[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4303 Introduced in House (IH)]

<DOC>






118th CONGRESS
  1st Session
                                H. R. 4303

                   To expand access to abortion care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 22, 2023

 Ms. Pressley (for herself, Ms. Williams of Georgia, Ms. Escobar, Ms. 
Bush, and Mr. Frost) introduced the following bill; which was referred 
    to the Committee on Energy and Commerce, and in addition to the 
 Committees on Ways and Means, the Judiciary, Natural Resources, Armed 
Services, Veterans' Affairs, Oversight and Accountability, 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 expand access to abortion care.

    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 ``Abortion Justice Act of 2023''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Abortion care is essential health care that should be 
        affordable, available, and supported for everyone who needs it.
            (2) On June 24, 2022, the Supreme Court overturned Roe v. 
        Wade and 50 years of legal precedent, and Roe v. Wade was never 
        enough. Without the ability to access abortion, the legal right 
        did not help many people working to make ends meet, who are 
        Black, Indigenous, Asian, Pacific Islander, Latinx, young 
        people, LGBTQ+ people, immigrants, disabled people and gender 
        nonconforming people.
            (3) Almost one-third (29 percent) of the total United 
        States population of women of reproductive age are currently 
        living in States where abortion is either unavailable or 
        severely restricted and a dozen other States are certain or 
        likely to ban abortion in the future.
            (4) Systemic racism, economic insecurity, abelism, and a 
        dehumanizing immigration system exacerbate the already-massive 
        barriers to abortion care.
            (5) While abortion bans and other legal restrictions harm 
        all people who are or may become pregnant, they cause even 
        greater harm to those already subject to systemic racism and 
        economic injustice.
            (6) Pregnancy is less safe for some than others because of 
        historic and ongoing racism and discrimination in health care 
        settings, and Black and Indigenous individuals face two to 
        three times the risk of dying from pregnancy-related causes. 
        Individuals in States banning or severely restricting access to 
        abortion care also have worse maternal health outcomes.
            (7) Forced pregnancy is always unconscionable, and 
        particularly so for individuals facing heightened risk of 
        maternal mortality and morbidity, where pregnancy is less safe 
        for some than others because of historic and ongoing racism and 
        discrimination in health care settings.
            (8) Maternal deaths in 2020 were 62 percent higher in 
        States where abortion is heavily restricted than in States 
        where abortion was available, and a Federal ban on abortion 
        would increase maternal mortality by an estimated 24 percent.
            (9) Congress has the authority to act pursuant to the 
        commerce clause, the necessary and proper clause, and section 5 
        of the 14th Amendment.
            (10) Attacks on bodily autonomy are not limited to threats 
        on abortion care. This year alone, more than 120 bills have 
        been introduced attacking gender-affirming care. States have 
        attempted to outlaw many forms of birth control, and 15 States 
        have near total abortion bans.
            (11) Several State courts have found that abortion 
        restrictions violate the right to bodily autonomy.
            (12) The criminalization of abortion care forces people to 
        travel hundreds of miles out of their community to try to get 
        care.
            (13) As in other forms of criminalization, the people 
        targeted for pregnancy loss and self-managed abortion 
        prosecution are disproportionately people of color, immigrants, 
        and people experiencing economic insecurity.
            (14) Throughout the more than 20 years that it has been 
        used in the United States, medication abortion has been proven 
        to be overwhelmingly safe and effective, and has expanded the 
        way people choose to self manage their abortion.
            (15) All Food and Drug Administration-approved drugs must 
        be available in all States and territories.
            (16) Research shows that with access to safe, effective 
        methods and accurate information, people may safely self-manage 
        an abortion on their own. Anyone who decides to end a pregnancy 
        should be able to choose to self-manage an abortion at home 
        with medical guidance and the support they want.
            (17) Abortion needs to be accessible where people live and 
        where they access health care. For young adults on college 
        campuses, student health centers are often where they access 
        the full range of care they need, and medication abortion must 
        be accessible and available to young adults who get their 
        health insurance through their State colleges and universities, 
        and three States (Massachusetts, New York, and California) have 
        passed laws ensuring access to medication abortion on college 
        campuses.
