II 

118TH CONGRESS 

1ST SESSION S. 1031 

To ensure affordable abortion coverage and care for every person, and for 

other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 29, 2023 

Ms. DUCKWORTH (for herself, Mrs. MURRAY, Ms. HIRONO, Mr. MERKLEY, 

Ms. WARREN, Mr. PADILLA, Mr. WHITEHOUSE, Mr. MARKEY, Ms. CORTEZ MASTO, Mr. FETTERMAN, Mrs. FEINSTEIN, Mr. BLUMENTHAL, Mr. 

BOOKER, Ms. STABENOW, Mr. WYDEN, Ms. KLOBUCHAR, Mr. CARDIN, 

Mr. BROWN, Mr. SANDERS, Ms. BALDWIN, Ms. CANTWELL, Ms. SMITH, 

Mr. MURPHY, Ms. ROSEN, Ms. HASSAN, Mrs. SHAHEEN, Mr. BENNET, 

Mrs. GILLIBRAND, Mr. VAN HOLLEN, Mr. WELCH, and Mr. HEINRICH) 

introduced the following bill; which was read twice and referred to the 

Committee on Health, Education, Labor, and Pensions 

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 2023’’ or the 

6 ‘‘EACH Act of 2023’’. 


pbinns on DSKJLVW7X2PROD with $$_JOB
2 

•S 1031 IS

1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) All people should have access to abortion 

4 services regardless of actual or perceived race, color, 

5 ethnicity, language, ancestry, citizenship, immigra6 tion status, sex (including a sex stereotype; preg7 nancy, childbirth, or a related medical condition; 

8 sexual orientation or gender identity; and sex char9 acteristics), age, disability, or sex work status or be10 havior. 

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

12 insurance should not prevent them from having ac13 cess to a full range of pregnancy-related health care, 

14 including abortion services. 

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

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

17 the ability or inability to afford the health care serv18 ice. 

19 (4) Since 1976, the Federal Government has 

20 banned the use of Federal funds to pay for abortion 

21 services and allows for exceptions only in very nar22 row circumstances. This ban affects people of repro23 ductive age in the United States who are insured 

24 through the Medicaid program, as well as individuals 

25 who receive insurance or care through other feder26 ally funded health programs and plans. 


pbinns on DSKJLVW7X2PROD with $$_JOB
3 

•S 1031 IS

1 (5) Women make up the majority of Medicaid 

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

3 14,000,000 women of reproductive age relied on the 

4 program for care. Due to systematic barriers and 

5 discrimination, a disproportionately higher number 

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

7 Transgender, or Queer (LGBTQ) individuals are en8 rolled in the program. 

9 (6) Women of color are more likely to be in10 sured by the Medicaid program. Nationwide, 29 per11 cent of Black women and 25 percent of Hispanic 

12 women aged 15 to 49 were enrolled in Medicaid in 

13 2018, compared with 15 percent of White women. 

14 (7) In the aggregate, nearly one-fifth (19 per15 cent) of Asian-American and Pacific-Islander women 

16 are enrolled in the Medicaid program, while enroll17 ment rates for certain Asian ethnic subgroups are 

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

19 percent of Hmong women and 32 percent of Paki20 stani women). 

21 (8) Medicaid also provides coverage to more 

22 than 1 in 4 (27 percent) non-elderly American In23 dian and Alaska Native (AIAN) adults and half of 

24 AIAN children. 


pbinns on DSKJLVW7X2PROD with $$_JOB
4 

•S 1031 IS

1 (9) In a 2014 nationwide survey of LGBT peo2 ple with incomes less than 400 percent Federal Pov3 erty Level (FPL), 61 percent of all respondents had 

4 incomes in the Medicaid expansion range—up to 

5 138 percent of the FPL—including 73 percent of 

6 African-American respondents, 67 percent of Latino 

7 respondents, and 53 percent of White respondents. 

8 Another survey found that 32 percent of Asian and 

9 Native Hawaiian/Pacific Islander transgender people 

10 were living in poverty. 

