[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4524 Introduced in Senate (IS)]

<DOC>






118th CONGRESS
  2d Session
                                S. 4524

   To amend the Public Health Service Act to prohibit discrimination 
 against health care entities that do not participate in abortion, and 
  to strengthen implementation and enforcement of Federal conscience 
                                 laws.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 12, 2024

  Mr. Lankford (for himself, Mr. Cramer, Mr. Daines, Mr. Hoeven, Mr. 
Rubio, Mr. Risch, Mr. Moran, Mr. Crapo, Ms. Lummis, Mrs. Blackburn, Mr. 
  Rounds, Mr. Hawley, Mr. Thune, Mr. Ricketts, Mrs. Fischer, and Mrs. 
  Hyde-Smith) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
   To amend the Public Health Service Act to prohibit discrimination 
 against health care entities that do not participate in abortion, and 
  to strengthen implementation and enforcement of Federal conscience 
                                 laws.

    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 ``Conscience Protection Act of 2024''.

SEC. 2. FINDINGS.

    Congress finds as follows:
            (1) Thomas Jefferson stated a conviction common to our 
        Nation's founders when he declared in 1809 that ``[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) No health care entity should have to choose between 
        giving up their religious, moral, ethical, or medical 
        convictions and abandoning a vital medical mission. Congress 
        enacted more than two dozen provisions in Federal statutes to 
        protect such rights in health care, which also protect States' 
        ability to operate in accordance with their laws to protect 
        similar rights without fear of retaliation from the Federal 
        Government. Such provisions of Federal statutes include--
                    (A) subsections (b) through (e) of section 401 of 
                the Health Programs Extension Act of 1973 (42 U.S.C. 
                300a-7) (commonly known, and referred to in this 
                section, as the ``Church Amendments'');
                    (B) section 245 of the Public Health Service Act 
                (42 U.S.C. 238n) (commonly known as the ``Coats-Snowe 
                Amendment'');
                    (C) the Weldon Amendment approved by Congresses and 
                Presidents of both parties every year since 2004 
                (including section 507(d) of the Departments of Labor, 
                Health and Human Services, and Education, and Related 
                Agencies Appropriations Act, 2023 (division H of the 
                Consolidated Appropriations Act, 2023 (Public Law 117-
                328))); and
                    (D) other conscience protections, as outlined in 
                the final rule issued by the Secretary of Health and 
                Human Services entitled ``Protecting Statutory 
                Conscience Rights in Health Care; Delegations of 
                Authority'' (84 Fed. Reg. 23170; May 21, 2019), under 
                the Patient Protection and Affordable Care Act, under 
                the Social Security Act, and with respect to global 
                health programs and advanced directives.
            (3) Courts have held that certain conscience protection 
        statutes do not provide a ``private right of action'' for 
        individuals or entities who have been discriminated against, 
        thereby leaving victims of discrimination unable to defend 
        their own conscience rights in court. At the same time, 
        administrative implementation and enforcement of these laws by 
        the Office for Civil Rights of the Department of Health and 
        Human Services have been inconsistent and at times cases are 
        allowed to languish for years or previously enacted enforcement 
        measures are abandoned or reversed.
            (4) Defying the Weldon Amendment, the California Department 
        of Managed Health Care has mandated coverage for elective 
        abortions in all health plans under its jurisdiction. Other 
        States, such as New York, Illinois, and Washington, have taken 
        or considered similar action, and some States have required 
        hospitals to provide or facilitate abortions. On June 21, 2016, 
        the Office for Civil Rights of the Department of Health and 
        Human Services, under the Obama Administration, concluded a 
        nearly 2-year investigation of this matter by determining that 
        the decision of California to require insurance plans under the 
        California Department for Managed Health Care authority to 
        cover abortion services did not violate the Weldon Amendment. 
        At least 28,000 individuals and families subsequently lost 
        abortion-free health plans as a result of this mandate in 
        violation of their consciences and rights under the Weldon 
        Amendment.
            (5) On January 24, 2020, the Office for Civil Rights of the 
        Department of Health and Human Services disavowed its prior 
        findings and issued a notice of violation of the Weldon 
        Amendment to California. After the State's continued 
        noncompliance with the Weldon Amendment, the Centers for 
        Medicare & Medicaid Services, on December 16, 2020, announced 
        the disallowance of $200,000,000 per quarter in Federal funds 
        to California beginning in the first quarter of 2021.
            (6) Although California had taken no action to come into 
        compliance with the Weldon Amendment, on August 13, 2021, the 
        Office for Civil Rights of the Department of Health and Human 