            (18) States have continually crafted legal restrictions to 
        ensure that abortion care is burdensome or impossible to 
        obtain. This strategy has led to more than 1,300 abortion 
        restrictions enacted since Roe v. Wade was originally decided 
        in 1973. These attacks are rooted in racism and compound the 
        failures of the health care and economic systems to provide 
        communities living with low incomes access to high-quality, 
        affordable health care, and safe and sustainable communities.
            (19) A lack of investment in both telehealth and 
        reproductive health care is a significant barrier to an 
        equitable experience of telehealth for medication abortion 
        care. Actualizing the promise of telehealth and technology 
        requires centering equity by investing in broadband, cultural 
        competency, health literacy, and digital and physical 
        infrastructure development.
            (20) Bans on insurance coverage of abortion compound 
        barriers to health care access for immigrant and migrant 
        communities, which can also include logistical barriers like 
        travel costs and distance to clinics, lodging needs and costs, 
        childcare costs and availability, limited access to translation 
        services, culturally competent care inclusive of low-literacy 
        services, lost wages, and lack of paid time off for health care 
        appointments can all delay or prohibit abortion care.
            (21) Nearly two out of three people live within the 100-
        mile border zone that allows for interior Customs and Border 
        Protection checkpoints where immigration officers have 
        increased discretion to detain and question individuals.
            (22) Immigrants of all statuses and people who are 
        undocumented or in mixed-status families are deprived of the 
        freedom to travel because of in-State immigration checkpoints 
        that put them at even greater risk of criminalization, all of 
        which contribute to a chilling effect for abortion access due 
        to heightened threats of family separation, detention, and 
        deportation.
            (23) In 2019, noncitizen immigrants aged 15 to 49 had three 
        times the uninsured rate of naturalized citizens or people born 
        in the United States (36 percent vs. 12 percent), and 
        immigrants with low incomes fared worse, where in 2019 50 
        percent of noncitizen immigrants aged 15 to 49 with a family 
        income below the Federal poverty level (earning less than 
        $21,330 for a family of three) were uninsured.
            (24) People held in immigration detention centers who are 
        separated from their children and families face additional 
        barriers to abortion care because of financial barriers due to 
        the abortion coverage bans and other restrictions.
            (25) On November 10, 2022, the Office of Refugee 
        Resettlement (ORR) issued new guidance to ensure that 
        unaccompanied immigrant minors have access to abortion while in 
        ORR custody awaiting reunification with family in the United 
        States. The Federal Government should implement policies 
        regarding the detention of pregnant, postpartum, and nursing 
        people, to ensure that no pregnant person is detained and if 
        such detention occurs, that there is no barrier to abortion 
        while detained regardless of the detaining agency.
            (26) More than 40 percent of youth and children under age 
        19 and 12 percent of young people age 19 to 25 have health 
        insurance through government programs.
            (27) Pregnant people younger than 18 face additional 
        barriers to accessing abortion care.
            (28) Young people face parental involvement laws in 22 
        States where abortion is still available, or the exercise of a 
        judicial bypass which requires minors to receive court approval 
        to access abortion care when they do not have their parents' 
        knowledge or consent.
            (29) Judicial bypass is not a meaningful alternative but 
        instead another hurdle faced by young people. Many minors do 
        not know judicial bypass is available or do not know how to get 
        it, do not have access to transportation to travel to the 
        necessary courts, or simply are denied bypass by resistant or 
        biased judges.
            (30) Abortion is one of the safest medical procedures in 
        the country and leading public health organizations such as the 
        American College of Obstetricians and Gynecologists, the 
        American Medical Association, and the American Academy of 
        Family Physicians strongly oppose efforts to impede access to 
        abortion care or interfere in the relationship between a person 
        and health care provider.
            (31) The ``2022 Violence and Disruption Report'' of the 
        National Abortion Federation found an alarming escalation in 
        incidents of obstruction, vandalism, and trespassing at 
        abortion clinics, with abortion providers reporting an alarming 
        rate of death threats and threats of harm, and documented 218 
        incidents in 2022, a 20-percent increase in death threats and 
        threats of harm over 2021.