11 (10) Of women aged 15 through 44 enrolled in 

12 Medicaid in 2018, 55 percent lived in the 34 States 

13 and the District of Columbia where Medicaid does 

14 not cover abortion services except in limited cir15 cumstances. This amounted to 7,200,000 women of 

16 reproductive age, including 3,000,000 women living 

17 below the FPL. Of this population, Black, Indige18 nous, and other People of Color (BIPOC) women ac19 counted for 51 percent of those enrolled. 

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

21 federally funded health program for American Indi22 ans and Alaska Natives. The IHS serves a popu23 lation of approximately 2,560,000 and as a federally 

24 funded system, since 1988, it has been barred from 

25 providing abortion services except for very limited 


pbinns on DSKJLVW7X2PROD with $$_JOB
5 

•S 1031 IS

1 cases. American Indians and Alaska Natives often 

2 face higher levels of poverty and limited access to 

3 health care for a number of intersecting oppressions 

4 thus leaving them without recourse for the Federal 

5 ban on abortion services. 

6 (12) Moreover, 26 States also prohibit coverage 

7 of abortion services in the marketplaces and 11 pro8 hibit coverage in private health insurance plans 

9 under the Patient Protection and Affordable Care 

10 Act (Public Law 111–148). 

11 (13) A recent report details how restrictions on 

12 abortion services coverage interfere with a person’s 

13 individual decision making, with their health and 

14 well-being, with their economic security, with their 

15 vulnerability to intimate partner violence, and with 

16 their constitutionally protected right to a safe and 

17 normal health care service. 

18 (14) About 25 percent of women covered by 

19 Medicaid seeking abortion services must carry their 

20 pregnancies to term because they are unable to ob21 tain funds for their care. Government-imposed bar22 riers to abortion services restrict people’s decisions 

23 on if, when, and how to parent, and have long-last24 ing and life-altering harmful effects on the pregnant 

25 person, their families and their communities. Those 


pbinns on DSKJLVW7X2PROD with $$_JOB
6 

•S 1031 IS

1 who seek and are denied abortion services are more 

2 likely to remain in or fall into poverty than those 

3 who access the care they need. 

4 (15) Restrictions on abortion service coverage 

5 have a disproportionately harmful impact on women 

6 with low incomes, women of color, immigrant 

7 women, LGBTQ people, and young women. Addi8 tionally, numerous State-imposed barriers make it 

9 disparately difficult for low-income people, people of 

10 color, immigrants, LGBTQ people, and young people 

11 to access the health care and resources necessary to 

12 prevent unintended pregnancy or to assure that they 

13 are able to carry healthy pregnancies to term. Fur14 thermore, young people of reproductive age (ages 15 

15 to 24) are more likely to have a lower income than 

16 those older than that, and this income gap is greater 

17 for young BIPOC. More than 40 percent of youth 

18 and children under age 19 and almost a quarter of 

19 young people age 19 to 25 have health insurance 

20 through government programs. Without insurance 

21 coverage for abortion services, young people are at 

22 greater risk of not having the economic means to af23 ford care outside of insurance. Young people face 

24 disproportionate access barriers to abortion services, 

25 including parental involvement requirement (notifiVerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031

pbinns on DSKJLVW7X2PROD with $$_JOB
7 

•S 1031 IS

1 cation and consent) and cost, in addition to barriers 

2 to contraception and inadequate and incomplete sex3 ual and sexuality education. These challenges, which 

4 are magnified for BIPOC and queer, trans, and non5 binary youth, can cause significant delays in access 

6 to needed care, and could ultimately harm the life of 

7 the young person seeking abortion services. These 

8 institutionalized barriers deny young people’s right 

9 to bodily autonomy and can force young people to 

10 encounter an abusive parent or guardian, ignores 

11 trusted relationships young people may have with 

12 adults other than a parent or legal guardian, and in 

13 the case of the judicial bypass process, may force 

14 young BIPOC to interact with a legal system that 

15 has historically targeted and caused harm to com16 munities of color. 

17 (16) These and other government-created and 

18 government-institutionalized barriers—including the 

19 restriction on funding for abortion services in Fed20 eral programs—exacerbate and create poverty and 

21 racial inequality in income, wealth-generation, and 

22 access to services. 

