S. 1031 PDF

II 118TH CONGRESS 1ST SESSION S. 1031...

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. COR- TEZ 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 Representa- 2 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 Abor- 5 tion Coverage in Health Insurance Act of 2023’’ or the pbinns on DSKJLVW7X2PROD with $$_JOB 6 ‘‘EACH Act of 2023’’. VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  2 1 SEC. 2. FINDINGS. 2 Congress makes the following findings: 3 (1) All people should have access to abortion 4 services regardless of actual or perceived race, color, 5 ethnicity, language, ancestry, citizenship, immigra- 6 tion status, sex (including a sex stereotype; preg- 7 nancy, childbirth, or a related medical condition; 8 sexual orientation or gender identity; and sex char- 9 acteristics), age, disability, or sex work status or be- 10 havior. 11 (2) A person’s income level, wealth, or type of 12 insurance should not prevent them from having ac- 13 cess to a full range of pregnancy-related health care, 14 including abortion services. 15 (3) No person should have the decision to have, 16 or not to have, an abortion made for them based on 17 the ability or inability to afford the health care serv- 18 ice. 19 (4) Since 1976, the Federal Government has 20 banned the use of Federal funds to pay for abortion 21 services and allows for exceptions only in very nar- 22 row circumstances. This ban affects people of repro- 23 ductive age in the United States who are insured 24 through the Medicaid program, as well as individuals pbinns on DSKJLVW7X2PROD with $$_JOB 25 who receive insurance or care through other feder- 26 ally funded health programs and plans. S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  3 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 en- 8 rolled in the program. 9 (6) Women of color are more likely to be in- 10 sured by the Medicaid program. Nationwide, 29 per- 11 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 per- 15 cent) of Asian-American and Pacific-Islander women 16 are enrolled in the Medicaid program, while enroll- 17 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 Paki- 20 stani women). 21 (8) Medicaid also provides coverage to more 22 than 1 in 4 (27 percent) non-elderly American In- 23 dian and Alaska Native (AIAN) adults and half of 24 AIAN children. pbinns on DSKJLVW7X2PROD with $$_JOB S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  4 1 (9) In a 2014 nationwide survey of LGBT peo- 2 ple with incomes less than 400 percent Federal Pov- 3 erty Level (FPL), 61 percent of all respondents had 4 incomes in the Medicaid expansion range—up to 5 138 percent of the FPL—including 73 percent of 6 African-American respondents, 67 percent of Latino 7 respondents, and 53 percent of White respondents. 8 Another survey found that 32 percent of Asian and 9 Native Hawaiian/Pacific Islander transgender people 10 were living in poverty. 11 (10) Of women aged 15 through 44 enrolled in 12 Medicaid in 2018, 55 percent lived in the 34 States 13 and the District of Columbia where Medicaid does 14 not cover abortion services except in limited cir- 15 cumstances. This amounted to 7,200,000 women of 16 reproductive age, including 3,000,000 women living 17 below the FPL. Of this population, Black, Indige- 18 nous, and other People of Color (BIPOC) women ac- 19 counted for 51 percent of those enrolled. 20 (11) The Indian Health Service (IHS) is the 21 federally funded health program for American Indi- 22 ans and Alaska Natives. The IHS serves a popu- 23 lation of approximately 2,560,000 and as a federally 24 funded system, since 1988, it has been barred from pbinns on DSKJLVW7X2PROD with $$_JOB 25 providing abortion services except for very limited S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  5 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 pro- 8 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 ob- 21 tain funds for their care. Government-imposed bar- 22 riers to abortion services restrict people’s decisions 23 on if, when, and how to parent, and have long-last- 24 ing and life-altering harmful effects on the pregnant pbinns on DSKJLVW7X2PROD with $$_JOB 25 person, their families and their communities. Those S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  6 1 who seek and