II 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Conscience Protection 

5 Act of 2024’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds as follows: 

3 (1) Thomas Jefferson stated a conviction com4 mon to our Nation’s founders when he declared in 

5 1809 that ‘‘[n]o provision in our Constitution ought 

6 to be dearer to man than that which protects the 

7 rights of conscience against the enterprises of the 

8 civil authority’’. 

9 (2) No health care entity should have to choose 

10 between giving up their religious, moral, ethical, or 

11 medical convictions and abandoning a vital medical 

12 mission. Congress enacted more than two dozen pro13 visions in Federal statutes to protect such rights in 

14 health care, which also protect States’ ability to op15 erate in accordance with their laws to protect similar 

16 rights without fear of retaliation from the Federal 

17 Government. Such provisions of Federal statutes in18 clude— 

19 (A) subsections (b) through (e) of section 

20 401 of the Health Programs Extension Act of 

21 1973 (42 U.S.C. 300a–7) (commonly known, 

22 and referred to in this section, as the ‘‘Church 

23 Amendments’’); 

24 (B) section 245 of the Public Health Serv25 ice Act (42 U.S.C. 238n) (commonly known as 

26 the ‘‘Coats-Snowe Amendment’’); 


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1 (C) the Weldon Amendment approved by 

2 Congresses and Presidents of both parties every 

3 year since 2004 (including section 507(d) of the 

4 Departments of Labor, Health and Human 

5 Services, and Education, and Related Agencies 

6 Appropriations Act, 2023 (division H of the 

7 Consolidated Appropriations Act, 2023 (Public 

8 Law 117–328))); and 

9 (D) other conscience protections, as out10 lined in the final rule issued by the Secretary 

11 of Health and Human Services entitled ‘‘Pro12 tecting Statutory Conscience Rights in Health 

13 Care; Delegations of Authority’’ (84 Fed. Reg. 

14 23170; May 21, 2019), under the Patient Pro15 tection and Affordable Care Act, under the So16 cial Security Act, and with respect to global 

17 health programs and advanced directives. 

18 (3) Courts have held that certain conscience 

19 protection statutes do not provide a ‘‘private right of 

20 action’’ for individuals or entities who have been dis21 criminated against, thereby leaving victims of dis22 crimination unable to defend their own conscience 

23 rights in court. At the same time, administrative im24 plementation and enforcement of these laws by the 

25 Office for Civil Rights of the Department of Health 


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1 and Human Services have been inconsistent and at 

2 times cases are allowed to languish for years or pre3 viously enacted enforcement measures are aban4 doned or reversed. 

5 (4) Defying the Weldon Amendment, the Cali6 fornia Department of Managed Health Care has 

7 mandated coverage for elective abortions in all 

8 health plans under its jurisdiction. Other States, 

9 such as New York, Illinois, and Washington, have 

10 taken or considered similar action, and some States 

11 have required hospitals to provide or facilitate abor12 tions. On June 21, 2016, the Office for Civil Rights 

13 of the Department of Health and Human Services, 

14 under the Obama Administration, concluded a nearly 

15 2-year investigation of this matter by determining 

16 that the decision of California to require insurance 

17 plans under the California Department for Managed 

18 Health Care authority to cover abortion services did 

19 not violate the Weldon Amendment. At least 28,000 

20 individuals and families subsequently lost abortion21 free health plans as a result of this mandate in vio22 lation of their consciences and rights under the 

23 Weldon Amendment. 

24 (5) On January 24, 2020, the Office for Civil 

25 Rights of the Department of Health and Human 


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1 Services disavowed its prior findings and issued a 

2 notice of violation of the Weldon Amendment to 

3 California. After the State’s continued noncompli4 ance with the Weldon Amendment, the Centers for 

5 Medicare & Medicaid Services, on December 16, 

6 2020, announced the disallowance of $200,000,000 

7 per quarter in Federal funds to California beginning 

8 in the first quarter of 2021. 

9 (6) Although California had taken no action to 

10 come into compliance with the Weldon Amendment, 

11 on August 13, 2021, the Office for Civil Rights of 

12 the Department of Health and Human Services 

13 under the Biden Administration withdrew the notice 

14 of violation and closed the complaints filed with the 

15 Department. As a result, individuals continue to be 

16 coerced contrary to law into choosing between vio17 lating their consciences or forgoing health care cov18 erage for themselves, their employees, and their fam19 ilies. 