23 (17) Access to health care, including abortion 

24 services, promotes the general welfare of people liv25 ing in the United States. Singling out abortion servVerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031

pbinns on DSKJLVW7X2PROD with $$_JOB
8 

•S 1031 IS

1 ices for funding restrictions in health care programs 

2 otherwise designed to promote the health and well3 being of people in the United States has cost preg4 nant people their lives, their livelihoods, their ability 

5 to obtain or maintain economic security for them6 selves and their families, their ability to meet their 

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

8 education without disruption, and their ability to 

9 break free of abusive relationships. 

10 (18) Like other health care and health insur11 ance markets in the United States, abortion services 

12 and public insurance programs are commercial ac13 tivities that affect interstate commerce. Providers 

14 and patients travel across State lines, and otherwise 

15 engage in interstate commerce, to provide and access 

16 abortion services. Material goods, services, and fed17 erally regulated medications used in abortion serv18 ices circulate in interstate commerce. 

19 (19) Congress has the authority to enact this 

20 Act to ensure affordable coverage of abortion serv21 ices pursuant to— 

22 (A) its powers under the necessary and 

23 proper clause of section 8, article I of the Con24 stitution of the United States; 


pbinns on DSKJLVW7X2PROD with $$_JOB
9 

•S 1031 IS

1 (B) its powers under the commerce clause 

2 of section 8, article I of the Constitution of the 

3 United States; 

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

5 general welfare under section 8, article I of the 

6 Constitution of the United States; and 

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

8 Fourteenth Amendment under section 5 of the 

9 Fourteenth Amendment to the Constitution of 

10 the United States. 

11 (20) Congress has exercised these constitutional 

12 powers to create, expand, and insure health care ac13 cess for people in the United States for decades. 

14 Pursuant to this constitutional authority, Congress 

15 has enacted, and subsequently reauthorized, numer16 ous health care programs including title XVIII of 

17 the Social Security Act (Medicare, enacted in 1965); 

18 title XIX of the Social Security Act (Medicaid, en19 acted in 1965); and title XXI of the Social Security 

20 Act (Children’s Health Insurance Program, enacted 

21 in 1997). 

22 SEC. 3. DEFINITIONS. 

23 For purposes of this Act: 

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

25 services’’ means an abortion and any services related 


pbinns on DSKJLVW7X2PROD with $$_JOB
10 

•S 1031 IS

1 to, and provided in conjunction with, an abortion, 

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

3 same day as the abortion. 

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

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

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

7 provide, health care: 

8 (A) The Medicaid program under title XIX 

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

10 seq.). 

11 (B) The Children’s Health Insurance Pro12 gram under title XXI of the Social Security Act 

13 (42 U.S.C. 1397 et seq.). 

14 (C) The Medicare program under title 

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

16 1395 et seq.). 

17 (D) A medicare supplemental policy as de18 fined in section 1882(g)(1) of the Social Secu19 rity Act (42 U.S.C. 1395ss(g)(1)). 

20 (E) The Indian Health Service program 

21 under the Indian Health Care Improvement Act 

22 (25 U.S.C. 1601 et seq.). 

23 (F) Medical care and health benefits under 

24 the TRICARE program (as defined in section 

25 1072(7) of title 10, United States Code). 


pbinns on DSKJLVW7X2PROD with $$_JOB
11 

•S 1031 IS

1 (G) Benefits under the uniform health ben2 efits program for employees of the Department 

3 of Defense assigned to a nonappropriated fund 

4 instrumentality of the Department established 

5 under section 349 of the National Defense Au6 thorization Act for Fiscal Year 1995 (Public 

7 Law 103–337; 10 U.S.C. 1587 note). 

8 (H) Benefits for veterans under chapter 17 

9 of title 38, United States Code. 

10 (I) Medical care for survivors and depend11 ents of veterans under section 1781 of title 38, 

12 United States Code. 

13 (J) Medical care for individuals in the care 

14 or custody of the Department of Homeland Se15 curity pursuant to any of section 235, 236, or 

16 241 of the Immigration and Nationality Act (8 

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

18 (K) Medical care for individuals in the care 

19 or custody of the Department of Health and 

20 Human Services, Office of Refugee Resettle21 ment under section 235 of the William Wilber22 force Trafficking Victims Protection Reauthor23 ization Act of 2008 (8 U.S.C. 1232) or section 

