[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.).
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