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. LAWRENCE, 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 Washington, Mr. GARCI ́A of Illinois, Mr. FOSTER, Ms. SHERRILL, Mr. MCNERNEY, 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, 


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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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Equal Access to Abor5 tion Coverage in Health Insurance Act of 2021’’ or the 

6 ‘‘EACH Act of 2021’’. 

7 SEC. 2. FINDINGS. 

8 Congress makes the following findings: 

9 (1) All people should have access to abortion 

10 services regardless of actual or perceived race, color, 

11 ethnicity, language, ancestry, citizenship, immigra12 tion status, sex (including a sex stereotype; preg13 nancy, childbirth, or a related medical condition; 

14 sexual orientation or gender identity; and sex char15 acteristics), age, disability, or sex work status or be16 havior. 


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1 (2) A person’s income level, wealth, or type of 

2 insurance should not prevent them from having ac3 cess to a full range of pregnancy-related health care, 

4 including abortion services. 

5 (3) No person should have the decision to have, 

6 or not to have, an abortion made for them based on 

7 the ability or inability to afford the health care serv8 ice. 

9 (4) Since 1976, the Federal Government has 

10 banned the use of Federal funds to pay for abortion 

11 services and allows for exceptions only in very nar12 row circumstances. This ban affects people of repro13 ductive age in the United States who are insured 

14 through the Medicaid program, as well as individuals 

15 who receive insurance or care through other feder16 ally-funded health programs and plans. 

17 (5) Women make up the majority of Medicaid 

18 enrollees (54 percent) and, in 2019, approximately 

19 14 million women of reproductive age relied on the 

20 program for care. Due to systematic barriers and 

21 discrimination, a disproportionately higher number 

22 of women of color and Lesbian, Gay, Bisexual, 

23 Transgender, or Queer (LGBTQ) individuals are en24 rolled in the program. 


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1 (6) Women of color are more likely to be in2 sured by the Medicaid program. Nationwide, 29 per3 cent of Black women and 25 percent of Hispanic 

4 women aged 15–49 were enrolled in Medicaid in 

5 2018 , compared with 15 percent of white women. 

6 (7) In the aggregate, nearly one-fifth (19 per7 cent) of Asian American and Pacific Islander women 

8 are enrolled in the Medicaid program, while enroll9 ment rates for certain Asian ethnic subgroups are 

10 much higher (at 62 percent of Bhutanese women, 43 

11 percent of Hmong women and 32 percent of Paki12 stani women). 

13 (8) Medicaid also provides coverage to more 

14 than one in four (27 percent) nonelderly American 

15 Indian and Alaska Native (AIAN) adults and half of 

16 AIAN children. 

17 (9) In a 2014 nationwide survey of LGBT peo18 ple with incomes less than 400 percent Federal Pov19 erty Level (FPL), 61 percent of all respondents had 

20 incomes in the Medicaid expansion range—up to 

21 138 percent of the FPL—including 73 percent of 

22 African-American respondents, 67 percent of Latino 

23 respondents, and 53 percent of white respondents. 

24 Another survey found that 32 percent of Asian and 


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1 Native Hawaiian/Pacific Islander transgender people 

2 were living in poverty. 

3 (10) Of women aged 15–44 enrolled in Med4 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 cir7 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, Indige10 nous, and other People of Color (BIPOC) women ac11 counted for 51 percent of those enrolled. 

12 (11) The Indian Health Service (IHS) is the 

13 federally funded health program for American Indi14 ans and Alaska Natives. The IHS serves a popu15 lation of approximately 2.56 million and as a feder16 ally funded system, since 1988, it has been barred 

17 from providing abortion services except for very lim18 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 oppres21 sions thus leaving them without recourse for the fed22 eral ban on abortion services. 

23 (12) Moreover, 26 States also prohibit coverage 

24 of abortion services in the marketplaces and 11 pro25 hibit coverage in private health insurance plans 


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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 decision-making, 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 ob13 tain funds for their care. Government-imposed bar14 riers to abortion services restrict people’s decisions 

15 on if, when, and how to parent, and have long-last16 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. Addi25 tionally, numerous state-imposed barriers make it 


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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. Fur6 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 af15 ford care outside of insurance. Young people face 

16 disproportionate access barriers to abortion includ17 ing parental involvement requirement (notification 

18 and consent) and cost, in addition to barriers to con19 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 per24 son seeking abortion services. These institutionalized 

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1 omy and can force young people to encounter an 

2 abusive parent or guardian, ignores trusted relation3 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 tar7 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 Fed11 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 liv16 ing in the United States. Singling out abortion serv17 ices for funding restrictions in health care programs 

18 otherwise designed to promote the health and 

19 wellbeing of people in the United States has cost 

20 pregnant people their lives, their livelihoods, their 

21 ability to obtain or maintain economic security for 

22 themselves and their families, their ability to meet 

23 their family’s basic needs, their ability to continue 

24 their education without disruption, and their ability 

25 to break free of abusive relationships. 


