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, 
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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) 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-
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 2023’’ or the 
‘‘EACH Act of 2023’’. 
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; 
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sexual orientation or gender identity; and sex char-
acteristics), age, disability, or sex work status or be-
havior. 
(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, 
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Transgender, or Queer (LGBTQ) individuals are en-
rolled in the program. 
(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. 
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Another survey found that 32 percent of Asian and 
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 
Federal ban on abortion services. 
(12) Moreover, 26 States also prohibit coverage 
of abortion services in the marketplaces and 11 pro-
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hibit coverage in private health insurance plans 
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 decisionmaking, 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-
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tionally, numerous state-imposed barriers make it 
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 
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barriers deny young people’s right to bodily auton-
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 well- 
being of people in the United States has cost preg-
nant people their lives, their livelihoods, their ability 
to obtain or maintain economic security for them-
selves and their families, their ability to meet their 
family’s basic needs, their ability to continue their 
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education without disruption, and their ability to 
break free of abusive relationships. 
(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 
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