[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 1204 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                S. 1204

  To amend the Patient Protection and Affordable Care Act to protect 
   rights of conscience with regard to requirements for coverage of 
specific items and services, to amend the Public Health Service Act to 
   prohibit certain abortion-related discrimination in governmental 
                  activities, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 20, 2013

  Mr. Coburn (for himself and Mrs. Fischer) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
  To amend the Patient Protection and Affordable Care Act to protect 
   rights of conscience with regard to requirements for coverage of 
specific items and services, to amend the Public Health Service Act to 
   prohibit certain abortion-related discrimination in governmental 
                  activities, and for other purposes.

    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 ``Health Care Conscience Rights Act''.

SEC. 2. FINDINGS.

    Congress finds as follows:
            (1) As Thomas Jefferson declared to New London Methodists 
        in 1809, ``[n]o provision in our Constitution ought to be 
        dearer to man than that which protects the rights of conscience 
        against the enterprises of the civil authority''.
            (2) Jefferson's conviction on respect for conscience is 
        deeply embedded in the history and traditions of our Nation, 
        and codified in numerous Federal laws approved by congressional 
        majorities and Presidents of both parties, including in the 
        Public Health Service Act (42 U.S.C. 201 et seq.); the United 
        States Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
        Act of 2003 (22 U.S.C. 7601 et seq.); the Religious Freedom 
        Restoration Act of 1993 (42 U.S.C. 2000bb et seq.); 
        longstanding provisions on respect for conscience rights in the 
        Federal Employees Health Benefits Program and District of 
        Columbia appropriations; and laws to protect individuals from 
        being forced to participate in Federal executions or 
        prosecutions.
            (3) Following enactment of the Patient Protection and 
        Affordable Care Act (Public Law 111-148, in this section 
        referred to as ``PPACA''), the Federal Government has sought to 
        impose specific requirements that infringe on the rights of 
        conscience of those who offer or purchase health coverage.
            (4) While PPACA provides an exemption for some religious 
        groups that object to participation in health insurance 
        generally, and exempts millions of Americans from most of the 
        Act's provisions, including the preventive services mandate, it 
        fails to provide statutory protection for those seeking to 
        offer or to purchase health coverage who have a religious or 
        moral objection only to specific items or services.
            (5) Nurses and other health care providers have 
        increasingly been subjected to discrimination for abiding by 
        their conscience rather than providing, paying for, or 
        referring for abortion.
            (6) Conscience rights protections for health care providers 
        are an important part of civil rights protections in Federal 
        law and are indispensable to the continued viability of the 
        health care system in the United States. The increasingly 
        significant discrimination suffered by faith-based nonprofit 
        health care providers risks undermining access to high-quality 
        compassionate care for some of the most vulnerable populations 
        in our country.

SEC. 3. APPLYING LONGSTANDING POLICY ON CONSCIENCE RIGHTS TO THE 
              AFFORDABLE CARE ACT.

    (a) In General.--Title I of the Patient Protection and Affordable 
Care Act (Public Law 111-148) is amended--
            (1) by redesignating the second section 1563 (relating to 
        conforming amendments and as redesignated by section 
        10107(b)(1) of the Patient Protection and Affordable Care Act) 
        as section 1564;
            (2) by redesignating the third section 1563 (relating to 
        the Sense of the Senate promoting fiscal responsibility) as 
        section 1565; and
            (3) by adding at the end the following new section:

``SEC. 1566. RESPECTING CONSCIENCE RIGHTS IN HEALTH COVERAGE.

    ``(a) In General.--Notwithstanding any other provision of this 
title, no provision of this title (and no amendment made by this title) 
shall--
            ``(1) require an individual to purchase individual health 
        insurance coverage that includes coverage of an abortion or 
        other item or service to which such individual has a moral or 
        religious objection, or prevent an issuer from offering or 
        issuing, to such individual, individual health insurance 
        coverage that excludes such item or service;
            ``(2) require a sponsor (or, in the case of health 
        insurance coverage offered to students through an institution 
        of higher education, the institution of higher education 
        offering such coverage) to sponsor, purchase, or provide any 
        health benefits coverage or group health plan that includes 
        coverage of an abortion or other item or service to which such 
        sponsor or institution, respectively, has a moral or religious 
        objection, or prevent an issuer from offering or issuing to 
        such sponsor or institution, respectively, health insurance 
        coverage that excludes such item or service;
            ``(3) require an issuer of health insurance coverage or the 
        sponsor of a group health plan to include, in any such coverage 
        or plan, coverage of an abortion or other item or service to 
        which such issuer or sponsor has a moral or religious 
        objection; or
            ``(4) authorize the imposition of a tax, penalty, fee, 
        fine, or other sanction, or the imposition of coverage of the 
        item or service to which there is a moral or religious 
        objection, in relation to health insurance coverage or a group 
        health plan that excludes an item or service pursuant to this 
        section.
    ``(b) Restriction on Contrary Governmental Action.--No provision in 
this title (or amendment made by this title) or law, regulation, 
guideline or other governmental action that implements such provision 
or amendment, or derives its authority therefrom, shall be given legal 
effect to the extent that it violates this section.
    ``(c) No Effect on Other Laws.--Nothing in this section shall be 
construed to preempt, modify, or otherwise have any effect on--
            ``(1) the Civil Rights Act of 1964;
            ``(2) the Americans with Disabilities Act of 1990;
            ``(3) the Pregnancy Discrimination Act of 1978;
            ``(4) the Mental Health Parity Act of 1996; or
            ``(5) any other State or Federal law, other than a 
        provision in this title (or an amendment made by this title) or 
        a law, regulation, guideline or other governmental action that 
        implements such provision or amendment or derives its authority 
        therefrom.
    ``(d) Aggregate Actuarial Value.--Nothing in this section shall be 
construed to prohibit the Secretary from issuing regulations or other 
guidance to ensure that health insurance coverage or group health plans 
excluding abortion or other items or services under this section shall 
have an aggregate actuarial value at least equivalent to that of health 
insurance coverage or group health plans at the same level of coverage 
that do not exclude such items or services.
    ``(e) Continued Application of Nondiscrimination Rules.--Nothing in 
this section shall be construed to permit a health insurance issuer, 
group health plan, or other health care provider to act in a manner 
inconsistent with subparagraph (B) or (D) of section 1302(b)(4).''.
    (b) Clerical Amendment.--The table of contents of the Patient 
Protection and Affordable Care Act (Public Law 111-148) is amended--
            (1) by striking the following items:

``1563. Conforming amendments.
``1563. Sense of the Senate promoting fiscal responsibility.'';
        and
            (2) by inserting after the item relating to the section 
        1563 relating to small business procurement the following 
        items:

``1564. Conforming amendments.
``1565. Sense of the Senate promoting fiscal responsibility.
``1566. Respecting conscience rights in health coverage.''.

SEC. 4. ABORTION NONDISCRIMINATION FOR HEALTH CARE PROVIDERS.

    Section 245 of the Public Health Service Act (42 U.S.C. 238n) is 
amended--
            (1) in the section heading, by striking ``and licensing of 
        physicians'' and inserting ``, licensing, and practice of 
        physicians and other health care entities'';
            (2) in subsection (a), by amending paragraph (1) to read as 
        follows:
            ``(1) the entity refuses--
                    ``(A) to undergo training in the performance of 
                induced abortions;
                    ``(B) to require or provide such training;
                    ``(C) to perform, participate in, provide coverage 
                of, or pay for induced abortions; or
                    ``(D) to provide referrals for such training or 
                such abortions;'';
            (3) in subsection (b)(1), by striking ``standards'' and 
        inserting ``standard'';
            (4) in subsection (c), by amending paragraphs (1) and (2) 
        to read as follows:
            ``(1) The term `financial assistance', with respect to a 
        government program, means governmental payments to cover the 
        cost of health care services or benefits, or other Federal 
        payments, grants, or loans to promote or otherwise facilitate 
        health-related activities.
            ``(2) The term `health care entity' includes an individual 
        physician or other health professional, a postgraduate 
        physician training program, a participant in a program of 
        training in the health professions, a hospital, a provider-
        sponsored organization as defined in section 1855(d) of the 
        Social Security Act, a health maintenance organization, an 
        accountable care organization, an issuer of health insurance 
        coverage, any other kind of health care facility, organization, 
        or plan, and an entity that provides or authorizes referrals 
        for health care services.'';
            (5) by adding at the end of subsection (c) the following 
        new paragraph:
            ``(4) The term `State or local government that receives 
        Federal financial assistance' includes any agency or other 
        governmental unit of a State or local government if such 
        government receives Federal financial assistance.'';
            (6) by redesignating subsection (c) as subsection (d); and
            (7) by inserting after subsection (b) the following new 
        subsection:
    ``(c) Administration.--The Secretary shall designate the Director 
of the Office for Civil Rights of the Department of Health and Human 
Services--
            ``(1) to receive complaints alleging a violation of this 
        section, section 1566 of the Patient Protection and Affordable 
        Care Act, or any of subsections (b) through (e) of section 401 
        of the Health Programs Extension Act of 1973; and
            ``(2) to pursue the investigation of such complaints, in 
        coordination with the Attorney General.''.

SEC. 5. REMEDIES FOR VIOLATIONS OF FEDERAL CONSCIENCE LAWS.

    Title II of the Public Health Service Act (42 U.S.C. 202 et seq.) 
is amended by inserting after section 245 the following:

``SEC. 245A. CIVIL ACTION FOR CERTAIN VIOLATIONS.

    ``(a) In General.--A qualified party may, in a civil action, obtain 
appropriate relief with regard to a designated violation.
    ``(b) Definitions.--In this section--
            ``(1) the term `qualified party' means--
                    ``(A) the Attorney General; or
                    ``(B) any person or entity adversely affected by 
                the designated violation; and
            ``(2) the term `designated violation' means an actual or 
        threatened violation of section 245 of this Act, section 1566 
        of the Patient Protection and Affordable Care Act, or any of 
        subsections (b) through (e) of section 401 of the Health 
        Programs Extension Act of 1973.
    ``(c) Administrative Remedies Not Required.--An action under this 
section may be commenced, and relief may be granted, without regard to 
whether the party commencing the action has sought or exhausted 
available administrative remedies.
    ``(d) Defendants in Actions Under This Section May Include 
Governmental Entities as Well as Others.--
            ``(1) In general.--An action under this section may be 
        maintained against, among others, a party that is a Federal or 
        State governmental entity. Relief in an action under this 
        section may include money damages even if the defendant is such 
        a governmental entity.
            ``(2) Definition.--For the purposes of this subsection, the 
        term `State governmental entity' means a State, a local 
        government within a State, or any agency or other governmental 
        unit or authority of a State or of such a local government.
    ``(e) Nature of Relief.--The court shall grant--
            ``(1) all necessary equitable and legal relief, including, 
        where appropriate, declaratory relief and compensatory damages, 
        to prevent the occurrence, continuance, or repetition of the 
        designated violation and to compensate for losses resulting 
        from the designated violation; and
            ``(2) to a prevailing plaintiff, reasonable attorneys' fees 
        and litigation expenses as part of the costs.''.
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