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1 (18) Like other health care and health insur2 ance markets in the United States, abortion services 

3 and public insurance programs are commercial ac4 tivities that affect interstate commerce. Providers 

5 and patients travel across state lines, and otherwise 

6 engage in interstate commerce, to provide and access 

7 abortion services. Material goods, services, and fed8 erally-regulated medications used in abortion serv9 ices circulate in interstate commerce. 

10 (19) Congress has the authority to enact this 

11 Act to ensure affordable coverage of abortion and 

12 other services pursuant to— 

13 (A) its powers under the necessary and 

14 proper clause of Section 8, Article I of the Con15 stitution of the United States; 

16 (B) its powers under the commerce clause 

17 of Section 8, Article 1 of the Constitution of the 

18 United States; 

19 (C) its powers to tax and spend for the 

20 general welfare under Section 8, Article 1 of 

21 the Constitution of the United States; and 

22 (D) its powers to enforce section 1 of the 

23 Fourteenth Amendment under Section 5 of the 

24 Fourteenth Amendment to the Constitution of 

25 the United States. 


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1 (20) Congress has exercised these constitutional 

2 powers to create, expand, and insure health care ac3 cess for people in the United States for decades. 

4 Pursuant to this constitutional authority, Congress 

5 has enacted, and subsequently reauthorized, numer6 ous health care programs including but not limited 

7 to title XVIII of the Social Security Act of 1965 

8 (Medicare); title XIX of the Social Security Act of 

9 1965 (Medicaid); and title XXI of the Social Secu10 rity Act (Children’s Health Insurance Program, en11 acted in 1997). 

12 SEC. 3. DEFINITIONS. 

13 For purposes of this Act: 

14 (1) ABORTION SERVICES.—The term ‘‘abortion 

15 services’’ means an abortion and any services related 

16 to and provided in conjunction with an abortion, 

17 whether or not provided at the same time or on the 

18 same day as the abortion. 

19 (2) HEALTH PROGRAM OR PLAN.—The term 

20 ‘‘health program or plan’’ means the following 

21 health programs or plans that pay the cost of, or 

22 provide, health care: 

23 (A) The Medicaid program under title XIX 

24 of the Social Security Act (42 U.S.C. 1396 et 

25 seq.). 


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1 (B) The Children’s Health Insurance Pro2 gram under title XXI of the Social Security Act 

3 (42 U.S.C. 1397 et seq.). 

4 (C) The Medicare program under title 

5 XVIII of the Social Security Act (42 U.S.C. 

6 1395 et seq.). 

7 (D) A Medicare supplemental policy as de8 fined in section 1882(g)(1) of the Social Secu9 rity Act (42 U.S.C. 1395ss(g)(1)). 

10 (E) The Indian Health Service program 

11 under the Indian Health Care Improvement Act 

12 (25 U.S.C. 1601 et seq.). 

13 (F) Medical care and health benefits under 

14 the TRICARE program (10 U.S.C. 1071 et 

15 seq.). 

16 (G) Benefits for veterans under chapter 17 

17 of title 38, United States Code, and medical 

18 care for survivors and dependents of veterans 

19 (38 U.S.C. 1781 et seq.). 

20 (H) Benefits under the uniform health 

21 benefits program for employees of the Depart22 ment of Defense assigned to a nonappropriated 

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1 fense Authorization Act for Fiscal Year 1995 

2 (Public Law 103–337; 10 U.S.C. 1587 note). 

3 (I) Medical care for individuals in the care 

4 or custody of the Department of Homeland Se5 curity pursuant to any of sections 235, 236, or 

6 241 of the Immigration and Nationality Act (8 

7 U.S.C. 1225, 1226, 1231). 

8 (J) Medical care for individuals in the care 

9 or custody of the Department of Health and 

10 Human Services, Office of Refugee Resettle11 ment under section 235 of the William Wilber12 force Trafficking Victims Protection Reauthor13 ization Act of 2008 (8 U.S.C. 1232) or section 

14 462 of the Homeland Security Act of 2002 (6 

15 U.S.C. 279). 

16 (K) Medical assistance to refugees under 

17 section 412 of the Immigration and Nationality 

18 Act (8 U.S.C. 1522). 

19 (L) Other coverage, such as a State health 

20 benefits risk pool, as the Secretary of Health 

21 and Human Services, in coordination with the 

22 Secretary of the Treasury, recognizes for pur23 poses of section 5000A(f)(1)(E) of the Internal 

24 Revenue Code of 1986 (26 U.S.C. 

25 5000A(f)(1)(E)). 