are denied abortion services are more 2 likely to remain in or fall into poverty than those 3 who access the care they need. 4 (15) Restrictions on abortion service coverage 5 have a disproportionately harmful impact on women 6 with low incomes, women of color, immigrant 7 women, LGBTQ people, and young women. Addi- 8 tionally, numerous State-imposed barriers make it 9 disparately difficult for low-income people, people of 10 color, immigrants, LGBTQ people, and young people 11 to access the health care and resources necessary to 12 prevent unintended pregnancy or to assure that they 13 are able to carry healthy pregnancies to term. Fur- 14 thermore, young people of reproductive age (ages 15 15 to 24) are more likely to have a lower income than 16 those older than that, and this income gap is greater 17 for young BIPOC. More than 40 percent of youth 18 and children under age 19 and almost a quarter of 19 young people age 19 to 25 have health insurance 20 through government programs. Without insurance 21 coverage for abortion services, young people are at 22 greater risk of not having the economic means to af- 23 ford care outside of insurance. Young people face 24 disproportionate access barriers to abortion services, pbinns on DSKJLVW7X2PROD with $$_JOB 25 including parental involvement requirement (notifi- S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  7 1 cation and consent) and cost, in addition to barriers 2 to contraception and inadequate and incomplete sex- 3 ual and sexuality education. These challenges, which 4 are magnified for BIPOC and queer, trans, and non- 5 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 com- 16 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 Fed- 20 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 liv- pbinns on DSKJLVW7X2PROD with $$_JOB 25 ing in the United States. Singling out abortion serv- S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  8 1 ices for funding restrictions in health care programs 2 otherwise designed to promote the health and well- 3 being of people in the United States has cost preg- 4 nant people their lives, their livelihoods, their ability 5 to obtain or maintain economic security for them- 6 selves and their families, their ability to meet their 7 family’s basic needs, their ability to continue their 8 education without disruption, and their ability to 9 break free of abusive relationships. 10 (18) Like other health care and health insur- 11 ance markets in the United States, abortion services 12 and public insurance programs are commercial ac- 13 tivities that affect interstate commerce. Providers 14 and patients travel across State lines, and otherwise 15 engage in interstate commerce, to provide and access 16 abortion services. Material goods, services, and fed- 17 erally regulated medications used in abortion serv- 18 ices circulate in interstate commerce. 19 (19) Congress has the authority to enact this 20 Act to ensure affordable coverage of abortion serv- 21 ices pursuant to— 22 (A) its powers under the necessary and 23 proper clause of section 8, article I of the Con- 24 stitution of the United States; pbinns on DSKJLVW7X2PROD with $$_JOB S 1031 IS VerDate Sep 11 2014 22:40 Apr 10, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  9 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 ac- 13 cess for people in the United States for decades. 14 Pursuant to this constitutional authority, Congress 15 has enacted, and subsequently reauthorized, numer- 16 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, en- 19 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 pbinns on DSKJLVW7X2PROD with $$_JOB 25 services’’ means an abortion and any services related S 1031 IS VerDate Sep 11 2014 23:27 Apr 10, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  10 1 to, and provided in conjunction with, an abortion, 2 whether or not provided at the same time or on the 3 same day as the abortion. 4 (2) HEALTH PROGRAM OR PLAN.—The term 5 ‘‘health program or plan’’ means the following 6 health programs or plans that pay the cost of, or 7 provide, health care: 8 (A) The Medicaid program under title XIX 9 of the Social Security Act (42 U.S.C. 1396 et 10 seq.). 11 (B) The Children’s Health Insurance Pro- 12 gram under title XXI of the Social Security Act 13 (42 U.S.C. 1397 et seq.). 