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. MCCOLLUM, Mr. FOSTER, Mrs. WATSON COLEMAN, Mr. SCHNEIDER, Mr. SHERMAN, 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. MANNING, 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. SCANLON, 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, 


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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) 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 Accountability, 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 2023’’ or the 

6 ‘‘EACH Act of 2023’’. 

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; 


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1 sexual orientation or gender identity; and sex char2 acteristics), age, disability, or sex work status or be3 havior. 

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

5 insurance should not prevent them from having ac6 cess to a full range of pregnancy-related health care, 

7 including abortion services. 

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

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

10 the ability or inability to afford the health care serv11 ice. 

12 (4) Since 1976, the Federal Government has 

13 banned the use of Federal funds to pay for abortion 

14 services and allows for exceptions only in very nar15 row circumstances. This ban affects people of repro16 ductive age in the United States who are insured 

17 through the Medicaid program, as well as individuals 

18 who receive insurance or care through other feder19 ally funded health programs and plans. 

20 (5) Women make up the majority of Medicaid 

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

22 14 million women of reproductive age relied on the 

23 program for care. Due to systematic barriers and 

24 discrimination, a disproportionately higher number 

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


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1 Transgender, or Queer (LGBTQ) individuals are en2 rolled in the program. 

3 (6) Women of color are more likely to be in4 sured by the Medicaid program. Nationwide, 29 per5 cent of Black women and 25 percent of Hispanic 

6 women aged 15–49 were enrolled in Medicaid in 

7 2018, compared with 15 percent of White women. 

8 (7) In the aggregate, nearly one-fifth (19 per9 cent) of Asian American and Pacific Islander women 

10 are enrolled in the Medicaid program, while enroll11 ment rates for certain Asian ethnic subgroups are 

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

13 percent of Hmong women and 32 percent of Paki14 stani women). 

15 (8) Medicaid also provides coverage to more 

16 than one in four (27 percent) nonelderly American 

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

18 AIAN children. 

19 (9) In a 2014 nationwide survey of LGBT peo20 ple with incomes less than 400 percent Federal Pov21 erty Level (FPL), 61 percent of all respondents had 

22 incomes in the Medicaid expansion range—up to 

23 138 percent of the FPL—including 73 percent of 

24 African-American respondents, 67 percent of Latino 

25 respondents, and 53 percent of White respondents. 


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1 Another survey found that 32 percent of Asian and 

2 Native Hawaiian/Pacific Islander transgender people 

3 were living in poverty. 

4 (10) Of women aged 15–44 enrolled in Med5 icaid in 2018, 55 percent lived in the 34 States and 

6 the District of Columbia where Medicaid does not 

7 cover abortion services except in limited cir8 cumstances. This amounted to 7.2 million women of 

9 reproductive age, including 3 million women living 

10 below the FPL. Of this population, Black, Indige11 nous, and other People of Color (BIPOC) women ac12 counted for 51 percent of those enrolled. 

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

14 federally funded health program for American Indi15 ans and Alaska Natives. The IHS serves a popu16 lation of approximately 2.56 million and as a feder17 ally funded system, since 1988, it has been barred 

18 from providing abortion services except for very lim19 ited cases. American Indians and Alaska Natives 

20 often face higher levels of poverty and limited access 

21 to health care for a number of intersecting oppres22 sions thus leaving them without recourse for the 

23 Federal ban on abortion services. 

24 (12) Moreover, 26 States also prohibit coverage 

25 of abortion services in the marketplaces and 11 proVerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H561.IH H561

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1 hibit coverage in private health insurance plans 

2 under the Patient Protection and Affordable Care 

3 Act of 2010 (Public Law 111–148). 

4 (13) A recent report details how restrictions on 

5 abortion services coverage interfere with a person’s 

6 individual decisionmaking, with their health and 

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

8 vulnerability to intimate partner violence, and with 

9 their constitutionally protected right to a safe and 

10 normal health care service. 

11 (14) About 25 percent of women covered by 

12 Medicaid seeking abortion services must carry their 

13 pregnancies to term because they are unable to ob14 tain funds for their care. Government-imposed bar15 riers to abortion services restrict people’s decisions 

16 on if, when, and how to parent, and have long-last17 ing and life-altering harmful effects on the pregnant 

18 person, their families and their communities. Those 

19 who seek and are denied abortion services are more 

20 likely to remain in or fall into poverty than those 

21 who access the care they need. 

