I 

118TH CONGRESS 

2D SESSION H. R. 8857 

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 HOUSE OF REPRESENTATIVES 

JUNE 27, 2024 

Mr. BANKS (for himself, Mr. MOONEY, Mr. LAMALFA, Mr. CRENSHAW, Mrs. 

MILLER of Illinois, Mrs. HINSON, Mr. ADERHOLT, Mr. BERGMAN, Mr. 

BACON, Mr. BURCHETT, Mr. FINSTAD, Mr. DUNCAN, Ms. FOXX, Mr. 

GOSAR, Mr. KUSTOFF, Mr. HIGGINS of Louisiana, Mrs. LESKO, Mr. 

MOOLENAAR, Mr. WALBERG, Mr. GOODEN of Texas, Mr. ARMSTRONG, 

Mr. WEBER of Texas, Mr. FEENSTRA, Mr. WALTZ, Mr. SMITH of Nebraska, Mr. LAMBORN, Mr. LUETKEMEYER, Mr. LOUDERMILK, Mr. FITZGERALD, Mr. TIMMONS, Mr. POSEY, Mr. RUTHERFORD, Mr. PENCE, Mr. 

WEBSTER of Florida, Mr. GUEST, Mr. MANN, Mrs. BICE, Mr. CRANE, 

and Mr. WENSTRUP) introduced the following bill; which was referred to 

the Committee on Energy and Commerce 

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, 


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1 SECTION 1. SHORT TITLE. 

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

3 Act of 2024’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds as follows: 

6 (1) Thomas Jefferson stated a conviction com7 mon to our Nation’s founders when he declared in 

8 1809 that ‘‘[n]o provision in our Constitution ought 

9 to be dearer to man than that which protects the 

10 rights of conscience against the enterprises of the 

11 civil authority’’. 

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

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

14 medical convictions and abandoning a vital medical 

15 mission. Congress enacted more than two dozen pro16 visions in Federal statutes to protect such rights in 

17 health care, which also protect States’ ability to op18 erate in accordance with their laws to protect similar 

19 rights without fear of retaliation from the Federal 

20 Government. Such provisions of Federal statutes in21 clude— 

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

23 401 of the Health Programs Extension Act of 

24 1973 (42 U.S.C. 300a–7) (commonly known, 

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

26 Amendments’’); 


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1 (B) section 245 of the Public Health Serv2 ice Act (42 U.S.C. 238n) (commonly known as 

3 the ‘‘Coats-Snowe Amendment’’); 

4 (C) the Weldon Amendment approved by 

5 Congresses and Presidents of both parties every 

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

7 Departments of Labor, Health and Human 

8 Services, and Education, and Related Agencies 

9 Appropriations Act, 2023 (division H of the 

10 Consolidated Appropriations Act, 2023 (Public 

11 Law 117–328))); and 

12 (D) other conscience protections, as out13 lined in the final rule issued by the Secretary 

14 of Health and Human Services entitled ‘‘Pro15 tecting Statutory Conscience Rights in Health 

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

17 23170; May 21, 2019), under the Patient Pro18 tection and Affordable Care Act, under the So19 cial Security Act, and with respect to global 

20 health programs and advanced directives. 

21 (3) Courts have held that certain conscience 

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

23 action’’ for individuals or entities who have been dis24 criminated against, thereby leaving victims of dis25 crimination unable to defend their own conscience 


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1 rights in court. At the same time, administrative im2 plementation and enforcement of these laws by the 

3 Office for Civil Rights of the Department of Health 

4 and Human Services have been inconsistent and at 

5 times cases are allowed to languish for years or pre6 viously enacted enforcement measures are aban7 doned or reversed. 

