EACH Act of 2021
Bill: S.1021 | Sponsor: Sen. Duckworth, Tammy (D-IL)
Policy area: Health

Summary:
Equal Access to Abortion Coverage in Health Insurance Act of 2021 or the EACH Act of 2021
This bill requires federal health care programs to provide coverage for abortion services and requires federal facilities to provide access to those services. The bill also permits qualified health plans to use funds attributable to premium tax credits and reduced cost sharing assistance to pay for abortion services.

To ensure affordable abortion coverage and care for every person, and 
                          for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Equal Access to Abortion 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, immigration status, sex 
        (including a sex stereotype; pregnancy, childbirth, or a 
        related medical condition; sexual orientation or gender 
        identity; and sex characteristics), age, disability, or sex 
        work status or behavior.
            (2) A person's income level, wealth, or type of insurance 
        should not prevent them from having access 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 service.
            (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 narrow circumstances. This ban affects 
        people of reproductive age in the United States who are insured 
        through the Medicaid program, as well as individuals who 
        receive insurance or care through other federally funded health 
        programs and plans.
            (5) Women make up the majority of Medicaid enrollees (54 
        percent) and, in 2019, approximately 14,000,000 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 enrolled in the 
        program.
            (6) Women of color are more likely to be insured by the 
        Medicaid program. Nationwide, 29 percent of Black women and 25 
        percent of Hispanic women aged 15 to 49 were enrolled in 
        Medicaid in 2018, compared with 15 percent of White women.
            (7) In the aggregate, nearly one-fifth (19 percent) of 
        Asian-American and Pacific-Islander women are enrolled in the 
        Medicaid program, while enrollment rates for certain Asian 
        ethnic subgroups are much higher (at 62 percent of Bhutanese 
        women, 43 percent of Hmong women and 32 percent of Pakistani 
        women).
            (8) Medicaid also provides coverage to more than 1 in 4 (27 
        percent) non-elderly American Indian and Alaska Native (AIAN) 
        adults and half of AIAN children.
            (9) In a 2014 nationwide survey of LGBT people with incomes 
        less than 400 percent Federal Poverty 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 Native Hawaiian/Pacific Islander 
        transgender people were living in poverty.
            (10) Of women aged 15 through 44 enrolled in Medicaid in 
        2018, 55 percent lived in the 34 States and the District of 
        Columbia where Medicaid does not cover abortion services except 
        in limited circumstances. This amounted to 7,200,000 women of 
        reproductive age, including 3,000,000 women living below the 
        FPL. Of this population, Black, Indigenous, and other People of 
        Color (BIPOC) women accounted for 51 percent of those enrolled.
            (11) The Indian Health Service (IHS) is the federally 
        funded health program for American Indians and Alaska Natives. 
        The IHS serves a population of approximately 2,560,000 and as a 
        federally funded system, since 1988, it has been barred from 
        providing abortion services except for very limited cases. 
        American Indians and Alaska Natives often face higher levels of 
        poverty and limited access to health care for a number of 
        intersecting oppressions 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 prohibit coverage in 
        private health insurance plans under the Patient Protection and 
        Affordable Care Act (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 obtain funds for their care. Government-
        imposed barriers to abortion services restrict people's 
        decisions on if, when, and how to parent, and have long-lasting 
        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. 
        Additionally, 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. Furthermore, young people of reproductive age (ages 15 to 
        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 afford care outside of insurance. 
        Young people face disproportionate access barriers to abortion 
        services, including parental involvement requirement 
        (notification and consent) and cost, in addition to barriers to 
        contraception and inadequate and incomplete sexual and 
        sexuality 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 person seeking abortion 
        services. These institutionalized barriers deny young people's 
        right to bodily autonomy and can force young people to 
        encounter an abusive parent or guardian, ignores trusted 
        relationships 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 targeted 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 Federal 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 living in the United 
        States. Singling out abortion services for funding restrictions 
        in health care programs otherwise designed to promote the 
        health and well-being 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.
            (18) Like other health care and health insurance markets in 
        the United States, abortion services and public insurance 
        programs are commercial activities 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 federally 
        regulated medications used in abortion services circulate in 
        interstate commerce.
            (19) Congress has the authority to enact this Act to ensure 
        affordable coverage of abortion services pursuant to--
                    (A) its powers under the necessary and proper 
                clause of Section 8, Article I of the Constitution 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.
            (20) Congress has exercised these constitutional powers to 
        create, expand, and insure health care access for people in the 
        United States for decades. Pursuant to this constitutional 
        authority, Congress has enacted, and subsequently reauthorized, 
        numerous health care programs including title XVIII of the 
        Social Security Act (Medicare, enacted in 1965); title XIX of 
        the Social Security Act (Medicaid, enacted in 1965); and title 
        XXI of the Social Security Act (Children's Health Insurance 
        Program, enacted 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.).
                    (B) The Children's Health Insurance Program 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 defined in 
                section 1882(g)(1) of the Social Security 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 (as defined in section 1072(7) of title 
                10, United States Code).
                    (G) Benefits under the uniform health benefits 
                program for employees of the Department of Defense 
                assigned to a nonappropriated fund instrumentality of 
                the Department established under section 349 of the 
                National Defense Authorization Act for Fiscal Year 1995 
                (Public Law 103-337; 10 U.S.C. 1587 note).
                    (H) Benefits for veterans under chapter 17 of title 
                38, United States Code.
                    (I) Medical care for survivors and dependents of 
                veterans under section 1781 of title 38, United States 
                Code.
                    (J) Medical care for individuals in the care or 
                custody of the Department of Homeland Security pursuant 
                to any of sections 235, 236, or 241 of the Immigration 
                and Nationality Act (8 U.S.C. 1225, 1226, 1231).
                    (K) Medical care for individuals in the care or 
                custody of the Department of Health and Human Services, 
                Office of Refugee Resettlement under section 235 of the 
                William Wilberforce Trafficking Victims Protection 
                Reauthorization Act of 2008 (8 U.S.C. 1232) or section 
                462 of the Homeland Security Act of 2002 (6 U.S.C. 
                279).
                    (L) Medical assistance to refugees under section 
                412 of the Immigration and Nationality Act (8 U.S.C. 
                1522).
                    (M) 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 purposes of section 
                5000A(f)(1)(E) of the Internal Revenue Code of 1986.
                    (N) The Federal Employees Health Benefit Plan under 
                chapter 89 of title 5, United States Code.
                    (O) Medical care for individuals under the care or 
                custody of the Department of Justice pursuant to 
                chapter 301 of title 18, United States Code.
                    (P) Medical care for Peace Corps volunteers under 
                section 5(e) of the Peace Corps Act (22 U.S.C. 
                2504(e)).
                    (Q) 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 a Health Care Provider.--In its role as a 
provider of health services, including under health programs described 
in section 3(2) and health services covered by health 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 Insurance Coverage Of 
Abortion Services.--The Federal Government shall not prohibit, 
restrict, or otherwise inhibit 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 Protection and 
Affordable Care Act (42 U.S.C. 18023) is repealed.
    (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
                    (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 capacity as an 
        insurer, employer, or health care provider, should serve as a 
        model for the Nation to ensure 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 abortion 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 held invalid, such 
invalidity shall not affect the portions or applications of this Act 
which can be given effect without the invalid portion or application.
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