            (32) Black, Indigenous, and other providers and patients of 
        color face heightened levels of threats, harassment, and 
        violence as compared to their White counterparts.
            (33) In the face of multifaceted attacks on their work, 
        abortion providers remain an essential and valued part of their 
        communities, providing high-quality, compassionate, and 
        necessary health care.
            (34) There is a critical shortage of health care providers, 
        including abortion care providers, and it is estimated that 28 
        percent of OB/GYN residency programs are based in States or 
        territories that are currently enforcing abortion bans.
            (35) Residents desiring abortion care training living in 
        hostile States are forced to travel to States without abortion 
        restrictions.
            (36) Abortion care training residents face barriers to 
        training including obtaining licensure and liability insurance, 
        making it difficult for the next generation of abortion 
        providers to provide comprehensive sexual and reproductive 
        health care in their communities.
            (37) In the face of the fear and stigma following the Dobbs 
        decision, health care facilities have denied patients lawful 
        emergency care because of the similarities in abortion care and 
        miscarriage management.
            (38) 91 facilities that provide abortion care have closed 
        since the Supreme Court's decision in Dobbs v. Jackson Women's 
        Health Organization. Of these, 62 facilities closed as a direct 
        consequence of Dobbs and enforced or anticipated abortion bans.
            (39) The ability to meaningfully access abortion gives 
        meaning to the right to abortion.
            (40) In the United States there is an existing support 
        network, including abortion funds, providers, doulas, and many 
        more, to help abortion seekers access care and navigate 
        restrictions with expertise in providing patient-centered care.
            (41) Investments to improve telehealth would improve care 
        for people with barriers to accessing in-person care, people 
        with disabilities, and rural communities, by providing expanded 
        autonomy and decreased barriers to access.
            (42) Creating more opportunities for telehealth services 
        should not substitute building much needed capacity for high-
        quality, in-person care, particularly in underserved rural, 
        low-income, and Black, Indigenous, and people of color 
        communities.
            (43) Removing Federal restrictions to abortion training and 
        investing in clinic infrastructure, including clinic security, 
        will allow more people to provide and more people to access 
        abortion in a safe and healthy environment and help to 
        alleviate the drastic shortage in abortion providers.
            (44) Critical investments in evidence-based, patient-
        centered research and innovation is needed to ensure abortion 
        care continues to meet the needs of patients across the country 
        and will help to improve access and quality of care.

SEC. 3. GRANT FOR FUNDING TO SUPPORT INDIVIDUALS WHO NEED TO ACCESS 
              ABORTION CARE.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall award grants to 
entities to increase abortion access or to support individuals who need 
access to abortion care.
    (b) Timing.--Not later than 180 days after the date of enactment of 
this Act, the Secretary shall award grants under this section.
    (c) Use of Funds.--A grant received under this section shall be 
used to increase abortion access or to support individuals who need 
access to abortion, which may include--
            (1) providing abortion care in person or by means of 
        telehealth;
            (2) training health care professionals in the provision of 
        abortion care;
            (3) offering funding to individuals seeking abortion care 
        for both the direct costs of the care and associated costs of 
        travel, lodging, and childcare;
            (4) conducting pharmaceutical and technological research 
        and innovation in abortion care;
            (5) employing patient navigators;
            (6) providing linguistically appropriate and culturally 
        competent legal assistance, case management, translation and 
        interpretation services, or care for individuals in need of 
        such services related to accessing abortion care;
            (7) providing the full spectrum of doula care and the full 
        spectrum of doula training;
            (8) providing escorts to support abortion seekers as they 
        access care;
            (9) constructing, installing, or improving facilities and 
        other infrastructure for health care providers that provide or 
        are seeking to provide abortion care, including by increasing 
        physical security and upgrading digital infrastructure such as 
        by switching to broadband internet service; and
            (10) otherwise assisting abortion providers or individuals 
        seeking abortion care.
    (d) Prioritization.--In awarding grants under this section, the 
Secretary shall give priority to applicants proposing to use the award 
to support individuals who need access to abortion care in medically 
underserved communities.