8 (4) Defying the Weldon Amendment, the Cali9 fornia Department of Managed Health Care has 

10 mandated coverage for elective abortions in all 

11 health plans under its jurisdiction. Other States, 

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

13 taken or considered similar action, and some States 

14 have required hospitals to provide or facilitate abor15 tions. On June 21, 2016, the Office for Civil Rights 

16 of the Department of Health and Human Services, 

17 under the Obama Administration, concluded a nearly 

18 2-year investigation of this matter by determining 

19 that the decision of California to require insurance 

20 plans under the California Department for Managed 

21 Health Care authority to cover abortion services did 

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

23 individuals and families subsequently lost abortion24 free health plans as a result of this mandate in vioVerDate Sep 11 2014 18:52 Aug 08, 2024 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H8857.IH H8857

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1 lation of their consciences and rights under the 

2 Weldon Amendment. 

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

4 Rights of the Department of Health and Human 

5 Services disavowed its prior findings and issued a 

6 notice of violation of the Weldon Amendment to 

7 California. After the State’s continued noncompli8 ance with the Weldon Amendment, the Centers for 

9 Medicare & Medicaid Services, on December 16, 

10 2020, announced the disallowance of $200,000,000 

11 per quarter in Federal funds to California beginning 

12 in the first quarter of 2021. 

13 (6) Although California had taken no action to 

14 come into compliance with the Weldon Amendment, 

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

16 the Department of Health and Human Services 

17 under the Biden Administration withdrew the notice 

18 of violation and closed the complaints filed with the 

19 Department. As a result, individuals continue to be 

20 coerced contrary to law into choosing between vio21 lating their consciences or forgoing health care cov22 erage for themselves, their employees, and their fam23 ilies. 

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

25 Rights of the Department of Health and Human 


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1 Services under the Trump Administration issued a 

2 notice of violation against the University of Vermont 

3 Medical Center for violation of the Church Amend4 ments after it was found to have scheduled approxi5 mately 10 nurses who had registered conscience ob6 jections to abortion to assist with approximately 20 

7 abortion procedures and for maintaining policies 

8 that explicitly required employees with conscience 

9 objections to participate in procedures with which 

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

11 negatively impacted’’. Such practices were found to 

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

13 of discriminating against health care providers who 

14 believe that the performance, or the assistance in the 

15 performance, of abortions is contrary to their reli16 gious beliefs or moral convictions’’. 

17 (B) After the University of Vermont Medical 

18 Center refused to come into compliance with the law, 

19 the Department of Justice brought an enforcement 

20 action in Federal court against the medical center 

21 on December 16, 2020. 

22 (C) On July 30, 2021, the Department of Jus23 tice under the Biden Administration voluntarily dis24 missed the case, without any binding settlement or 

25 requirement that the University of Vermont Medical 


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1 Center remedy its unlawful policies or make restitu2 tion to the employees whose rights it violated. 

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

4 and Human Services issued the final rule entitled 

5 ‘‘Protecting Statutory Conscience Rights in Health 

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

7 23170; May 21, 2019) to implement 25 Federal con8 science protection provisions governing programs 

9 funded under the Department of Health and Human 

10 Services and provide mechanisms to enforce con11 science laws to ensure that the government and gov12 ernment-funded entities are not unlawfully discrimi13 nating against health care entities. Despite this reg14 ulation providing for enforcement of laws passed by 

15 Congress, the rule faced numerous legal challenges 

16 and was vacated. 

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

18 Health and Human Services published a final rule 

19 that fails to equip the Department with the tools 

20 necessary for effective enforcement of Federal statu21 tory protections of rights of conscience. 

22 (10) Congress has acted numerous times to ex23 pand access to health care and has also acted nu24 merous times to provide unqualified statutorily pro25 tected rights of conscience to individuals and entities 


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1 in certain circumstances. A health care entity’s deci2 sion not to participate in an abortion, assisted sui3 cide, procedures that can result in sterilization, or 

4 other interventions erects no barrier to those legally 

5 seeking to perform or undergo such interventions 

6 elsewhere. 

7 (11) The vast majority of medical professionals 

8 do not perform abortions. Ninety-three percent of 

9 obstetricians/gynecologists in private practice report 

10 that they did not provide abortions (National Li11 brary of Medicine, April 2018) and the great major12 ity of hospitals choose to do so only in rare cases or 

13 not at all. 