24 462 of the Homeland Security Act of 2002 (6 

25 U.S.C. 279). 


pbinns on DSKJLVW7X2PROD with $$_JOB
12 

•S 1031 IS

1 (L) Medical assistance to refugees under 

2 section 412 of the Immigration and Nationality 

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

4 (M) Other coverage, such as a State health 

5 benefits risk pool, as the Secretary of Health 

6 and Human Services, in coordination with the 

7 Secretary of the Treasury, recognizes for pur8 poses of section 5000A(f)(1)(E) of the Internal 

9 Revenue Code of 1986. 

10 (N) The Federal Employees Health Ben11 efit Plan under chapter 89 of title 5, United 

12 States Code. 

13 (O) Medical care for individuals under the 

14 care or custody of the Department of Justice 

15 pursuant to chapter 301 of title 18, United 

16 States Code. 

17 (P) Medical care for Peace Corps volun18 teers under section 5(e) of the Peace Corps Act 

19 (22 U.S.C. 2504(e)). 

20 (Q) Other government-sponsored programs 

21 established after the date of the enactment of 

22 this Act. 


pbinns on DSKJLVW7X2PROD with $$_JOB
13 

•S 1031 IS

1 SEC. 4. ABORTION COVERAGE AND CARE REGARDLESS OF 

2 INCOME OR SOURCE OF INSURANCE. 

3 (a) ENSURING ABORTION COVERAGE AND CARE

4 THROUGH THE FEDERAL GOVERNMENT IN ITS ROLE AS

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

6 enrolled in, or otherwise receiving medical care from 

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

8 receive coverage of abortion services. Health programs or 

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

10 abortion services. 

11 (b) ENSURING ABORTION COVERAGE AND CARE

12 THROUGH THE FEDERAL GOVERNMENT IN ITS ROLE AS

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

14 of health services, including under health programs de15 scribed in section 3(2) and health services covered by 

16 health plans described in section 3(2), the Federal Govern17 ment shall ensure access to abortion services for individ18 uals who are eligible to receive medical care in its own 

19 facilities or in facilities with which it contracts to provide 

20 medical care. 

21 (c) PROHIBITING RESTRICTIONS ON PRIVATE INSUR22 ANCE COVERAGE OF ABORTION SERVICES.—The Federal 

23 Government shall not prohibit, restrict, or otherwise in24 hibit insurance coverage of abortion services by State or 

25 local government or by private health plans. 


pbinns on DSKJLVW7X2PROD with $$_JOB
14 

•S 1031 IS

1 SEC. 5. REPEAL OF SECTION 1303. 

2 (a) IN GENERAL.—Section 1303 of the Patient Pro3 tection and Affordable Care Act (42 U.S.C. 18023) is re4 pealed. 

5 (b) CONFORMING AMENDMENTS.— 

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

7 the Patient Protection and Affordable Care Act (42 

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

9 (4). 

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

11 the Patient Protection and Affordable Care Act 

12 (Public Law 111–148) is amended— 

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

14 (B) by redesignating paragraph (7) as 

15 paragraph (6). 

16 SEC. 6. SENSE OF CONGRESS. 

17 It is the sense of Congress that— 

18 (1) the Federal Government, acting in its ca19 pacity as an insurer, employer, or health care pro20 vider, should serve as a model for the Nation to en21 sure coverage of abortion services; and 

22 (2) restrictions on coverage of abortion services 

23 in the private insurance market must end. 

24 SEC. 7. RULE OF CONSTRUCTION. 

25 Nothing in this Act shall be construed to have any 

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


pbinns on DSKJLVW7X2PROD with $$_JOB
15 

•S 1031 IS

1 more protections for abortion coverage or abortion services 

2 than those set forth in this Act. 

3 SEC. 8. RELATIONSHIP TO FEDERAL LAW. 

4 This Act supersedes and applies to all Federal law, 

5 and the implementation of that law, whether statutory or 

6 otherwise, and whether adopted before or after the date 

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

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

9 seq.). 

10 SEC. 9. SEVERABILITY. 

11 If any portion of this Act or the application thereof 

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

13 held invalid, such invalidity shall not affect the portions 

14 or applications of this Act which can be given effect with15 out the invalid portion or application. 

Æ 


pbinns on DSKJLVW7X2PROD with $$_JOB