22 (15) Restrictions on abortion service coverage 

23 have a disproportionately harmful impact on women 

24 with low incomes, women of color, immigrant 

25 women, LGBTQ people, and young women. AddiVerDate Sep 11 2014 04:24 Feb 09, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H561.IH H561

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1 tionally, numerous state-imposed barriers make it 

2 disparately difficult for low-income people, people of 

3 color, immigrants, LGBTQ people, and young people 

4 to access the health care and resources necessary to 

5 prevent unintended pregnancy or to assure that they 

6 are able to carry healthy pregnancies to term. Fur7 thermore, young people of reproductive age (15–24) 

8 are more likely to have a lower income than those 

9 older than that, and this income gap is greater for 

10 young BIPOC. More than 40 percent of youth and 

11 children under age 19 and almost a quarter of 

12 young people age 19 to 25 have health insurance 

13 through government programs. Without insurance 

14 coverage for abortion services, young people are at 

15 greater risk of not having the economic means to af16 ford care outside of insurance. Young people face 

17 disproportionate access barriers to abortion includ18 ing parental involvement requirement (notification 

19 and consent) and cost, in addition to barriers to con20 traception and inadequate and incomplete sexual(ity) 

21 education. These challenges, which are magnified for 

22 BIPOC and queer, trans, and nonbinary youth, can 

23 cause significant delays in access to needed care, 

24 and could ultimately harm the life of the young per25 son seeking abortion services. These institutionalized 


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1 barriers deny young people’s right to bodily auton2 omy and can force young people to encounter an 

3 abusive parent or guardian, ignores trusted relation4 ships young people may have with adults other than 

5 a parent or legal guardian, and in the case of the 

6 judicial bypass process, may force young BIPOC to 

7 interact with a legal system that has historically tar8 geted and caused harm to communities of color. 

9 (16) These and other government-created and 

10 government-institutionalized barriers—including the 

11 restriction on funding for abortion services in Fed12 eral programs—exacerbate and create poverty and 

13 racial inequality in income, wealth-generation, and 

14 access to services. 

15 (17) Access to health care, including abortion 

16 services, promotes the general welfare of people liv17 ing in the United States. Singling out abortion serv18 ices for funding restrictions in health care programs 

19 otherwise designed to promote the health and well20 being of people in the United States has cost preg21 nant people their lives, their livelihoods, their ability 

22 to obtain or maintain economic security for them23 selves and their families, their ability to meet their 

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


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1 education without disruption, and their ability to 

2 break free of abusive relationships. 

3 (18) Like other health care and health insur4 ance markets in the United States, abortion services 

5 and public insurance programs are commercial ac6 tivities that affect interstate commerce. Providers 

7 and patients travel across State lines, and otherwise 

8 engage in interstate commerce, to provide and access 

9 abortion services. Material goods, services, and fed10 erally regulated medications used in abortion serv11 ices circulate in interstate commerce. 

12 (19) Congress has the authority to enact this 

13 Act to ensure affordable coverage of abortion and 

14 other services pursuant to— 

15 (A) its powers under the necessary and 

16 proper clause of section 8, article I of the Con17 stitution of the United States; 

18 (B) its powers under the commerce clause 

19 of section 8, article 1 of the Constitution of the 

20 United States; 

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

22 general welfare under section 8, article 1 of the 

23 Constitution of the United States; and 

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

25 Fourteenth Amendment under section 5 of the 


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1 Fourteenth Amendment to the Constitution of 

2 the United States. 

3 (20) Congress has exercised these constitutional 

4 powers to create, expand, and insure health care ac5 cess for people in the United States for decades. 

6 Pursuant to this constitutional authority, Congress 

7 has enacted, and subsequently reauthorized, numer8 ous health care programs including but not limited 

9 to title XVIII of the Social Security Act of 1965 

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

11 1965 (Medicaid); and title XXI of the Social Secu12 rity Act (Children’s Health Insurance Program, en13 acted in 1997). 

14 SEC. 3. DEFINITIONS. 

15 For purposes of this Act: 

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

17 services’’ means an abortion and any services related 

18 to and provided in conjunction with an abortion, 

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

20 same day as the abortion. 

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

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

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

24 provide, health care: 


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1 (A) The Medicaid program under title XIX 

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

3 seq.). 

4 (B) The Children’s Health Insurance Pro5 gram under title XXI of the Social Security Act 

6 (42 U.S.C. 1397 et seq.). 

7 (C) The Medicare program under title 

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

9 1395 et seq.). 

10 (D) A Medicare supplemental policy as de11 fined in section 1882(g)(1) of the Social Secu12 rity Act (42 U.S.C. 1395ss(g)(1)). 

13 (E) The Indian Health Service program 

14 under the Indian Health Care Improvement Act 

15 (25 U.S.C. 1601 et seq.). 

