,,ii #aagth ,,congress #ast ,session ,s4 #ajba ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #be1 #bjba ,ms4 ,duckworth 7for herself1 ,mrs4 ,murray1 ,ms4 ,hirono1 ,ms4 ,cortez ,masto1 ,mrs4 ,shaheen1 ,ms4 ,klobuchar1 ,mr4 ,blumenthal1 ,mr4 ,brown1 ,ms4 ,warren1 ,mrs4 ,gillibrand1 ,mr4 ,whitehouse1 ,ms4 ,rosen1 ,mrs4 ,feinstein1 ,mr4 ,merkley1 ,ms4 ,hassan1 ,mr4 ,bennet1 ,mr4 ,markey1 ,ms4 ,smith1 ,mr4 ,murphy1 ,mr4 ,booker1 ,mr4 ,van ,hollen1 ,mr4 ,sanders1 ,mr4 ,wyden1 ,mr4 ,padilla1 and ,mr4 ,lujn7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to ensure affordable abortion coverage and care for every person1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,equal ,access to ,abortion ,coverage in ,health ,insurance ,act of #bjba or the ,,each ,act of #bjba4 #b4 ,findings ,congress makes the following findings3 7#a7 ,all people should have access to abortion services regardless of actual or perceived race1 color1 ethnicity1 language1 ancestry1 citizenship1 immigration status1 sex 7including a sex stereotype2 pregnancy1 childbirth1 or a related medical condition2 sexual orientation or gender identity2 and sex characteristics71 age1 disability1 or sex work status or behavior4 7#b7 ,a person's income level1 wealth1 or type of insurance should not prevent them from having access to a full range of pregnancy-related health care1 including abortion services4 7#c7 ,no person should have the decision to have1 or not to have1 an abortion made for them based on the ability or inability to afford the health care service4 7#d7 ,since #aigf1 the ,federal ,government has banned the use of ,federal funds to pay for abortion services and allows for exceptions only in very narrow circumstances4 ,this ban affects people of reproductive age in the ,united ,states who are insured through the ,medicaid program1 as well as individuals who receive insurance or care through other federally funded health programs and plans4 7#e7 ,women make up the majority of ,medicaid enrollees 7#ed percent7 and1 in #bjai1 approximately #ad1jjj1jjj women of reproductive age relied on the program for care4 ,due to systematic barriers and discrimination1 a disproportionately higher number of women of color and ,lesbian1 ,gay1 ,bisexual1 ,transgender1 or ,queer 7,,lgbtq7 individuals are enrolled in the program4 7#f7 ,women of color are more likely to be insured by the ,medicaid program4 ,nationwide1 #bi percent of ,black women and #be percent of ,hispanic women aged #ae to #di were enrolled in ,medicaid in #bjah1 compared with #ae percent of ,white women4 7#g7 ,in the aggregate1 nearly one-fifth 7#ai percent7 of ,asian-,american and ,pacific-,islander women are enrolled in the ,medicaid program1 while enrollment rates for certain ,asian ethnic subgroups are much higher 7at #fb percent of ,bhutanese women1 #dc percent of ,hmong women and #cb percent of ,pakistani women74 7#h7 ,medicaid also provides coverage to more than #a in #d 7#bg percent7 non-elderly ,american ,indian and ,alaska ,native 7,,aian7 adults and half of ,,aian children4 7#i7 ,in a #bjad nationwide survey of ,,lgbt people with incomes less than #djj percent ,federal ,poverty ,level 7,,fpl71 #fa percent of all respondents had incomes in the ,medicaid expansion range--up to #ach percent of the ,,fpl--including #gc percent of ,african-,american respondents1 #fg percent of ,latino respondents1 and #ec percent of ,white respondents4 ,another survey found that #cb percent of ,asian and ,native ,hawaiian_/,pacific ,islander transgender people were living in poverty4 7#aj7 ,of women aged #ae through #dd enrolled in ,medicaid in #bjah1 #ee percent lived in the #cd ,states and the ,district of ,columbia where ,medicaid does not cover abortion services except in limited circumstances4 ,this amounted to #g1bjj1jjj women of reproductive age1 including #c1jjj1jjj women living below the ,,fpl4 ,of this population1 ,black1 ,indigenous1 and other ,people of ,color 7,,bipoc7 women accounted for #ea percent of those enrolled4 7#aa7 ,the ,indian ,health ,service 7,,ihs7 is the federally funded health program for ,american ,indians and ,alaska ,natives4 ,the ,,ihs serves a population of approximately #b1efj1jjj and as a federally funded system1 since #aihh1 it has been barred from providing abortion services except for very limited cases4 ,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 services4 7#ab7 ,moreover1 #bf ,states also prohibit coverage of abortion services in the marketplaces and #aa prohibit coverage in private health insurance plans under the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh74 7#ac7 ,a recent report details how restrictions on abortion services coverage interfere with a person's individual decision making1 with their health and well-being1 with their economic security1 with their vulnerability to intimate partner violence1 and with their constitutionally protected right to a safe and normal health care service4 7#ad7 ,about #be percent of women covered by ,medicaid seeking