        Services under the Biden Administration withdrew the notice of 
        violation and closed the complaints filed with the Department. 
        As a result, individuals continue to be coerced contrary to law 
        into choosing between violating their consciences or forgoing 
        health care coverage for themselves, their employees, and their 
        families.
            (7)(A) On August 28, 2019, the Office for Civil Rights of 
        the Department of Health and Human Services under the Trump 
        Administration issued a notice of violation against the 
        University of Vermont Medical Center for violation of the 
        Church Amendments after it was found to have scheduled 
        approximately 10 nurses who had registered conscience 
        objections to abortion to assist with approximately 20 abortion 
        procedures and for maintaining policies that explicitly 
        required employees with conscience objections to participate in 
        procedures with which they disagreed to ``ensure that patient 
        care is not negatively impacted''. Such practices were found to 
        be part of an ``ongoing pattern, practice, and policy of 
        discriminating against health care providers who believe that 
        the performance, or the assistance in the performance, of 
        abortions is contrary to their religious beliefs or moral 
        convictions''.
            (B) After the University of Vermont Medical Center refused 
        to come into compliance with the law, the Department of Justice 
        brought an enforcement action in Federal court against the 
        medical center on December 16, 2020.
            (C) On July 30, 2021, the Department of Justice under the 
        Biden Administration voluntarily dismissed the case, without 
        any binding settlement or requirement that the University of 
        Vermont Medical Center remedy its unlawful policies or make 
        restitution to the employees whose rights it violated.
            (8) On May 21, 2019, the Secretary of Health and Human 
        Services issued the final rule entitled ``Protecting Statutory 
        Conscience Rights in Health Care; Delegations of Authority'' 
        (84 Fed. Reg. 23170; May 21, 2019) to implement 25 Federal 
        conscience protection provisions governing programs funded 
        under the Department of Health and Human Services and provide 
        mechanisms to enforce conscience laws to ensure that the 
        government and government-funded entities are not unlawfully 
        discriminating against health care entities. Despite this 
        regulation providing for enforcement of laws passed by 
        Congress, the rule faced numerous legal challenges and was 
        vacated.
            (9) On January 11, 2024, the Department of Health and Human 
        Services published a final rule that fails to equip the 
        Department with the tools necessary for effective enforcement 
        of Federal statutory protections of rights of conscience.
            (10) Congress has acted numerous times to expand access to 
        health care and has also acted numerous times to provide 
        unqualified statutorily protected rights of conscience to 
        individuals and entities in certain circumstances. A health 
        care entity's decision not to participate in an abortion, 
        assisted suicide, procedures that can result in sterilization, 
        or other interventions erects no barrier to those legally 
        seeking to perform or undergo such interventions elsewhere.
            (11) The vast majority of medical professionals do not 
        perform abortions. Ninety-three percent of obstetricians/
        gynecologists in private practice report that they did not 
        provide abortions (National Library of Medicine, April 2018) 
        and the great majority of hospitals choose to do so only in 
        rare cases or not at all.
            (12) In the landmark 2022 decision, Dobbs v. Jackson 
        Women's Health Organization, the Supreme Court held that ``the 
        Constitution does not confer a right to abortion''.
            (13) On July 13, 2022, the Department of Health and Human 
        Services issued guidance to retail pharmacies in the United 
        States. Such guidance purported to address their obligations 
        under Federal nondiscrimination laws, but in actuality orders 
        pharmacies to stock and dispense abortion pills despite the 
        fact that pharmacies and pharmacists have a right to not 
        violate their conscience by participating in abortion under 
        existing law.
            (14) Conscience protections pose no conflict with other 
        Federal laws, such as the law requiring stabilizing treatment 
        for a ``pregnant woman . . . or her unborn child'' when either 
        needs emergency care (Emergency Medical Treatment and Active 
        Labor Act). As previous Administrations have said, these areas 
        of law have operated side by side for many years and both 
        should be fully enforced (76 Fed. Reg. 9968-77 (2011) at 9973).
            (15) Reaffirming longstanding Federal policy on conscience 
        rights and providing a private right of action in cases where 
        it is violated allows longstanding and widely supported Federal 
        laws to work as intended.

SEC. 3. PROHIBITING DISCRIMINATION AGAINST HEALTH CARE ENTITIES THAT DO 
              NOT PARTICIPATE IN ABORTION.

    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. PROHIBITING DISCRIMINATION AGAINST HEALTH CARE ENTITIES 
              THAT DO NOT PARTICIPATE IN ABORTION.

