKLAND, Mr. DESAULNIER, Mr. POCAN, Mr. TAKANO, Ms. SCAN- LON, Mr. CARTWRIGHT, Ms. STANSBURY, Mr. LEVIN, Mr. QUIGLEY, Mr. THOMPSON of California, Ms. SHERRILL, Ms. BARRAGA´N, Ms. WILLIAMS of Georgia, Ms. BUDZINSKI, Mrs. TORRES of California, Ms. VELA´ZQUEZ, Mr. RYAN, Mr. TONKO, Mr. AGUILAR, Ms. JAYAPAL, Mr. KRISHNAMOORTHI, Ms. TLAIB, Mr. GRIJALVA, Mr. RUIZ, Mr. LARSEN of Washington, Mr. TORRES of New York, Mr. KHANNA, Mr. MENENDEZ, VerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H561.IH H561 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 561 IH Mr. SCOTT of Virginia, Mr. ROBERT GARCIA of California, Ms. KELLY of Illinois, Ms. DELAURO, Mr. GALLEGO, Mr. CARBAJAL, Ms. JACOBS, Mr. PETERS, Mr. CASTEN, Mr. MOULTON, Ms. DAVIDS of Kansas, Mrs. CHERFILUS-MCCORMICK, Ms. JACKSON LEE, Ms. BROWN, Mr. COHEN, Ms. WILD, Mrs. LEE of Nevada, Ms. DELBENE, Ms. BONAMICI, Ms. KAMLAGER-DOVE, Ms. GARCIA of Texas, Mr. LIEU, Ms. LEGER FERNANDEZ, Mr. CA´RDENAS, Mr. CARTER of Louisiana, Ms. HOYLE of Oregon, Mrs. FOUSHEE, Ms. ESCOBAR, Mr. KEATING, Ms. CLARKE of New York, Ms. OCASIO-CORTEZ, Ms. PELOSI, and Ms. LOFGREN) intro- duced 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 Accountability, and Foreign Affairs, for a period to be sub- sequently 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 2023’’ or the 5 ‘‘EACH Act of 2023’’. 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 VerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H561.IH H561 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 561 IH sexual orientation or gender identity; and sex char- 1 acteristics), age, disability, or sex work status or be- 2 havior. 3 (2) A person’s income level, wealth, or type of 4 insurance should not prevent them from having ac- 5 cess to a full range of pregnancy-related health care, 6 including abortion services. 7 (3) No person should have the decision to have, 8 or not to have, an abortion made for them based on 9 the ability or inability to afford the health care serv- 10 ice. 11 (4) Since 1976, the Federal Government has 12 banned the use of Federal funds to pay for abortion 13 services and allows for exceptions only in very nar- 14 row circumstances. This ban affects people of repro- 15 ductive age in the United States who are insured 16 through the Medicaid program, as well as individuals 17 who receive insurance or care through other feder- 18 ally funded health programs and plans. 19 (5) Women make up the majority of Medicaid 20 enrollees (54 percent) and, in 2019, approximately 21 14 million women of reproductive age relied on the 22 program for care. Due to systematic barriers and 23 discrimination, a disproportionately higher number 24 of women of color and Lesbian, Gay, Bisexual, 25 VerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H561.IH H561 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 561 IH Transgender, or Queer (LGBTQ) individuals are en- 1 rolled in the program. 2 (6) Women of color are more likely to be in- 3 sured by the Medicaid program. Nationwide, 29 per- 4 cent of Black women and 25 percent of Hispanic 5 women aged 15–49 were enrolled in Medicaid in 6 2018, compared with 15 percent of White women. 7 (7) In the aggregate, nearly one-fifth (19 per- 8 cent) of Asian American and Pacific Islander women 9 are enrolled in the Medicaid program, while enroll- 10 ment rates for certain Asian ethnic subgroups are 11 much higher (at 62 percent of Bhutanese women, 43 12 percent of Hmong women and 32 percent of Paki- 13 stani women). 14 (8) Medicaid also provides coverage to more 15 than one in four (27 percent) nonelderly American 16 Indian and Alaska Native (AIAN) adults and half of 17 AIAN children. 18 (9) In a 2014 nationwide survey of LGBT peo- 19 ple with incomes less than 400 percent Federal Pov- 20 erty Level (FPL), 61 percent of all respondents had 21 incomes in the Medicaid expansion range—up to 22 138 percent of the FPL—including 73 percent of 23 African-American respondents, 67 percent of Latino 24 respondents, and 53 percent of White respondents. 25 VerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H561.IH H561 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 561 IH Another survey found that 32 percent of Asian and 1 Native Hawaiian/Pacific Islander transgender people 2 were living in poverty. 3 (10) Of women aged 15–44 enrolled in Med- 4 icaid in 2018, 55 percent lived in the 34 States and 5 the District of Columbia where Medicaid does not 6 cover abortion services except in limited cir- 7 cumstances. This amounted to 7.2 million women of 8 reproductive age, including 3 million women living 9 below the FPL. Of this population, Black, Indige- 10 nous, and other People of Color (BIPOC) women ac- 11 counted for 51 percent of those enrolled. 12 (11) The Indian Health Service (IHS) is the 13 federally funded health program for American Indi- 14 ans and Alaska Natives. The IHS serves a popu- 15 lation of approximately 2.56 million and as a feder- 16 ally funded system, since 1988, it has been barred 17 from providing abortion services except for very lim- 18 ited cases. American Indians and Alaska Natives 19 often face higher levels of poverty and limited access 20 to health care for a number of intersecting oppres- 21 sions thus leaving them without recourse for the 22 Federal ban on abortion services. 23 (12) Moreover, 26 States also prohibit coverage 24 of abortion services in the marketplaces and 11 pro- 25 VerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H561.IH H561 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 561 IH hibit coverage in private health insurance plans 1 under the Patient Protection and Affordable Care 2 Act of 2010 (Public Law 111–148). 3 (13) A recent report details how restrictions on 4 abortion services coverage interfere with a person’s 5 individual decisionmaking, with their health and 6 well-being, with their economic security, with their 7 vulnerability to intimate partner violence, and with 8 their constitutionally protected right to a safe and 9 normal health care service. 