abortion services must carry their pregnancies to term because they are unable to obtain funds for their care4 ,government-imposed barriers to abortion services restrict people's decisions on if1 when1 and how to parent1 and have long-lasting and life-altering harmful effects on the pregnant person1 their families and their communities4 ,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 need4 7#ae7 ,restrictions on abortion service coverage have a disproportionately harmful impact on women with low incomes1 women of color1 immigrant women1 ,,lgbtq people1 and young women4 ,additionally1 numerous ,state-imposed barriers make it disparately difficult for low-income people1 people of color1 immigrants1 ,,lgbtq people1 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 term4 ,furthermore1 young people of reproductive age 7ages #ae to #bd7 are more likely to have a lower income than those older than that1 and this income gap is greater for young ,,bipoc4 ,more than #dj percent of youth and children under age #ai and almost a quarter of young people age #ai to #be have health insurance through government programs4 ,without insurance coverage for abortion services1 young people are at greater risk of not having the economic means to afford care outside of insurance4 ,young people face disproportionate access barriers to abortion services1 including parental involvement requirement 7notification and consent7 and cost1 in addition to barriers to contraception and inadequate and incomplete sexual and sexuality education4 ,these challenges1 which are magnified for ,,bipoc and queer1 trans1 and nonbinary youth1 can cause significant delays in access to needed care1 and could ultimately harm the life of the young person seeking abortion services4 ,these institutionalized barriers deny young people's right to bodily autonomy and can force young people to encounter an abusive parent or guardian1 ignores trusted relationships young people may have with adults other than a parent or legal guardian1 and in the case of the judicial bypass process1 may force young ,,bipoc to interact with a legal system that has historically targeted and caused harm to communities of color4 7#af7 ,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 income1 wealth-generation1 and access to services4 7#ag7 ,access to health care1 including abortion services1 promotes the general welfare of people living in the ,united ,states4 ,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 lives1 their livelihoods1 their ability to obtain or maintain economic security for themselves and their families1 their ability to meet their family's basic needs1 their ability to continue their education without disruption1 and their ability to break free of abusive relationships4 7#ah7 ,like other health care and health insurance markets in the ,united ,states1 abortion services and public insurance programs are commercial activities that affect interstate commerce4 ,providers and patients travel across ,state lines1 and otherwise engage in interstate commerce1 to provide and access abortion services4 ,material goods1 services1 and federally regulated medications used in abortion services circulate in interstate commerce4 7#ai7 ,congress has the authority to enact this ,act to ensure affordable coverage of abortion services pursuant to-- 7,a7 its powers under the necessary and proper clause of ,section #h1 ,article ,i of the ,constitution of the ,united ,states2 7,b7 its powers under the commerce clause of ,section #h1 ,article #a of the ,constitution of the ,united ,states2 7,c7 its powers to tax and spend for the general welfare under ,section #h1 ,article #a of the ,constitution of the ,united ,states2 and 7,d7 its powers to enforce section #a of the ,fourteenth ,amendment under ,section #e of the ,fourteenth ,amendment to the ,constitution of the ,united ,states4 7#bj7 ,congress has exercised these constitutional powers to create1 expand1 and insure health care access for people in the ,united ,states for decades4 ,pursuant to this constitutional authority1 ,congress has enacted1 and subsequently reauthorized1 numerous health care programs including title ,,xviii of the ,social ,security ,act 7,medicare1 enacted in #aife72 title ,,xix of the ,social ,security ,act 7,medicaid1 enacted in #aife72 and title ,,xxi of the ,social ,security ,act 7,children's ,health ,insurance ,program1 enacted in #aiig74 #c4 ,definitions ,for purposes of this ,act3 7#a7 ,abortion services ,the term abortion services means an abortion and any services related to1 and provided in conjunction with1 an abortion1 whether or not provided at the same time or on the same day as the abortion4 7#b7 ,health program or plan ,the term health program or plan means the following health programs or plans that pay the cost of1 or provide1 health care3 7,a7 ,the ,medicaid program under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7,b7 ,the ,children's ,health ,insurance ,program under title ,,xxi of the ,social ,security ,act 7#db ,u4,s4,c4 #acig et seq474 7,c7 ,the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7,d7 ,a medicare supplemental policy as defined in section #ahhb7;g77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7g77#a774 7,e7 ,the ,indian ,health ,service program under the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afja et seq474 7,f7 ,medical care and health benefits under the ,,tricare program 7as defined in section #ajgb7g7 of title #aj1 ,united ,states ,code74 7,g7 ,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 #cdi of the ,national ,defense ,authorization ,act for ,fiscal ,year #aiie 7,public ,law #ajc-ccg2 #aj ,u4,s4,c4 #aehg note74 7,h7 ,benefits for veterans under chapter #ag of title #ch1 ,united ,states ,code4 7,i7 ,medical care for survivors and dependents of veterans under section #agha of title #ch1 ,united ,states ,code4 7,j7 ,medical care for individuals in the care or custody of the ,department of ,homeland ,security pursuant to any of sections #bce1 #bcf1 or #bda of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #abbe1 #abbf1 #abca74 7,k7 ,medical care for individuals in the care or custody of the ,department of ,health and ,human ,services1 ,office of ,refugee ,resettlement under section #bce of the ,william ,wilberforce ,trafficking ,victims ,protection ,reauthorization ,act of #bjjh 7#h ,u4,s4,c4 #abcb7 or section #dfb of the ,homeland ,security ,act of #bjjb 7#f ,u4,s4,c4 #bgi74 7,l7 ,medical assistance to refugees under section #dab of the ,immigration and ,nationality ,act 7#h ,u4,s4,c4 #aebb74 7,m7 ,other coverage1 such as a ,state health benefits risk pool1 as the ,secretary of ,health and ,human ,services1 in coordination with the ,secretary of the ,treasury1 recognizes for purposes of section #ejjj;,a7f77#a77;,e7 of the ,internal ,revenue ,code of #aihf4 7,n7 ,the ,federal ,employees ,health ,benefit ,plan under chapter #hi of title #e1 ,united ,states ,code4 7,o7 ,medical care for individuals under the care or custody of the ,department of ,justice pursuant to chapter #cja of title #ah1 ,united ,states ,code4 7,p7 ,medical care for ,peace ,corps volunteers under section #e7;e7 of the ,peace ,corps ,act 7#bb ,u4,s4,c4 #bejd7;e774 7,q7 ,other government-sponsored programs established after the date of the enactment of this ,act4 #d4 ,abortion coverage and care regardless of income or source of insurance 7a7 ,ensuring ,abortion ,coverage and ,care ,through the ,federal ,government in its ,role as an ,insurer and ,employer ,each person insured by1 enrolled in1 or otherwise receiving medical care from health programs or plans described in section #c7b7 shall receive coverage of abortion services4 ,health programs or plans described in section #c7b7 shall provide coverage of abortion services4 7b7 ,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 services1 including under health programs described in section #c7b7 and health services covered by health plans described in section #c7b71 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 care4 7c7 ,prohibiting ,restrictions ,on ,private ,insurance ,coverage ,of ,abortion ,services ,the ,federal ,government shall not prohibit1 restrict1 or otherwise inhibit insurance coverage of abortion services by ,state or local government or by private health plans4 #e4 ,repeal of section #acjc 7a7 ,in general ,section #acjc of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjbc7 is repealed4 7b7 ,conforming amendments 7#a7 ,basic health plans ,section #acca7;d7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjea7;d77 is amended by striking paragraph 7#d74 7#b7 ,multi-,state plans ,section #accd7;a7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh7 is amended-- 7,a7 by striking paragraph 7#f72 and 7,b7 by redesignating paragraph 7#g7 as paragraph 7#f74 #f4 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 the ,federal ,government1 acting in its capacity as an insurer1 employer1 or health care provider1 should serve as a model for the ,nation to ensure coverage of abortion services2 and 7#b7 restrictions on coverage of abortion services in the private insurance market must end4 #g4 ,rule of construction ,nothing in this ,act shall be construed to have any effect on any ,federal1 ,state1 or local law that includes more protections for abortion coverage or abortion services than those set forth in this ,act4 #h4 ,relationship to ,federal law ,this ,act supersedes and applies to all ,federal law1 and the implementation of that law1 whether statutory or otherwise1 and whether adopted before or after the date of enactment of this ,act and is not subject to the ,religious ,freedom ,restoration ,act of #aiic 7#db ,u4,s4,c4 #bjjj;bb et seq474 #i4 ,severability ,if any portion of this ,act or the application thereof to any person1 entity1 government1 or circumstances is held invalid1 such invalidity shall not affect the portions or applications of this ,act which can be given effect without the invalid portion or application4