14 (C) The Medicare program under title 15 XVIII of the Social Security Act (42 U.S.C. 16 1395 et seq.). 17 (D) A medicare supplemental policy as de- 18 fined in section 1882(g)(1) of the Social Secu- 19 rity Act (42 U.S.C. 1395ss(g)(1)). 20 (E) The Indian Health Service program 21 under the Indian Health Care Improvement Act 22 (25 U.S.C. 1601 et seq.). 23 (F) Medical care and health benefits under 24 the TRICARE program (as defined in section pbinns on DSKJLVW7X2PROD with $$_JOB 25 1072(7) of title 10, United States Code). S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  11 1 (G) Benefits under the uniform health ben- 2 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 Au- 6 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 depend- 11 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 Se- 15 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 Resettle- 21 ment under section 235 of the William Wilber- 22 force Trafficking Victims Protection Reauthor- 23 ization Act of 2008 (8 U.S.C. 1232) or section 24 462 of the Homeland Security Act of 2002 (6 pbinns on DSKJLVW7X2PROD with $$_JOB 25 U.S.C. 279). S 1031 IS VerDate Sep 11 2014 22:40 Apr 10, 2023 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  12 1 (L) Medical assistance to refugees under 2 section 412 of the Immigration and Nationality 3 Act (8 U.S.C. 1522). 4 (M) Other coverage, such as a State health 5 benefits risk pool, as the Secretary of Health 6 and Human Services, in coordination with the 7 Secretary of the Treasury, recognizes for pur- 8 poses of section 5000A(f)(1)(E) of the Internal 9 Revenue Code of 1986. 10 (N) The Federal Employees Health Ben- 11 efit Plan under chapter 89 of title 5, United 12 States Code. 13 (O) Medical care for individuals under the 14 care or custody of the Department of Justice 15 pursuant to chapter 301 of title 18, United 16 States Code. 17 (P) Medical care for Peace Corps volun- 18 teers under section 5(e) of the Peace Corps Act 19 (22 U.S.C. 2504(e)). 20 (Q) Other government-sponsored programs 21 established after the date of the enactment of 22 this Act. pbinns on DSKJLVW7X2PROD with $$_JOB S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  13 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 de- 15 scribed in section 3(2) and health services covered by 16 health plans described in section 3(2), the Federal Govern- 17 ment shall ensure access to abortion services for individ- 18 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 INSUR- 22 ANCE COVERAGE OF ABORTION SERVICES.—The Federal 23 Government shall not prohibit, restrict, or otherwise in- 24 hibit insurance coverage of abortion services by State or pbinns on DSKJLVW7X2PROD with $$_JOB 25 local government or by private health plans. S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  14 1 SEC. 5. REPEAL OF SECTION 1303. 2 (a) IN GENERAL.—Section 1303 of the Patient Pro- 3 tection and Affordable Care Act (42 U.S.C. 18023) is re- 4 pealed. 5 (b) CONFORMING AMENDMENTS.— 6 (1) BASIC HEALTH PLANS.—Section 1331(d) of 7 the Patient Protection and Affordable Care Act (42 8 U.S.C. 18051(d)) is amended by striking paragraph 9 (4). 10 (2) MULTI-STATE PLANS.—Section 1334(a) of 11 the Patient Protection and Affordable Care Act 12 (Public Law 111–148) is amended— 13 (A) by striking paragraph (6); and 14 (B) by redesignating paragraph (7) as 15 paragraph (6). 16 SEC. 6. SENSE OF CONGRESS. 17 It is the sense of Congress that— 18 (1) the Federal Government, acting in its ca- 19 pacity as an insurer, employer, or health care pro- 20 vider, should serve as a model for the Nation to en- 21 sure coverage of abortion services; and 22 (2) restrictions on coverage of abortion services 23 in the private insurance market must end. 24 SEC. 7. RULE OF CONSTRUCTION. pbinns on DSKJLVW7X2PROD with $$_JOB 25 Nothing in this Act shall be construed to have any 26 effect on any Federal, State, or local law that includes S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\S1031.IS S1031  15 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 with- 15 out the invalid portion or application. Æ pbinns on DSKJLVW7X2PROD with $$_JOB S 1031 IS VerDate Sep 11 2014 03:56 Apr 08, 2023 Jkt 039200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6301 E:\BILLS\S1031.IS S1031