    ``(a) In General.--Notwithstanding any other law, the Federal 
Government, and any individual or entity that receives Federal 
financial assistance, including any State or local government, may not 
penalize, retaliate against, or otherwise discriminate against a health 
care entity on the basis that such health care entity does not or 
declines to--
            ``(1) provide, perform, refer for, pay for, or otherwise 
        participate in abortion;
            ``(2) provide or sponsor abortion coverage; or
            ``(3) facilitate or make arrangements for any of the 
        activities specified in this subsection.
    ``(b) Rule of Construction.--Nothing in this section shall be 
construed--
            ``(1) to prevent any health care entity from voluntarily 
        electing to participate in abortions or abortion referrals 
        where not prohibited by any other law;
            ``(2) to prevent any health care entity from voluntarily 
        electing to provide or sponsor abortion coverage or health 
        benefits coverage that includes abortion where not prohibited 
        by any other law;
            ``(3) to prevent an accrediting agency, the Federal 
        Government, or a State or local government from establishing 
        standards of medical competency applicable only to those who 
        have knowingly, voluntarily, and specifically elected to 
        perform abortions, or from enforcing contractual obligations 
        applicable only to those who, as part of such contract, 
        knowingly, voluntarily, and specifically elect to provide 
        abortions;
            ``(4) to affect, or be affected by, any Federal law that 
        requires stabilizing treatment for a pregnant woman or her 
        unborn child when either needs emergency care; or
            ``(5) to supersede any law enacted by any State for the 
        purpose of regulating insurance, except as specified in 
        subsection (a).
    ``(c) Definitions.--For purposes of this section:
            ``(1) Federal financial assistance.--The term `Federal 
        financial assistance' means Federal 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) Health care entity.--The term `health care entity' 
        includes--
                    ``(A) an individual physician, health care 
                assistant, nurse, pharmacist, health researcher, or 
                other health care personnel;
                    ``(B) a hospital, laboratory, pharmacy, health 
                system, or other health care or medical research 
                facility or organization (including a party to a 
                proposed merger or other collaborative arrangement 
                relating to health services, and an entity resulting 
                therefrom);
                    ``(C) a provider-sponsored organization, an 
                accountable care organization, or a health maintenance 
                organization;
                    ``(D) a social services provider that provides or 
                authorizes referrals for health care services;
                    ``(E) a program of training or education in the 
                health professions or medical research, a participant 
                in such a program, or any individual applying or 
                otherwise aspiring to participate in such a program;
                    ``(F) an issuer of health insurance coverage or of 
                a health plan;
                    ``(G) a health care sharing ministry;
                    ``(H) a health insurance plan, including group, 
                individual, or student health plans, or a sponsor or 
                administrator thereof; or
                    ``(I) any other health care organization, program, 
                facility, or plan.
            ``(3) State or local government.--The term `State or local 
        government' includes every agency and other governmental unit 
        and subdivision of a State or local government, if such State 
        or local government, or any agency or governmental unit or 
        subdivision thereof, receives Federal financial assistance.''.

SEC. 4. STRENGTHENING ENFORCEMENT OF FEDERAL CONSCIENCE LAWS.

    Title II of the Public Health Service Act (42 U.S.C. 202 et seq.), 
as amended by section 3, is further amended by inserting after section 
245A the following:

``SEC. 245B. ADMINISTRATIVE ENFORCEMENT OF FEDERAL CONSCIENCE LAWS.