    (e) Authorization of Appropriations.--To carry out this section, 
there is authorized to be appropriated $350,000,000 for fiscal year 
2024 and each subsequent fiscal year, to remain available until 
expended.

SEC. 4. FACILITIES AND PROVIDERS.

    (a) Increase the Number of Abortion Providers.--The Public Health 
Service Act is amended by striking section 245 of such Act (42 U.S.C. 
238n).
    (b) Requirement To Provide Abortion Care.--As a condition on the 
direct or indirect receipt of any Federal funds, a health care facility 
shall agree to provide patients with, or refer patients to--
            (1) all medically appropriate reproductive health care, 
        including abortion care, that is within the capability of the 
        staff and medical equipment of the health care facility 
        providing the care; and
            (2) any routinely available ancillary services.
    (c) University Student Health Centers.--
            (1) In general.--As a condition on the direct or indirect 
        receipt of any Federal funds, an institution of higher 
        education shall agree to provide--
                    (A) medication abortion to students of the 
                institution through--
                            (i) an on-campus student health center;
                            (ii) providers associated with a contracted 
                        external agency; or
                            (iii) telehealth services; and
                    (B) referrals to other abortion care providers 
                located within a reasonable distance as needed for 
                other medically appropriate reproductive health care, 
                including abortion care.
    (d) Definitions.--In this section:
            (1) The term ``institution of higher education'' has the 
        meaning given to such term in subsections (a) and (b) of 
        section 101 of the Higher Education Act of 1965 (20 U.S.C. 
        1001).
            (2) The term ``medically appropriate reproductive health 
        care'' means reproductive health care that is--
                    (A) evidence-based; and
                    (B) appropriate for the patient.
            (3) The term ``health care facility'' includes--
                    (A) any institution, entity, or agency that 
                provides health care services; and
                    (B) any community pharmacy, hospital, doctor's 
                office, health clinic, family planning clinic, emergent 
                or urgent care facility, or community health center.

SEC. 5. COMPREHENSIVE COVERAGE.

    (a) In General.--The Secretary of Health and Human Services shall 
issue a rule ensuring that all health programs or plans provide 
consumer-friendly information about abortion coverage provided by 
health programs or plans.
    (b) Reimbursement for Abortion Care.--
            (1) In general.--Each person insured by, enrolled in, or 
        otherwise receiving medical care from health programs or plans 
        described in subsection (c) shall receive coverage of abortion 
        services. Health programs or plans described in section (c) 
        shall provide coverage of abortion services.
            (2) Amounts.--The Secretary of Health and Human Services 
        shall issue a rule ensuring that reimbursement rates for such 
        coverage are similar to like care and sufficient to cover the 
        cost of care.
    (c) Definition.--The term ``health program or plan'' means a public 
health insurance program or private health insurance plan that 
provides, or pays the cost of, medical care (as such term is defined in 
42 U.S.C. Sec.  300gg-91). Such terms include but are not limited to 
the following, and any combination thereof:
            (1) The Medicaid program under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.).
            (2) The Children's Health Insurance Program under title XXI 
        of the Social Security Act (42 U.S.C. 1397 et seq.).
            (3) The Medicare program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (4) A Medicare supplemental policy as defined in section 
        1882(g)(1) of the Social Security Act (42 U.S.C. 1395ss(g)(1)).
            (5) The Indian Health Service program under the Indian 
        Health Care Improvement Act (25 U.S.C. 1601 et seq.).
            (6) Medical care and health benefits under the TRICARE 
        program (10 U.S.C. 1071 et seq.).
            (7) 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.).
            (8) 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).
            (9) Medical care for individuals in the care or custody of 
        the Department of Homeland Security pursuant to any of section 
        235, 236, or 241 of the Immigration and Nationality Act (8 
        U.S.C. 1225, 1226, 1231).
            (10) 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).
            (11) Medical assistance to refugees under section 412 of 
        the Immigration and Nationality Act (8 U.S.C. 1522).
            (12) 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 (26 U.S.C. 5000A(f)(1)(E)).
