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-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Equal Access to Abor-
tion Coverage in Health Insurance Act of 2021’’ or the 
‘‘EACH Act of 2021’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) All people should have access to abortion 
services regardless of actual or perceived race, color, 
ethnicity, language, ancestry, citizenship, immigra-
tion status, sex (including a sex stereotype; preg-
nancy, childbirth, or a related medical condition; 
sexual orientation or gender identity; and sex char-
acteristics), age, disability, or sex work status or be-
havior. 
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(2) A person’s income level, wealth, or type of 
insurance should not prevent them from having ac-
cess to a full range of pregnancy-related health care, 
including abortion services. 
(3) No person should have the decision to have, 
or not to have, an abortion made for them based on 
the ability or inability to afford the health care serv-
ice. 
(4) Since 1976, the Federal Government has 
banned the use of Federal funds to pay for abortion 
services and allows for exceptions only in very nar-
row circumstances. This ban affects people of repro-
ductive age in the United States who are insured 
through the Medicaid program, as well as individuals 
who receive insurance or care through other feder-
ally-funded health programs and plans. 
(5) Women make up the majority of Medicaid 
enrollees (54 percent) and, in 2019, approximately 
14 million women of reproductive age relied on the 
program for care. Due to systematic barriers and 
discrimination, a disproportionately higher number 
of women of color and Lesbian, Gay, Bisexual, 
Transgender, or Queer (LGBTQ) individuals are en-
rolled in the program. 
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(6) Women of color are more likely to be in-
sured by the Medicaid program. Nationwide, 29 per-
cent of Black women and 25 percent of Hispanic 
women aged 15–49 were enrolled in Medicaid in 
2018 , compared with 15 percent of white women. 
(7) In the aggregate, nearly one-fifth (19 per-
cent) of Asian American and Pacific Islander women 
are enrolled in the Medicaid program, while enroll-
ment rates for certain Asian ethnic subgroups are 
much higher (at 62 percent of Bhutanese women, 43 
percent of Hmong women and 32 percent of Paki-
stani women). 
(8) Medicaid also provides coverage to more 
than one in four (27 percent) nonelderly American 
Indian and Alaska Native (AIAN) adults and half of 
AIAN children. 
(9) In a 2014 nationwide survey of LGBT peo-
ple with incomes less than 400 percent Federal Pov-
erty Level (FPL), 61 percent of all respondents had 
incomes in the Medicaid expansion range—up to 
138 percent of the FPL—including 73 percent of 
African-American respondents, 67 percent of Latino 
respondents, and 53 percent of white respondents. 
Another survey found that 32 percent of Asian and 
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Native Hawaiian/Pacific Islander transgender people 
were living in poverty. 
(10) Of women aged 15–44 enrolled in Med-
icaid in 2018, 55 percent lived in the 34 States and 
the District of Columbia where Medicaid does not 
cover abortion services except in limited cir-
cumstances. This amounted to 7.2 million women of 
reproductive age, including 3 million women living 
below the FPL. Of this population, Black, Indige-
nous, and other People of Color (BIPOC) women ac-
counted for 51 percent of those enrolled. 
(11) The Indian Health Service (IHS) is the 
federally funded health program for American Indi-
ans and Alaska Natives. The IHS serves a popu-
lation of approximately 2.56 million and as a feder-
ally funded system, since 1988, it has been barred 
from providing abortion services except for very lim-
ited cases. American Indians and Alaska Natives 
often face higher levels of poverty and limited access 
to health care for a number of intersecting oppres-
sions thus leaving them without recourse for the fed-
eral ban on abortion services. 
(12) Moreover, 26 States also prohibit coverage 
of abortion services in the marketplaces and 11 pro-
hibit coverage in private health insurance plans 
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under the Patient Protection and Affordable Care 
Act of 2010 (Public Law 111–148). 
(13) A recent report details how restrictions on 
abortion services coverage interfere with a person’s 
individual decision-making, with their health and 
well-being, with their economic security, with their 
vulnerability to intimate partner violence, and with 
their constitutionally protected right to a safe and 
normal health care service. 
(14) About 25 percent of women covered by 
Medicaid seeking abortion services must carry their 
pregnancies to term because they are unable to ob-
tain funds for their care. Government-imposed bar-
riers to abortion services restrict people’s decisions 
on if, when, and how to parent, and have long-last-
ing and life-altering harmful effects on the pregnant 
person, their families and their communities. Those 
who seek and are denied abortion services are more 
likely to remain in or fall into poverty than those 
who access the care they need. 