    ``(a) Regulations.--
            ``(1) In general.--Under this section, the Secretary may 
        issue regulations under any provision of law described in 
        paragraph (2).
            ``(2) Provisions of law.--The provisions of law described 
        in this paragraph are each of the following:
                    ``(A) Sections 245, 245A, 399M(d), and 520E(f) of 
                this Act.
                    ``(B) The Religious Freedom Restoration Act of 
                1993, with respect to any program or activity funded, 
                administered, or conducted by the Department of Health 
                and Human Services.
                    ``(C) Any of subsections (b) through (e) of section 
                401 of the Health Programs Extension Act of 1973 
                (commonly known as the `Church Amendments'), only with 
                respect to an objection based on a religious belief or 
                moral conviction.
                    ``(D) Section 507(d) of the Departments of Labor, 
                Health and Human Services, and Education, and Related 
                Agencies Appropriations Act, 2023 (division H of the 
                Consolidated Appropriations Act, 2023 (Public Law 117-
                328)) (commonly known as the `Weldon Amendment') and 
                any subsequent substantially similar provision in an 
                appropriations Act, to the extent administered by the 
                Secretary.
                    ``(E) Section 209 of the Departments of Labor, 
                Health and Human Services, and Education, and Related 
                Agencies Appropriations Act, 2023 (division H of the 
                Consolidated Appropriations Act, 2023 (Public Law 117-
                328)) and any subsequent substantially similar 
                provision in an appropriations Act, to the extent 
                administered by the Secretary.
                    ``(F) Clauses (i) and (ii) of paragraph (1)(A) of 
                section 1303(b) of the Patient Protection and 
                Affordable Care Act (only with respect to a 
                determination not to provide coverage of abortion), and 
                paragraph (4) of such section.
                    ``(G) Section 1411(b)(5)(A) of the Patient 
                Protection and Affordable Care Act (other than with 
                respect to an exemption as an Indian or a hardship 
                exemption) and section 5000A(d)(2)(A) of the Internal 
                Revenue Code of 1986.
                    ``(H) Section 1553 of the Patient Protection and 
                Affordable Care Act.
                    ``(I) Sections 1122(h), 1162, 1821, 1861(e), 
                1861(y)(1), and 1861(ss) of the Social Security Act, 
                and the first paragraph of the matter following section 
                1902(a)(87)(D) of such Act, each of such provisions 
                only with respect to protections for religious 
                nonmedical health care institutions.
                    ``(J) Sections 1852(j)(3)(B), 1866(f)(4), 
                1902(w)(3), 1902(w)(5), 1907, 1928(c)(2)(B)(ii) (with 
                respect to a religious or other exemption), 
                1932(b)(3)(B), and 2012(b) of such Act.
                    ``(K) Section 4206(c) of the Omnibus Budget 
                Reconciliation Act of 1990.
                    ``(L) Section 7 of the Assisted Suicide Funding 
                Restriction Act of 1997.
                    ``(M) Section 113(a) of the Child Abuse Prevention 
                and Treatment Act.
                    ``(N) Section 301(d) of the United States 
                Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
                Act of 2003 to the extent administered by the 
                Secretary.
                    ``(O) The third sentence of section 20(a)(5) of the 
                Occupational Safety and Health Act of 1970.
                    ``(P) Section 104(f)(1) of the Foreign Assistance 
                Act of 1961 (commonly known as the `Helms Amendment'), 
                and any provision of an appropriations Act or other 
                Federal law that restates or incorporates by reference 
                the protections of such section, to the extent 
                administered by the Secretary.
                    ``(Q) The ninth proviso under the heading `Global 
                Health Programs' under the heading `Funds Appropriated 
                to the President' under title III of the Department of 
                State, Foreign Operations, and Related Programs 
                Appropriations Act, 2023 (division K of the 
                Consolidated Appropriations Act, 2023 (Public Law 117-
                328)) and any subsequent substantially similar 
                provision in an appropriations Act to the extent 
                administered by the Secretary.
                    ``(R) Any other provision of law protecting the 
                exercise of conscience or religious freedom under 
                programs or activities funded, administered, or 
                conducted by the Department of Health and Human 
                Services.
    ``(b) Office for Civil Rights.--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 any 
        provision of law described in subsection (a)(2); and
            ``(2) to promptly investigate such complaints, issue 
        findings, and require corrective action in cases of such a 
        violation.
    ``(c) Enforcement.--
            ``(1) In general.--The Secretary shall, as permitted under 
        law (including the Constitution of the United States), induce 
        compliance of an individual or entity, including a State or 
        local government, failing to comply with any provision of law 
        described in subsection (a)(2), by terminating, in whole or in 
        part, any Federal financial assistance provided by the 
        Secretary to such individual or entity.
            ``(2) Referrals.--The Secretary shall, as the Secretary 
        determines necessary for inducing compliance with a provision 
        described in paragraph (1), refer a violation of such a 
        provision to the Attorney General for a civil action in 
        accordance with section 245C.

``SEC. 245C. CIVIL ACTION FOR VIOLATIONS OF FEDERAL CONSCIENCE LAWS.

    ``(a) In General.--A qualified party may, in a civil action, obtain 
relief described in subsection (e) with respect to a designated 
violation.
    ``(b) Definitions.--For purposes of this section:
            ``(1) Designated violation.--The term `designated 
        violation' means an actual or threatened violation of any 
        provision of law described in section 245B(a)(2).
            ``(2) Qualified party.--The term `qualified party' means--
                    ``(A) the Attorney General; or
                    ``(B) any individual or entity adversely affected 
                by the designated violation without regard to whether 
                such individual or entity is a health care entity as 
                defined in section 245A(c).
    ``(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 any 
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 any individual or entity receiving Federal 
        financial assistance (as defined in section 245A(c)), including 
        a State governmental entity. Relief in an action under this 
        section may include money damages even if the defendant is 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, and any agency or other governmental 
        unit or subdivision of a State, or of such a local government.
    ``(e) Nature of Relief.--In an action under this section, the court 
shall grant--
            ``(1) all appropriate relief, including injunctive relief, 
        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 costs.''.

SEC. 5. SEVERABILITY.

    If any provision of this Act or an amendment made by this Act, or 
the application of such a provision or amendment to any individual, 
entity, government, or circumstance, is held to be unconstitutional, 
the remainder of this Act and the amendments made by this Act, and the 
application of such provision or amendment to any other individual, 
entity, government, or circumstance, shall not be affected.
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