            (13) The Federal Employees Health Benefit Plan under 
        chapter 89 of title 5, United States Code.
            (14) 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.).
            (15) Medical care for Peace Corps volunteers under section 
        5(e) of the Peace Corps Act (22 U.S.C. 2504(e)).
            (16) Other government-sponsored programs established after 
        the date of the enactment of this Act.
            (17) Plans in the Federal marketplace or an individual 
        marketplace within a State.
            (18) Eligible employer-sponsored plan as defined in 26 
        U.S.C. 5000A(f)(2).
            (19) Grandfathered health plan as defined in 42 U.S.C. 
        18011(e).
            (20) A standard health plan established through a State 
        basic health program as defined in 42 U.S.C. 18051.
            (21) 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 Internal Revenue 
        Services, recognizes for purposes of 26 U.S.C. Sec.  
        5000A(f)(E).
    (d) Repeal.--Section 1303 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18023) is repealed.
    (e) Removing Barriers to Coverage for Immigrant Families.--
            (1) In general.--Section 1903(v)(4) of the Social Security 
        Act (42 U.S.C. 1396b(v)(4)) is amended--
                    (A) by amending subparagraph (A) to read as 
                follows:
                    ``(A) Notwithstanding sections 401(a), 402(b), 403, 
                and 421 of the Personal Responsibility and Work 
                Opportunity Reconciliation Act of 1996, a State shall 
                provide medical assistance under this title, to 
                individuals who are lawfully residing in the United 
                States (including individuals described in paragraph 
                (1), battered individuals described in section 431(c) 
                of such Act, and individuals with an approved or 
                pending application for deferred action or other 
                federally authorized presence), if they otherwise meet 
                the eligibility requirements for medical assistance 
                under the State plan approved under this title (other 
                than the requirement of the receipt of aid or 
                assistance under title IV, supplemental security income 
                benefits under title XVI, or a State supplementary 
                payment).'';
                    (B) by amending subparagraph (B) to read as 
                follows:
                    ``(B) No debt shall accrue under an affidavit of 
                support against any sponsor of an individual provided 
                medical assistance under subparagraph (A) on the basis 
                of provision of assistance to such individual and the 
                cost of such assistance shall not be considered as an 
                unreimbursed cost.''; and
                    (C) in subparagraph (C)--
                            (i) by striking ``an election by the State 
                        under subparagraph (A)'' and inserting ``the 
                        application of subparagraph (A)'';
                            (ii) by inserting ``or be lawfully 
                        present'' after ``lawfully reside''; and
                            (iii) by inserting ``or present'' after 
                        ``lawfully residing'' each place it appears.
            (2) CHIP.--Subparagraph (N) of section 2107(e)(1) of the 
        Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended to read 
        as follows:
                    ``(N) Paragraph (4) of section 1903(v) (relating to 
                lawfully present individuals).''.
            (3) Effective date.--
                    (A) In general.--Except as provided in subparagraph 
                (A), the amendments made by this subsection shall take 
                effect on the date of enactment of this Act and shall 
                apply to services furnished on or after the date that 
                is 90 days after such date of enactment.
                    (B) Exception if state legislation required.--In 
                the case of a State plan for medical assistance under 
                title XIX, or a State child health plan under title 
                XXI, of the Social Security Act which the Secretary of 
                Health and Human Services determines requires State 
                legislation (other than legislation appropriating 
                funds) in order for the plan to meet the additional 
                requirements imposed by the amendments made by this 
                section, the respective State plan shall not be 
                regarded as failing to comply with the requirements of 
                such title solely on the basis of its failure to meet 
                these additional requirements before the first day of 
                the first calendar quarter beginning after the close of 
                the first regular session of the State legislature that 
                begins after the date of enactment of this Act. For 
                purposes of the previous sentence, in the case of a 
                State that has a 2-year legislative session, each year 
                of such session shall be deemed to be a separate 
                regular session of the State legislature.
    (e) Coverage for Individuals With Federal Authorized Presence, 
Including Deferred Action.--
            (1) In general.--For purposes of eligibility under any of 
        the provisions described in paragraph (2), all individuals 
        granted federally authorized presence in the United States 
        shall be considered to be lawfully present in the United 
        States.