(15) Restrictions on abortion service coverage 
have a disproportionately harmful impact on women 
with low incomes, women of color, immigrant 
women, LGBTQ people, and young women. Addi-
tionally, numerous state-imposed barriers make it 
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disparately difficult for low-income people, people of 
color, immigrants, LGBTQ people, and young people 
to access the health care and resources necessary to 
prevent unintended pregnancy or to assure that they 
are able to carry healthy pregnancies to term. Fur-
thermore, young people of reproductive age (15–24) 
are more likely to have a lower income than those 
older than that, and this income gap is greater for 
young BIPOC. More than 40 percent of youth and 
children under age 19 and almost a quarter of 
young people age 19 to 25 have health insurance 
through government programs. Without insurance 
coverage for abortion services, young people are at 
greater risk of not having the economic means to af-
ford care outside of insurance. Young people face 
disproportionate access barriers to abortion includ-
ing parental involvement requirement (notification 
and consent) and cost, in addition to barriers to con-
traception and inadequate and incomplete sexual(ity) 
education. These challenges, which are magnified for 
BIPOC and queer, trans, and nonbinary youth, can 
cause significant delays in access to needed care, 
and could ultimately harm the life of the young per-
son seeking abortion services. These institutionalized 
barriers deny young people’s right to bodily auton-
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omy and can force young people to encounter an 
abusive parent or guardian, ignores trusted relation-
ships young people may have with adults other than 
a parent or legal guardian, and in the case of the 
judicial bypass process, may force young BIPOC to 
interact with a legal system that has historically tar-
geted and caused harm to communities of color. 
(16) These and other government-created and 
government-institutionalized barriers—including the 
restriction on funding for abortion services in Fed-
eral programs—exacerbate and create poverty and 
racial inequality in income, wealth-generation, and 
access to services. 
(17) Access to health care, including abortion 
services, promotes the general welfare of people liv-
ing in the United States. Singling out abortion serv-
ices for funding restrictions in health care programs 
otherwise designed to promote the health and 
wellbeing of people in the United States has cost 
pregnant people their lives, their livelihoods, their 
ability to obtain or maintain economic security for 
themselves and their families, their ability to meet 
their family’s basic needs, their ability to continue 
their education without disruption, and their ability 
to break free of abusive relationships. 
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(18) Like other health care and health insur-
ance markets in the United States, abortion services 
and public insurance programs are commercial ac-
tivities that affect interstate commerce. Providers 
and patients travel across state lines, and otherwise 
engage in interstate commerce, to provide and access 
abortion services. Material goods, services, and fed-
erally-regulated medications used in abortion serv-
ices circulate in interstate commerce. 
(19) Congress has the authority to enact this 
Act to ensure affordable coverage of abortion and 
other services pursuant to— 
(A) its powers under the necessary and 
proper clause of Section 8, Article I of the Con-
stitution of the United States; 
(B) its powers under the commerce clause 
of Section 8, Article 1 of the Constitution of the 
United States; 
(C) its powers to tax and spend for the 
general welfare under Section 8, Article 1 of 
the Constitution of the United States; and 
(D) its powers to enforce section 1 of the 
Fourteenth Amendment under Section 5 of the 
Fourteenth Amendment to the Constitution of 
the United States. 
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(20) Congress has exercised these constitutional 
powers to create, expand, and insure health care ac-
cess for people in the United States for decades. 
Pursuant to this constitutional authority, Congress 
has enacted, and subsequently reauthorized, numer-
ous health care programs including but not limited 
to title XVIII of the Social Security Act of 1965 
(Medicare); title XIX of the Social Security Act of 
1965 (Medicaid); and title XXI of the Social Secu-
rity Act (Children’s Health Insurance Program, en-
acted in 1997). 
SEC. 3. DEFINITIONS. 
For purposes of this Act: 
(1) ABORTION SERVICES.—The term ‘‘abortion 
services’’ means an abortion and any services related 
to and provided in conjunction with an abortion, 
whether or not provided at the same time or on the 
same day as the abortion. 
(2) HEALTH
PROGRAM
OR
PLAN.—The term 
‘‘health program or plan’’ means the following 
health programs or plans that pay the cost of, or 
provide, health care: 
(A) The Medicaid program under title XIX 
of the Social Security Act (42 U.S.C. 1396 et 
seq.). 
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(B) The Children’s Health Insurance Pro-
gram under title XXI of the Social Security Act 
(42 U.S.C. 1397 et seq.). 
(C) The Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.). 
(D) A Medicare supplemental policy as de-
fined in section 1882(g)(1) of the Social Secu-
rity Act (42 U.S.C. 1395ss(g)(1)). 
(E) The Indian Health Service program 
under the Indian Health Care Improvement Act 
(25 U.S.C. 1601 et seq.). 
(F) Medical care and health benefits under 
the TRICARE program (10 U.S.C. 1071 et 
seq.). 
(G) Benefits for veterans under chapter 17 
of title 38, United States Code, and medical 
care for survivors and dependents of veterans 
(38 U.S.C. 1781 et seq.). 