16 (F) Medical care and health benefits under 

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

18 seq.). 

19 (G) Benefits for veterans under chapter 17 

20 of title 38, United States Code, and medical 

21 care for survivors and dependents of veterans 

22 (38 U.S.C. 1781 et seq.). 

23 (H) Benefits under the uniform health 

24 benefits program for employees of the Depart25 ment of Defense assigned to a nonappropriated 


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1 fund instrumentality of the Department estab2 lished under section 349 of the National De3 fense Authorization Act for Fiscal Year 1995 

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

5 (I) Medical care for individuals in the care 

6 or custody of the Department of Homeland Se7 curity pursuant to any of sections 235, 236, or 

8 241 of the Immigration and Nationality Act (8 

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

10 (J) Medical care for individuals in the care 

11 or custody of the Department of Health and 

12 Human Services, Office of Refugee Resettle13 ment under section 235 of the William Wilber14 force Trafficking Victims Protection Reauthor15 ization Act of 2008 (8 U.S.C. 1232) or section 

16 462 of the Homeland Security Act of 2002 (6 

17 U.S.C. 279). 

18 (K) Medical assistance to refugees under 

19 section 412 of the Immigration and Nationality 

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

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

22 benefits risk pool, as the Secretary of Health 

23 and Human Services, in coordination with the 

24 Secretary of the Treasury, recognizes for pur25 poses of section 5000A(f)(1)(E) of the Internal 


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

2 5000A(f)(1)(E)). 

3 (M) The Federal Employees Health Ben4 efit Plan under chapter 89 of title 5, United 

5 States Code. 

6 (N) Medical care for individuals under the 

7 care or custody of the Department of Justice 

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

9 4001 et seq.). 

10 (O) Medical care for Peace Corps volun11 teers under section 5(e) of the Peace Corps Act 

12 (22 U.S.C. 2504(e)). 

13 (P) Other government-sponsored programs 

14 established after the date of the enactment of 

15 this Act. 

16 SEC. 4. ABORTION COVERAGE AND CARE REGARDLESS OF 

17 INCOME OR SOURCE OF INSURANCE. 

18 (a) ENSURING ABORTION COVERAGE AND CARE

19 THROUGH THE FEDERAL GOVERNMENT IN ITS ROLE AS

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

21 enrolled in, or otherwise receiving medical care from 

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

23 receive coverage of abortion services. Health programs or 

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

25 abortion services. 


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1 (b) ENSURING ABORTION COVERAGE AND CARE

2 THROUGH THE FEDERAL GOVERNMENT IN ITS ROLE AS

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

4 of health services including in health programs and plans 

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

6 ensure access to abortion services for individuals who are 

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

8 facilities with which it contracts to provide medical care. 

9 (c) PROHIBITING RESTRICTIONS ON PRIVATE INSUR10 ANCE COVERAGE OF ABORTION SERVICES.—The Federal 

11 Government shall not prohibit, restrict, or otherwise in12 hibit insurance coverage of abortion services by State or 

13 local government or by private health plans. 

14 SEC. 5. REPEAL OF SECTION 1303. 

15 (a) IN GENERAL.—Section 1303 of the Patient Pro16 tection and Affordable Care Act (42 U.S.C. 18023) is re17 pealed. 

18 (b) CONFORMING AMENDMENTS.— 

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

20 the Patient Protection and Affordable Care Act (42 

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

22 (4). 

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

24 the Patient Protection and Affordable Care Act 

25 (Public Law 111–148) is amended— 


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

2 (B) by redesignating paragraph (7) as 

3 paragraph (6). 

4 SEC. 6. SENSE OF CONGRESS. 

5 It is the sense of Congress that— 

6 (1) the Federal Government, acting in its ca7 pacity as an insurer, employer, or health care pro8 vider, should serve as a model for the Nation to en9 sure coverage of abortion services; and 

10 (2) restrictions on coverage of abortion services 

11 in the private insurance market must end. 

12 SEC. 7. RULE OF CONSTRUCTION. 

13 Nothing in this Act shall be construed to have any 

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

15 more protections for abortion coverage or services than 

16 those set forth in this Act. 

17 SEC. 8. RELATIONSHIP TO FEDERAL LAW. 

18 This Act supersedes and applies to all Federal law, 

19 and the implementation of that law, whether statutory or 

20 otherwise, and whether adopted before or after the date 

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

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

23 seq.). 


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1 SEC. 9. SEVERABILITY. 

2 If any portion of this Act or the application thereof 

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

4 held invalid, such invalidity shall not affect the portions 

5 or applications of this Act which can be given effect with6 out the invalid portion or application. 

Æ 


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