            (2) Provisions described.--The provisions described in this 
        paragraph are the following:
                    (A) Exchange eligibility.--Section 1411 of the 
                Patient Protection and Affordable Care Act (42 U.S.C. 
                18031).
                    (B) Reduced cost-sharing eligibility.--Section 1402 
                of the Patient Protection and Affordable Care Act (42 
                U.S.C. 18071).
                    (C) Premium subsidy eligibility.--Section 36B of 
                the Internal Revenue Code of 1986 (26 U.S.C. 36B).
                    (D) Medicaid and chip eligibility.--Titles XIX and 
                XXI of the Social Security Act, including under section 
                1903(v) of such Act (42 U.S.C. 1396b(v)).
            (3) Transition through special enrollment period.--In the 
        case of an individual described in paragraph (1) who, before 
        the first day of the first annual open enrollment period under 
        subparagraph (B) of section 1311(c)(6) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18031(c)(6)) 
        beginning after the date of enactment of this Act, is granted 
        federally authorized presence in the United States and who, as 
        a result of such subsection, qualifies for a subsidy under a 
        provision described in subparagraph (B) or (C) of paragraph 
        (2), the Secretary of Health and Human Services shall establish 
        a special enrollment period under subparagraph (C) of such 
        section 1311(c)(6) during which such individual may enroll in 
        qualified health plans through Exchanges under title I of the 
        Patient Protection and Affordable Care Act and qualify for such 
        a subsidy. For such an individual who has been granted 
        federally authorized presence in the United States as of the 
        date of enactment of this Act, such special enrollment period 
        shall begin not later than 90 days after such date of 
        enactment. Nothing in this paragraph shall be construed as 
        affecting the authority of the Secretary to establish 
        additional special enrollment periods under such subparagraph 
        (C).
    (f) Removing Citizenship and Immigration Barriers To Access ACA 
Care.----
            (1) In general.--
                    (A) Premium tax credits.--Section 36B of the 
                Internal Revenue Code of 1986 is amended--
                            (i) in subsection (c)(1)(B)--
                                    (I) by amending the heading to read 
                                as follows: ``SPECIAL RULE FOR CERTAIN 
                                INDIVIDUALS INELIGIBLE FOR MEDICAID DUE 
                                TO STATUS''; and
                                    (II) by amending clause (ii) to 
                                read as follows:
                            ``(ii) the taxpayer is a noncitizen who is 
                        not eligible for the Medicaid program under 
                        title XIX of the Social Security Act by reason 
                        of the individual's immigration status,''; and
                            (ii) by striking subsection (e).
                    (B) Cost-sharing reductions.--Section 1402 of the 
                Patient Protection and Affordable Care Act (42 U.S.C. 
                18071) is amended by striking subsection (e) and 
                redesignating subsection (f) as subsection (e).
                    (C) Basic health program eligibility.--Section 
                1331(e)(1)(B) of the Patient Protection and Affordable 
                Care Act (42 U.S.C. 18051(e)(1)(B)) is amended by 
                striking ``lawfully present in the United States,''.
                    (D) Restrictions on federal payments.--Section 1412 
                of the Patient Protection and Affordable Care Act (42 
                U.S.C. 18082) is amended by striking subsection (d) and 
                redesignating subsection (e) as subsection (d).
                    (E) Requirement to maintain minimum essential 
                coverage.--Subsection (d) of section 5000A of the 
                Internal Revenue Code of 1986 is amended by striking 
                paragraph (3) and by redesignating paragraph (4) as 
                paragraph (3).
    (g) Conforming Amendments.--
            (1) Establishment of program.--Section 1411(a) of the 
        Patient Protection and Affordable Care Act (42 U.S.C. 18081(a)) 
        is amended by striking paragraph (1) and redesignating 
        paragraphs (2), (3), and (4) as paragraphs (1), (2), and (3), 
        respectively.