10 (14) About 25 percent of women covered by 11 Medicaid seeking abortion services must carry their 12 pregnancies to term because they are unable to ob- 13 tain funds for their care. Government-imposed bar- 14 riers to abortion services restrict people’s decisions 15 on if, when, and how to parent, and have long-last- 16 ing and life-altering harmful effects on the pregnant 17 person, their families and their communities. Those 18 who seek and are denied abortion services are more 19 likely to remain in or fall into poverty than those 20 who access the care they need. 21 (15) Restrictions on abortion service coverage 22 have a disproportionately harmful impact on women 23 with low incomes, women of color, immigrant 24 women, LGBTQ people, and young women. Addi- 25 VerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H561.IH H561 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 561 IH tionally, numerous state-imposed barriers make it 1 disparately difficult for low-income people, people of 2 color, immigrants, LGBTQ people, and young people 3 to access the health care and resources necessary to 4 prevent unintended pregnancy or to assure that they 5 are able to carry healthy pregnancies to term. Fur- 6 thermore, young people of reproductive age (15–24) 7 are more likely to have a lower income than those 8 older than that, and this income gap is greater for 9 young BIPOC. More than 40 percent of youth and 10 children under age 19 and almost a quarter of 11 young people age 19 to 25 have health insurance 12 through government programs. Without insurance 13 coverage for abortion services, young people are at 14 greater risk of not having the economic means to af- 15 ford care outside of insurance. Young people face 16 disproportionate access barriers to abortion includ- 17 ing parental involvement requirement (notification 18 and consent) and cost, in addition to barriers to con- 19 traception and inadequate and incomplete sexual(ity) 20 education. These challenges, which are magnified for 21 BIPOC and queer, trans, and nonbinary youth, can 22 cause significant delays in access to needed care, 23 and could ultimately harm the life of the young per- 24 son seeking abortion services. These institutionalized 25 VerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H561.IH H561 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 561 IH barriers deny young people’s right to bodily auton- 1 omy and can force young people to encounter an 2 abusive parent or guardian, ignores trusted relation- 3 ships young people may have with adults other than 4 a parent or legal guardian, and in the case of the 5 judicial bypass process, may force young BIPOC to 6 interact with a legal system that has historically tar- 7 geted and caused harm to communities of color. 8 (16) These and other government-created and 9 government-institutionalized barriers—including the 10 restriction on funding for abortion services in Fed- 11 eral programs—exacerbate and create poverty and 12 racial inequality in income, wealth-generation, and 13 access to services. 14 (17) Access to health care, including abortion 15 services, promotes the general welfare of people liv- 16 ing in the United States. Singling out abortion serv- 17 ices for funding restrictions in health care programs 18 otherwise designed to promote the health and well- 19 being of people in the United States has cost preg- 20 nant people their lives, their livelihoods, their ability 21 to obtain or maintain economic security for them- 22 selves and their families, their ability to meet their 23 family’s basic needs, their ability to continue their 24 VerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H561.IH H561 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 561 IH education without disruption, and their ability to 1 break free of abusive relationships. 2 (18) Like other health care and health insur- 3 ance markets in the United States, abortion services 4 and public insurance programs are commercial ac- 5 tivities that affect interstate commerce. Providers 6 and patients travel across State lines, and otherwise 7 engage in interstate commerce, to provide and access 8 abortion services. Material goods, services, and fed- 9 erally regulated medications used in abortion serv- 10 ices circulate in interstate commerce. 11 (19) Congress has the authority to enact this 12 Act to ensure affordable coverage of abortion and 13 other services pursuant to— 14 (A) its powers under the necessary and 15 proper clause of section 8, article I of the Con- 16 stitution of the United States; 17 (B) its powers under the commerce clause 18 of section 8, article 1 of the Constitution of the 19 United States; 20 (C) its powers to tax and spend for the 21 general welfare under section 8, article 1 of the 22 Constitution of the United States; and 23 (D) its powers to enforce section 1 of the 24 Fourteenth Amendment under section 5 of the 25 VerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H561.IH H561 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 561 IH Fourteenth Amendment to the Constitution of 1 the United States. 2 (20) Congress has exercised these constitutional 3 powers to create, expand, and insure health care ac- 4 cess for people in the United States for decades. 5 Pursuant to this constitutional authority, Congress 6 has enacted, and subsequently reauthorized, numer- 7 ous health care programs including but not limited 8 to title XVIII of the Social Security Act of 1965 9 (Medicare); title XIX of the Social Security Act of 10 1965 (Medicaid); and title XXI of the Social Secu- 11 rity Act (Children’s Health Insurance Program, en- 12 acted in 1997). 13 SEC. 3. DEFINITIONS. 14 For purposes of th [Text truncated for display. Full text available on Congress.gov.]