Illinois pursues abortion coverage for people with little or no insurance

SPRINGFIELD — Gov. JB Pritzker and Democrats have added a new abortion access measure to their agenda that would allow people with limited or no insurance to get financial assistance for abortion care in Illinois.

House Bill 5408 would take advantage of an under-used provision of the Affordable Care Act that requires insurance plans that offer coverage for abortions in instances that go beyond rape, incest and life of the mother to collect at least $1 a month from enrollees to cover the cost of abortion claims.

Federal law requires the insurers to segregate that money and use it only for abortion care. Illinois' bill would allow the state to exert greater authority over the funds.

The bill is meant to give insurers clarity about how to use the money they collect, according to Rep. Anna Moeller, D-Elgin, who sponsored the bill. She also said another reason for the bill is because the state doesn't have a clear picture of the amount of funds being collected.

"Similar bills have passed in California and Maryland and are under consideration in Massachusetts and Washington State to require the insurance industry to release these funds and put them into these kinds of grant programs so that people can access these services if they don't have insurance or they're underinsured," Moeller said in an interview with Capitol News Illinois. "So I think maybe the insurance industry didn't have clarity on how to use it."

Counting the money

In California, actual amounts collected haven't been reported publicly, but analysts have estimated it could be more than $100 million. When Maryland's law was expanded in 2025, insurers had collected $25 million. Under its law, the Maryland health department allocates up to $2.5 million annually.

In Illinois, Moeller said, "there's not a lot of clarity" when it comes to fund balances. The Illinois Department of Insurance said it was unable to speculate about pending legislation and didn't provide an estimate for how much money has been collected in these accounts.

HB 5408 would require insurance companies to report to the Department of Insurance how much money is in these separate accounts, how much has been spent, and to transfer remaining funds to the newly created state Abortion Access Fund. After that, the Illinois Department of Public Health could use the money to award grants for abortion providers to cover uninsured and underinsured individuals through a new grant program.

Passed on partisan lines

Moeller presented the bill at the House Human Services Committee on March 25, where it passed 8-4 along partisan lines and was placed on the House calendar for a second reading.

"My colleagues, we all understand, especially on the Democratic side, how important it is to provide a place for women to access reproductive health care, especially since these rights are under assault in so many places in our country," Moeller said.

Federal law prohibits federal money being used for abortion care unless the pregnancy is the result of rape or incest or the abortion is needed to save the life of the mother, but states have more leeway. Illinois already requires state Medicaid, ACA plans and private insurance to cover abortions.

Moeller said this bill is just another way the state can support people who need abortions for reasons that don't meet federal guidelines. Advocates said it also creates a new funding stream to help providers keep up with demand.

Insurers object

Opponents of the Illinois' bill point to December 2025 guidance from the Centers for Medicare & Medicaid that changed the way funds can be managed and used — although health policy attorneys argue that guidance misinterprets the language in the statute and violates the law.

The Illinois Life & Health Insurance Council opposes the Illinois measure, Kate Morthland, its policy and advocacy director, said in a statement.

"It mirrors the Maryland approach, which federal regulators have already warned 'exceeds the permissible uses of the segregated funds under Section 1303 of the ACA,' creating clear compliance concerns," Morthland said in a statement.

She said the Illinois bill risks putting the state at odds with federal regulations and risks "legal and operational uncertainty."

"While we remain committed to working with the sponsor, this bill, in its current form, is not workable for the industry," she said.

Illinois a major out-of-state provider

Since the 2022 overturn of Roe v. Wade, Illinois has become a national haven for people seeking abortion care. The state has responded by passing many protections and supporting the clinics that provide these services.

According to the governor's office, this fund is not connected to the recently announced Prairie State Access Fund, which is a separate partnership with the Michael Reese Health Trust. The money in the Abortion Access Fund would be entirely made up of money set aside by insurance companies.

According to the latest numbers from the Guttmacher Institute, an independent abortion policy research organization, 87,210 abortions were provided by clinicians in Illinois in 2025, a slight decrease from previous years, but still far more than any other state in the Midwest. The numbers represent procedural and medication abortions that were provided in physical facilities and via telehealth.

"We need to just stay vigilant so that it (abortion access) stays protected in Illinois. Because clearly things can change very quickly, as we saw with the overturn of Roe," Moeller said. "Illinois, I think, has done a lot, but it's kind of up to other states to do the same. We just have to stay vigilant."