Illinois House Passes Abortion Access Fund Bill to Help Uninsured Patients
Illinois House Democrats advanced legislation Thursday that would create a state-funded abortion access program for uninsured and underinsured patients, drawing sharp opposition from Republicans who call it an overreach of state authority.
House Bill 5408 would take advantage of an underused provision of the Affordable Care Act that requires insurance plans covering abortions beyond federal guidelines to collect at least $1 monthly from enrollees. Federal law mandates these funds be segregated and used only for abortion care. The Illinois bill would give the state greater authority over these funds.
The bill passed on a 69-36 vote along party lines and now moves to the Senate for consideration.
Creating a State Fund
House Bill 5408 would require insurance companies to report to the Department of Insurance how much money sits in these segregated accounts, how much has been spent, and transfer remaining funds to the newly created state Abortion Access Fund.
After that transfer, the Illinois Department of Public Health could award grants for abortion providers to cover uninsured and underinsured individuals through a new grant program.
Representative Anna Moeller, D-Elgin, who sponsored the bill, said similar legislation has passed in California and Maryland and is under consideration in Massachusetts and Washington State.
"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 told Capitol News Illinois.
Moeller added that the Illinois insurance industry did not have clarity on how to use the segregated funds.
"Let me be clear. The insurance companies did not have clarity on how to use the funds," Moeller said.
How Much Money?
In California, actual amounts collected have not been reported publicly, but analysts have estimated it could be more than $100 million.
When Maryland expanded its law in 2025, insurers had collected $25 million under it, with the state health department allocating up to $2.5 million annually.
The Illinois Department of Insurance said it was unable to speculate about pending legislation and did not provide an estimate for how much money has been collected in these accounts.
The Debate
The Illinois Life and Health Insurance Council opposes the state measure, arguing it mirrors the Maryland approach that federal regulators warned exceeded permissible uses of segregated funds under Section 1303 of the Affordable Care Act.
"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," Kate Morthland, policy and advocacy director for the Illinois Life and Health Insurance Council, said in a statement.
Morthland added that the bill risks putting the state at odds with federal regulations and creates 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," Morthland said.
Illinois as a National Haven
Since the 2022 Supreme Court decision overturning Roe v Wade, Illinois has become a national destination for people seeking abortion care.
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.
The Guttmacher Institute reported that 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.
Staying Vigilant
Moeller said the state needs to stay vigilant to protect abortion access in Illinois.
"We need to just stay vigilant so that abortion access stays protected in Illinois. Because clearly things can change very quickly, as we saw with the overturn of Roe," Moeller said.
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 do not meet federal guidelines.
Federal law prohibits federal money from 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.
The House approved 81 bills Thursday, bringing the week's total to 133.
Senate Action
The bill now moves to the Senate where Republicans have indicated they will oppose it.
The Senate version of the bill will be debated and could face amendments before reaching the House floor for a final vote.
The timeline for the Senate vote and any subsequent House action remains uncertain as the legislative session moves through its final weeks.