20 (7)(A) On August 28, 2019, the Office for Civil 

21 Rights of the Department of Health and Human 

22 Services under the Trump Administration issued a 

23 notice of violation against the University of Vermont 

24 Medical Center for violation of the Church Amend25 ments after it was found to have scheduled approxiVerDate Sep 11 2014 02:14 Aug 07, 2024 Jkt 049200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4524.IS S4524

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1 mately 10 nurses who had registered conscience ob2 jections to abortion to assist with approximately 20 

3 abortion procedures and for maintaining policies 

4 that explicitly required employees with conscience 

5 objections to participate in procedures with which 

6 they disagreed to ‘‘ensure that patient care is not 

7 negatively impacted’’. Such practices were found to 

8 be part of an ‘‘ongoing pattern, practice, and policy 

9 of discriminating against health care providers who 

10 believe that the performance, or the assistance in the 

11 performance, of abortions is contrary to their reli12 gious beliefs or moral convictions’’. 

13 (B) After the University of Vermont Medical 

14 Center refused to come into compliance with the law, 

15 the Department of Justice brought an enforcement 

16 action in Federal court against the medical center 

17 on December 16, 2020. 

18 (C) On July 30, 2021, the Department of Jus19 tice under the Biden Administration voluntarily dis20 missed the case, without any binding settlement or 

21 requirement that the University of Vermont Medical 

22 Center remedy its unlawful policies or make restitu23 tion to the employees whose rights it violated. 

24 (8) On May 21, 2019, the Secretary of Health 

25 and Human Services issued the final rule entitled 


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1 ‘‘Protecting Statutory Conscience Rights in Health 

2 Care; Delegations of Authority’’ (84 Fed. Reg. 

3 23170; May 21, 2019) to implement 25 Federal con4 science protection provisions governing programs 

5 funded under the Department of Health and Human 

6 Services and provide mechanisms to enforce con7 science laws to ensure that the government and gov8 ernment-funded entities are not unlawfully discrimi9 nating against health care entities. Despite this reg10 ulation providing for enforcement of laws passed by 

11 Congress, the rule faced numerous legal challenges 

12 and was vacated. 

13 (9) On January 11, 2024, the Department of 

14 Health and Human Services published a final rule 

15 that fails to equip the Department with the tools 

16 necessary for effective enforcement of Federal statu17 tory protections of rights of conscience. 

18 (10) Congress has acted numerous times to ex19 pand access to health care and has also acted nu20 merous times to provide unqualified statutorily pro21 tected rights of conscience to individuals and entities 

22 in certain circumstances. A health care entity’s deci23 sion not to participate in an abortion, assisted sui24 cide, procedures that can result in sterilization, or 

25 other interventions erects no barrier to those legally 


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1 seeking to perform or undergo such interventions 

2 elsewhere. 

3 (11) The vast majority of medical professionals 

4 do not perform abortions. Ninety-three percent of 

5 obstetricians/gynecologists in private practice report 

6 that they did not provide abortions (National Li7 brary of Medicine, April 2018) and the great major8 ity of hospitals choose to do so only in rare cases or 

9 not at all. 

10 (12) In the landmark 2022 decision, Dobbs v. 

11 Jackson Women’s Health Organization, the Supreme 

12 Court held that ‘‘the Constitution does not confer a 

13 right to abortion’’. 

14 (13) On July 13, 2022, the Department of 

15 Health and Human Services issued guidance to re16 tail pharmacies in the United States. Such guidance 

17 purported to address their obligations under Federal 

18 nondiscrimination laws, but in actuality orders phar19 macies to stock and dispense abortion pills despite 

20 the fact that pharmacies and pharmacists have a 

21 right to not violate their conscience by participating 

22 in abortion under existing law. 

23 (14) Conscience protections pose no conflict 

24 with other Federal laws, such as the law requiring 

25 stabilizing treatment for a ‘‘pregnant woman . . . or 


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1 her unborn child’’ when either needs emergency care 

2 (Emergency Medical Treatment and Active Labor 

3 Act). As previous Administrations have said, these 

4 areas of law have operated side by side for many 

5 years and both should be fully enforced (76 Fed. 

6 Reg. 9968–77 (2011) at 9973). 

7 (15) Reaffirming longstanding Federal policy 

8 on conscience rights and providing a private right of 

9 action in cases where it is violated allows long10 standing and widely supported Federal laws to work 

11 as intended. 