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1 (M) The Federal Employees Health Ben2 efit Plan under chapter 89 of title 5, United 

3 States Code. 

4 (N) Medical care for individuals under the 

5 care or custody of the Department of Justice 

6 pursuant to chapter 301 of title 18 (18 U.S.C. 

7 4001 et seq.). 

8 (O) Medical care for Peace Corps volun9 teers under section 5(e) of the Peace Corps Act 

10 (22 U.S.C. 2504(e)). 

11 (P) Other government-sponsored programs 

12 established after the date of the enactment of 

13 this Act. 

14 SEC. 4. ABORTION COVERAGE AND CARE REGARDLESS OF 

15 INCOME OR SOURCE OF INSURANCE. 

16 (a) ENSURING ABORTION COVERAGE AND CARE

17 THROUGH THE FEDERAL GOVERNMENT IN ITS ROLE AS

18 AN INSURER AND EMPLOYER.—Each person insured by, 

19 enrolled in, or otherwise receiving medical care from 

20 health programs or plans described in section 3(2) shall 

21 receive coverage of abortion services. Health programs or 

22 plans described in section 3(2) shall provide coverage of 

23 abortion services. 

24 (b) ENSURING ABORTION COVERAGE AND CARE

25 THROUGH THE FEDERAL GOVERNMENT IN ITS ROLE AS


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1 A HEALTH CARE PROVIDER.—In its role as a provider 

2 of health services including in health programs and plans 

3 described in section 3(2), the Federal Government shall 

4 ensure access to abortion services for individuals who are 

5 eligible to receive medical care in its own facilities or in 

6 facilities with which it contracts to provide medical care. 

7 (c) PROHIBITING RESTRICTIONS ON PRIVATE INSUR8 ANCE COVERAGE OF ABORTION SERVICES.—The Federal 

9 Government shall not prohibit, restrict, or otherwise in10 hibit insurance coverage of abortion services by State or 

11 local government or by private health plans. 

12 SEC. 5. REPEAL OF SECTION 1303. 

13 (a) IN GENERAL.—Section 1303 of the Patient Pro14 tection and Affordable Care Act (42 U.S.C. 18023) is re15 pealed. 

16 (b) CONFORMING AMENDMENTS.— 

17 (1) BASIC HEALTH PLANS.—Section 1331(d) of 

18 the Patient Protection and Affordable Care Act (42 

19 U.S.C. 18051(d)) is amended by striking paragraph 

20 (4). 

21 (2) MULTI-STATE PLANS.—Section 1334(a) of 

22 the Patient Protection and Affordable Care Act 

23 (Public Law 111–148) is amended— 

24 (A) by striking paragraph (6); and 


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1 (B) by redesignating paragraph (7) as 

2 paragraph (6). 

3 SEC. 6. SENSE OF CONGRESS. 

4 It is the sense of Congress that— 

5 (1) the Federal Government, acting in its ca6 pacity as an insurer, employer, or health care pro7 vider, should serve as a model for the Nation to en8 sure coverage of abortion services; and 

9 (2) restrictions on coverage of abortion services 

10 in the private insurance market must end. 

11 SEC. 7. RULE OF CONSTRUCTION. 

12 Nothing in this Act shall be construed to have any 

13 effect on any Federal, State, or local law that includes 

14 more protections for abortion coverage or services than 

15 those set forth in this Act. 

16 SEC. 8. RELATIONSHIP TO FEDERAL LAW. 

17 This Act supersedes and applies to all Federal law, 

18 and the implementation of that law, whether statutory or 

19 otherwise, and whether adopted before or after the date 

20 of enactment of this Act and is not subject to the Religious 

21 Freedom Restoration Act of 1993 (42 U.S.C. 2000bb et 

22 seq.). 

23 SEC. 9. SEVERABILITY. 

24 If any portion of this Act or the application thereof 

25 to any person, entity, government, or circumstances is 


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1 held invalid, such invalidity shall not affect the portions 

2 or applications of this Act which can be given effect with3 out the invalid portion or application. 

Æ 


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