Bill S1204 (2013)
Health Care Conscience Rights Act
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.
20 June, 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.
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
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 the following:
(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; the United States Leadership Against HIV/AIDS, Tuberculosis,
and Malaria Act; the Religious Freedom Restoration Act; 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 and 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
(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 any such
'(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;
'(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 such provision) 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 such provision) or a law,
regulation, guideline or other governmental action that
implements such provision or amendment or derives its authority
'(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
'(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.';
(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
(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
'(1) the entity refuses--
'(A) to undergo training in the performance of induced
'(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
(3) in subsection (b)(1), by striking 'standards' and inserting
(4) in subsection (c), by amending paragraphs (1) and (2) to read
'(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
'(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
(5) by adding at the end of subsection (c) the following new
'(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
'(c) Administration- The Secretary shall designate the Director
of the Office for Civil Rights of the Department of Health and Human
'(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.'.