12 SEC. 3. PROHIBITING DISCRIMINATION AGAINST HEALTH 

13 CARE ENTITIES THAT DO NOT PARTICIPATE 

14 IN ABORTION. 

15 Title II of the Public Health Service Act (42 U.S.C. 

16 202 et seq.) is amended by inserting after section 245 the 

17 following: 

18 ‘‘SEC. 245A. PROHIBITING DISCRIMINATION AGAINST 

19 HEALTH CARE ENTITIES THAT DO NOT PAR20 TICIPATE IN ABORTION. 

21 ‘‘(a) IN GENERAL.—Notwithstanding any other law, 

22 the Federal Government, and any individual or entity that 

23 receives Federal financial assistance, including any State 

24 or local government, may not penalize, retaliate against, 

25 or otherwise discriminate against a health care entity on 


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1 the basis that such health care entity does not or declines 

2 to— 

3 ‘‘(1) provide, perform, refer for, pay for, or oth4 erwise participate in abortion; 

5 ‘‘(2) provide or sponsor abortion coverage; or 

6 ‘‘(3) facilitate or make arrangements for any of 

7 the activities specified in this subsection. 

8 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec9 tion shall be construed— 

10 ‘‘(1) to prevent any health care entity from vol11 untarily electing to participate in abortions or abor12 tion referrals where not prohibited by any other law; 

13 ‘‘(2) to prevent any health care entity from vol14 untarily electing to provide or sponsor abortion cov15 erage or health benefits coverage that includes abor16 tion where not prohibited by any other law; 

17 ‘‘(3) to prevent an accrediting agency, the Fed18 eral Government, or a State or local government 

19 from establishing standards of medical competency 

20 applicable only to those who have knowingly, volun21 tarily, and specifically elected to perform abortions, 

22 or from enforcing contractual obligations applicable 

23 only to those who, as part of such contract, know24 ingly, voluntarily, and specifically elect to provide 

25 abortions; 


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1 ‘‘(4) to affect, or be affected by, any Federal 

2 law that requires stabilizing treatment for a preg3 nant woman or her unborn child when either needs 

4 emergency care; or 

5 ‘‘(5) to supersede any law enacted by any State 

6 for the purpose of regulating insurance, except as 

7 specified in subsection (a). 

8 ‘‘(c) DEFINITIONS.—For purposes of this section: 

9 ‘‘(1) FEDERAL FINANCIAL ASSISTANCE.—The 

10 term ‘Federal financial assistance’ means Federal 

11 payments to cover the cost of health care services or 

12 benefits, or other Federal payments, grants, or loans 

13 to promote or otherwise facilitate health-related ac14 tivities. 

15 ‘‘(2) HEALTH CARE ENTITY.—The term ‘health 

16 care entity’ includes— 

17 ‘‘(A) an individual physician, health care 

18 assistant, nurse, pharmacist, health researcher, 

19 or other health care personnel; 

20 ‘‘(B) a hospital, laboratory, pharmacy, 

21 health system, or other health care or medical 

22 research facility or organization (including a 

23 party to a proposed merger or other collabo24 rative arrangement relating to health services, 

25 and an entity resulting therefrom); 


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1 ‘‘(C) a provider-sponsored organization, an 

2 accountable care organization, or a health 

3 maintenance organization; 

4 ‘‘(D) a social services provider that pro5 vides or authorizes referrals for health care 

6 services; 

7 ‘‘(E) a program of training or education in 

8 the health professions or medical research, a 

9 participant in such a program, or any individual 

10 applying or otherwise aspiring to participate in 

11 such a program; 

12 ‘‘(F) an issuer of health insurance cov13 erage or of a health plan; 

14 ‘‘(G) a health care sharing ministry; 

15 ‘‘(H) a health insurance plan, including 

16 group, individual, or student health plans, or a 

17 sponsor or administrator thereof; or 

18 ‘‘(I) any other health care organization, 

19 program, facility, or plan. 

20 ‘‘(3) STATE OR LOCAL GOVERNMENT.—The 

21 term ‘State or local government’ includes every 

22 agency and other governmental unit and subdivision 

23 of a State or local government, if such State or local 

24 government, or any agency or governmental unit or 


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1 subdivision thereof, receives Federal financial assist2 ance.’’. 