            (2) Qualified individuals.--Section 1312(f) of the Patient 
        Protection and Affordable Care Act (42 U.S.C. 18032(f)) is 
        amended--
                    (A) in the heading, by striking ``; ACCESS LIMITED 
                TO CITIZENS AND LAWFUL RESIDENTS''; and
                    (B) by striking paragraph (3).
    (h) Effective Date.--The amendments made by this section shall 
apply to years, plan years, and taxable years, as applicable, beginning 
after December 31, 2021.
    (i) Access to Coverage.--
            (1) In general.--Nothing in this Act, including the 
        amendments made by this Act, shall prevent lawfully present 
        noncitizens who are ineligible for full benefits under the 
        Medicaid program under title XIX of the Social Security Act 
        from securing a credit for which such lawfully present 
        noncitizens would be eligible under section 36B(c)(1)(B) of the 
        Internal Revenue Code of 1986 and under the Medicaid provisions 
        for lawfully present noncitizens, as in effect on the date 
        prior to the date of enactment of this Act.
            (2) Definition.--For purposes of paragraph (1), the term 
        ``full benefits'' means, with respect to an individual and 
        State, medical assistance for all services covered under the 
        State plan under title XIX of the Social Security Act that is 
        not less in amount, duration, or scope, or is determined by the 
        Secretary of Health and Human Services to be substantially 
        equivalent to the medical assistance available for an 
        individual described in section 1902(a)(10)(A)(i) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(A)(i)).

SEC. 6. RIGHTS AND PROTECTIONS.

    (a) Fundamental Right.--All persons have a fundamental right to 
make and effectuate decisions about abortion and miscarriage. Pursuant 
to this right the Government may not:
            (1) Deny, interfere with, or restrict the right of any 
        person to obtain an abortion.
            (2) Penalize any person for providing, assisting, 
        supporting, or facilitating another person's abortion or 
        miscarriage.
            (3) Penalize an individual for seeking, inducing, or 
        attempting to induce, the individual's own abortion or alleged 
        abortion.
    (b) Civil Action.--Any person aggrieved by a violation of this Act 
may bring a civil action for a such violation against a Federal, State, 
or local government in an appropriate district court of the United 
States.
    (c) Clarify Privacy Protections Under HIPAA.--The Secretary of 
Health and Human Services shall revise section 164.512 of title 42, 
Code of Federal Regulations, and any associated regulations under the 
HIPAA privacy and security law (as defined in section 3009 of the 
Public Health Service Act (42 U.S.C. 300jj-19)) to clarify that such 
regulations expressly prohibit disclosures of personal health 
information without authorization to law enforcement officials, 
including immigration officials, in cases involving reproductive and 
sexual health, including in case of a miscarriage, abortion (whether 
self-managed or otherwise), or stillbirth.
    (d) Prohibition With Respect to Immigration Enforcement Actions.--
            (1) In general.--Notwithstanding any other provision of 
        law, in order to ensure that an individuals' access to abortion 
        services is protected, this Act shall prohibit immigration 
        enforcement actions within 2,000 feet of any health care 
        facility.
            (2) Applicability.--The prohibition under paragraph (1) 
        shall apply to--
                    (A) any officer or agent of the Department of 
                Homeland Security, including any officer or agent of 
                the U.S. Immigration and Customs Enforcement or the 
                U.S. Customs and Border Protection; or
                    (B) any State or local employee pursuing 
                immigration enforcement actions.
            (3) Health care facility defined.--The term ``health care 
        facility'' includes--
                    (A) any institution, entity, or agency that 
                provides health care services; and
                    (B) any community pharmacy, hospital, doctor's 
                office, health clinic, family planning clinic, emergent 
                or urgent care facility, or community health center.
    (e) Abrogation of State Immunity.--Neither a State that enforces or 
maintains, nor a government official who is permitted to implement or 
enforce any limitation or requirement that violates this Act shall be 
immune under the Tenth Amendment to the Constitution of the United 
States, the Eleventh Amendment to the Constitution of the United 
States, or any other source of law, from an action in a Federal or 
State court of competent jurisdiction challenging that limitation or 
requirement, unless such immunity is required by clearly established 
Federal law, as determined by the Supreme Court of the United States.
    (f) Supersedes.--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.).
                                 <all>