(H) Benefits under the uniform health 
benefits program for employees of the Depart-
ment of Defense assigned to a nonappropriated 
fund instrumentality of the Department estab-
lished under section 349 of the National De-
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fense Authorization Act for Fiscal Year 1995 
(Public Law 103–337; 10 U.S.C. 1587 note). 
(I) Medical care for individuals in the care 
or custody of the Department of Homeland Se-
curity pursuant to any of sections 235, 236, or 
241 of the Immigration and Nationality Act (8 
U.S.C. 1225, 1226, 1231). 
(J) Medical care for individuals in the care 
or custody of the Department of Health and 
Human Services, Office of Refugee Resettle-
ment under section 235 of the William Wilber-
force Trafficking Victims Protection Reauthor-
ization Act of 2008 (8 U.S.C. 1232) or section 
462 of the Homeland Security Act of 2002 (6 
U.S.C. 279). 
(K) Medical assistance to refugees under 
section 412 of the Immigration and Nationality 
Act (8 U.S.C. 1522). 
(L) Other coverage, such as a State health 
benefits risk pool, as the Secretary of Health 
and Human Services, in coordination with the 
Secretary of the Treasury, recognizes for pur-
poses of section 5000A(f)(1)(E) of the Internal 
Revenue 
Code 
of 
1986 
(26 
U.S.C. 
5000A(f)(1)(E)). 
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(M) The Federal Employees Health Ben-
efit Plan under chapter 89 of title 5, United 
States Code. 
(N) Medical care for individuals under the 
care or custody of the Department of Justice 
pursuant to chapter 301 of title 18 (18 U.S.C. 
4001 et seq.). 
(O) Medical care for Peace Corps volun-
teers under section 5(e) of the Peace Corps Act 
(22 U.S.C. 2504(e)). 
(P) Other government-sponsored programs 
established after the date of the enactment of 
this Act. 
SEC. 4. ABORTION COVERAGE AND CARE REGARDLESS OF 
INCOME OR SOURCE OF INSURANCE. 
(a) ENSURING ABORTION COVERAGE
AND CARE 
THROUGH THE FEDERAL GOVERNMENT IN ITS ROLE AS 
AN INSURER AND EMPLOYER.—Each person insured by, 
enrolled in, or otherwise receiving medical care from 
health programs or plans described in section 3(2) shall 
receive coverage of abortion services. Health programs or 
plans described in section 3(2) shall provide coverage of 
abortion services. 
(b) ENSURING ABORTION COVERAGE AND CARE 
THROUGH THE FEDERAL GOVERNMENT IN ITS ROLE AS 
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A HEALTH CARE PROVIDER.—In its role as a provider 
of health services including in health programs and plans 
described in section 3(2), the Federal Government shall 
ensure access to abortion services for individuals who are 
eligible to receive medical care in its own facilities or in 
facilities with which it contracts to provide medical care. 
(c) PROHIBITING RESTRICTIONS ON PRIVATE INSUR-
ANCE COVERAGE OF ABORTION SERVICES.—The Federal 
Government shall not prohibit, restrict, or otherwise in-
hibit insurance coverage of abortion services by State or 
local government or by private health plans. 
SEC. 5. REPEAL OF SECTION 1303. 
(a) IN GENERAL.—Section 1303 of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 18023) is re-
pealed. 
(b) CONFORMING AMENDMENTS.— 
(1) BASIC HEALTH PLANS.—Section 1331(d) of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18051(d)) is amended by striking paragraph 
(4). 
(2) MULTI-STATE PLANS.—Section 1334(a) of 
the Patient Protection and Affordable Care Act 
(Public Law 111–148) is amended— 
(A) by striking paragraph (6); and 
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(B) by redesignating paragraph (7) as 
paragraph (6). 
SEC. 6. SENSE OF CONGRESS. 
It is the sense of Congress that— 
(1) the Federal Government, acting in its ca-
pacity as an insurer, employer, or health care pro-
vider, should serve as a model for the Nation to en-
sure coverage of abortion services; and 
(2) restrictions on coverage of abortion services 
in the private insurance market must end. 
SEC. 7. RULE OF CONSTRUCTION. 
Nothing in this Act shall be construed to have any 
effect on any Federal, State, or local law that includes 
more protections for abortion coverage or services than 
those set forth in this Act. 
SEC. 8. RELATIONSHIP TO FEDERAL LAW. 
This Act supersedes and applies to all Federal law, 
and the implementation of that law, whether statutory or 
otherwise, and whether adopted before or after the date 
of enactment of this Act and is not subject to the Religious 
Freedom Restoration Act of 1993 (42 U.S.C. 2000bb et 
seq.). 
SEC. 9. SEVERABILITY. 
If any portion of this Act or the application thereof 
to any person, entity, government, or circumstances is 
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held invalid, such invalidity shall not affect the portions 
or applications of this Act which can be given effect with-
out the invalid portion or application. 
Æ 
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