3 SEC. 4. STRENGTHENING ENFORCEMENT OF FEDERAL 

4 CONSCIENCE LAWS. 

5 Title II of the Public Health Service Act (42 U.S.C. 

6 202 et seq.), as amended by section 3, is further amended 

7 by inserting after section 245A the following: 

8 ‘‘SEC. 245B. ADMINISTRATIVE ENFORCEMENT OF FEDERAL 

9 CONSCIENCE LAWS. 

10 ‘‘(a) REGULATIONS.— 

11 ‘‘(1) IN GENERAL.—Under this section, the 

12 Secretary may issue regulations under any provision 

13 of law described in paragraph (2). 

14 ‘‘(2) PROVISIONS OF LAW.—The provisions of 

15 law described in this paragraph are each of the fol16 lowing: 

17 ‘‘(A) Sections 245, 245A, 399M(d), and 

18 520E(f) of this Act. 

19 ‘‘(B) The Religious Freedom Restoration 

20 Act of 1993, with respect to any program or ac21 tivity funded, administered, or conducted by the 

22 Department of Health and Human Services. 

23 ‘‘(C) Any of subsections (b) through (e) of 

24 section 401 of the Health Programs Extension 

25 Act of 1973 (commonly known as the ‘Church 


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1 Amendments’), only with respect to an objection 

2 based on a religious belief or moral conviction. 

3 ‘‘(D) Section 507(d) of the Departments of 

4 Labor, Health and Human Services, and Edu5 cation, and Related Agencies Appropriations 

6 Act, 2023 (division H of the Consolidated Ap7 propriations Act, 2023 (Public Law 117–328)) 

8 (commonly known as the ‘Weldon Amendment’) 

9 and any subsequent substantially similar provi10 sion in an appropriations Act, to the extent ad11 ministered by the Secretary. 

12 ‘‘(E) Section 209 of the Departments of 

13 Labor, Health and Human Services, and Edu14 cation, and Related Agencies Appropriations 

15 Act, 2023 (division H of the Consolidated Ap16 propriations Act, 2023 (Public Law 117–328)) 

17 and any subsequent substantially similar provi18 sion in an appropriations Act, to the extent ad19 ministered by the Secretary. 

20 ‘‘(F) Clauses (i) and (ii) of paragraph 

21 (1)(A) of section 1303(b) of the Patient Protec22 tion and Affordable Care Act (only with respect 

23 to a determination not to provide coverage of 

24 abortion), and paragraph (4) of such section. 


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1 ‘‘(G) Section 1411(b)(5)(A) of the Patient 

2 Protection and Affordable Care Act (other than 

3 with respect to an exemption as an Indian or a 

4 hardship exemption) and section 

5 5000A(d)(2)(A) of the Internal Revenue Code 

6 of 1986. 

7 ‘‘(H) Section 1553 of the Patient Protec8 tion and Affordable Care Act. 

9 ‘‘(I) Sections 1122(h), 1162, 1821, 

10 1861(e), 1861(y)(1), and 1861(ss) of the Social 

11 Security Act, and the first paragraph of the 

12 matter following section 1902(a)(87)(D) of such 

13 Act, each of such provisions only with respect 

14 to protections for religious nonmedical health 

15 care institutions. 

16 ‘‘(J) Sections 1852(j)(3)(B), 1866(f)(4), 

17 1902(w)(3), 1902(w)(5), 1907, 

18 1928(c)(2)(B)(ii) (with respect to a religious or 

19 other exemption), 1932(b)(3)(B), and 2012(b) 

20 of such Act. 

21 ‘‘(K) Section 4206(c) of the Omnibus 

22 Budget Reconciliation Act of 1990. 

23 ‘‘(L) Section 7 of the Assisted Suicide 

24 Funding Restriction Act of 1997. 


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1 ‘‘(M) Section 113(a) of the Child Abuse 

2 Prevention and Treatment Act. 

3 ‘‘(N) Section 301(d) of the United States 

4 Leadership Against HIV/AIDS, Tuberculosis, 

5 and Malaria Act of 2003 to the extent adminis6 tered by the Secretary. 

7 ‘‘(O) The third sentence of section 

8 20(a)(5) of the Occupational Safety and Health 

9 Act of 1970. 

10 ‘‘(P) Section 104(f)(1) of the Foreign As11 sistance Act of 1961 (commonly known as the 

12 ‘Helms Amendment’), and any provision of an 

13 appropriations Act or other Federal law that re14 states or incorporates by reference the protec15 tions of such section, to the extent administered 

16 by the Secretary. 

17 ‘‘(Q) The ninth proviso under the heading 

18 ‘Global Health Programs’ under the heading 

19 ‘Funds Appropriated to the President’ under 

20 title III of the Department of State, Foreign 

21 Operations, and Related Programs Appropria22 tions Act, 2023 (division K of the Consolidated 

23 Appropriations Act, 2023 (Public Law 117– 

24 328)) and any subsequent substantially similar 


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1 provision in an appropriations Act to the extent 

2 administered by the Secretary. 

3 ‘‘(R) Any other provision of law protecting 

4 the exercise of conscience or religious freedom 

5 under programs or activities funded, adminis6 tered, or conducted by the Department of 

7 Health and Human Services. 

8 ‘‘(b) OFFICE FOR CIVIL RIGHTS.—The Secretary 

9 shall designate the Director of the Office for Civil Rights 

10 of the Department of Health and Human Services— 

11 ‘‘(1) to receive complaints alleging a violation of 

12 any provision of law described in subsection (a)(2); 

13 and 

14 ‘‘(2) to promptly investigate such complaints, 

15 issue findings, and require corrective action in cases 

16 of such a violation. 

17 ‘‘(c) ENFORCEMENT.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall, as 

19 permitted under law (including the Constitution of 

20 the United States), induce compliance of an indi21 vidual or entity, including a State or local govern22 ment, failing to comply with any provision of law de23 scribed in subsection (a)(2), by terminating, in whole 

24 or in part, any Federal financial assistance provided 

25 by the Secretary to such individual or entity. 


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1 ‘‘(2) REFERRALS.—The Secretary shall, as the 

2 Secretary determines necessary for inducing compli3 ance with a provision described in paragraph (1), 

4 refer a violation of such a provision to the Attorney 

5 General for a civil action in accordance with section 

6 245C. 

7 ‘‘SEC. 245C. CIVIL ACTION FOR VIOLATIONS OF FEDERAL 

8 CONSCIENCE LAWS. 

9 ‘‘(a) IN GENERAL.—A qualified party may, in a civil 

10 action, obtain relief described in subsection (e) with re11 spect to a designated violation. 

12 ‘‘(b) DEFINITIONS.—For purposes of this section: 

13 ‘‘(1) DESIGNATED VIOLATION.—The term ‘des14 ignated violation’ means an actual or threatened vio15 lation of any provision of law described in section 

16 245B(a)(2). 

17 ‘‘(2) QUALIFIED PARTY.—The term ‘qualified 

18 party’ means— 

19 ‘‘(A) the Attorney General; or 

20 ‘‘(B) any individual or entity adversely af21 fected by the designated violation without re22 gard to whether such individual or entity is a 

23 health care entity as defined in section 245A(c). 

24 ‘‘(c) ADMINISTRATIVE REMEDIES NOT REQUIRED.— 

25 An action under this section may be commenced, and relief 


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1 may be granted, without regard to whether the party com2 mencing the action has sought or exhausted any available 

3 administrative remedies. 

4 ‘‘(d) DEFENDANTS IN ACTIONS UNDER THIS SEC5 TION MAY INCLUDE GOVERNMENTAL ENTITIES AS WELL

6 AS OTHERS.— 

7 ‘‘(1) IN GENERAL.—An action under this sec8 tion may be maintained against any individual or en9 tity receiving Federal financial assistance (as defined 

10 in section 245A(c)), including a State governmental 

11 entity. Relief in an action under this section may in12 clude money damages even if the defendant is a gov13 ernmental entity. 

14 ‘‘(2) DEFINITION.—For the purposes of this 

15 subsection, the term ‘State governmental entity’ 

16 means a State, a local government within a State, 

17 and any agency or other governmental unit or sub18 division of a State, or of such a local government. 

19 ‘‘(e) NATURE OF RELIEF.—In an action under this 

20 section, the court shall grant— 

21 ‘‘(1) all appropriate relief, including injunctive 

22 relief, declaratory relief, and compensatory damages 

23 to prevent the occurrence, continuance, or repetition 

24 of the designated violation and to compensate for 

25 losses resulting from the designated violation; and 


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1 ‘‘(2) to a prevailing plaintiff, reasonable attor2 neys’ fees and litigation costs.’’. 

3 SEC. 5. SEVERABILITY. 

4 If any provision of this Act or an amendment made 

5 by this Act, or the application of such a provision or 

6 amendment to any individual, entity, government, or cir7 cumstance, is held to be unconstitutional, the remainder 

8 of this Act and the amendments made by this Act, and 

9 the application of such provision or amendment to any 

10 other individual, entity, government, or circumstance, 

11 shall not be affected. 

Æ 


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