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

15 Jackson Women’s Health Organization, the Supreme 

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

17 right to abortion’’. 

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

19 Health and Human Services issued guidance to re20 tail pharmacies in the United States. Such guidance 

21 purported to address their obligations under Federal 

22 nondiscrimination laws, but in actuality orders phar23 macies to stock and dispense abortion pills despite 

24 the fact that pharmacies and pharmacists have a 


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1 right to not violate their conscience by participating 

2 in abortion under existing law. 

3 (14) Conscience protections pose no conflict 

4 with other Federal laws, such as the law requiring 

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

6 her unborn child’’ when either needs emergency care 

7 (Emergency Medical Treatment and Active Labor 

8 Act). As previous Administrations have said, these 

9 areas of law have operated side by side for many 

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

11 Reg. 9968–77 (2011) at 9973). 

12 (15) Reaffirming longstanding Federal policy 

13 on conscience rights and providing a private right of 

14 action in cases where it is violated allows long15 standing and widely supported Federal laws to work 

16 as intended. 

17 SEC. 3. PROHIBITING DISCRIMINATION AGAINST HEALTH 

18 CARE ENTITIES THAT DO NOT PARTICIPATE 

19 IN ABORTION. 

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

21 202 et seq.) is amended by inserting after section 245 the 

22 following: 


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1 ‘‘SEC. 245A. PROHIBITING DISCRIMINATION AGAINST 

2 HEALTH CARE ENTITIES THAT DO NOT PAR3 TICIPATE IN ABORTION. 

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

5 the Federal Government, and any individual or entity that 

6 receives Federal financial assistance, including any State 

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

8 or otherwise discriminate against a health care entity on 

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

10 to— 

11 ‘‘(1) provide, perform, refer for, pay for, or oth12 erwise participate in abortion; 

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

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

15 the activities specified in this subsection. 

16 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec17 tion shall be construed— 

18 ‘‘(1) to prevent any health care entity from vol19 untarily electing to participate in abortions or abor20 tion referrals where not prohibited by any other law; 

21 ‘‘(2) to prevent any health care entity from vol22 untarily electing to provide or sponsor abortion cov23 erage or health benefits coverage that includes abor24 tion where not prohibited by any other law; 

25 ‘‘(3) to prevent an accrediting agency, the Fed26 eral Government, or a State or local government 


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1 from establishing standards of medical competency 

2 applicable only to those who have knowingly, volun3 tarily, and specifically elected to perform abortions, 

4 or from enforcing contractual obligations applicable 

5 only to those who, as part of such contract, know6 ingly, voluntarily, and specifically elect to provide 

7 abortions; 

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

9 law that requires stabilizing treatment for a preg10 nant woman or her unborn child when either needs 

11 emergency care; or 

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

13 for the purpose of regulating insurance, except as 

14 specified in subsection (a). 

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

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

17 term ‘Federal financial assistance’ means Federal 

18 payments to cover the cost of health care services or 

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

20 to promote or otherwise facilitate health-related ac21 tivities. 

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

23 care entity’ includes— 


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

2 assistant, nurse, pharmacist, health researcher, 

3 or other health care personnel; 

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

5 health system, or other health care or medical 

6 research facility or organization (including a 

7 party to a proposed merger or other collabo8 rative arrangement relating to health services, 

9 and an entity resulting therefrom); 

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

11 accountable care organization, or a health 

12 maintenance organization; 

13 ‘‘(D) a social services provider that pro14 vides or authorizes referrals for health care 

15 services; 

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

17 the health professions or medical research, a 

18 participant in such a program, or any individual 

19 applying or otherwise aspiring to participate in 

20 such a program; 

21 ‘‘(F) an issuer of health insurance cov22 erage or of a health plan; 

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


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

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

3 sponsor or administrator thereof; or 

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

5 program, facility, or plan. 

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

7 term ‘State or local government’ includes every 

8 agency and other governmental unit and subdivision 

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

10 government, or any agency or governmental unit or 

11 subdivision thereof, receives Federal financial assist12 ance.’’. 

13 SEC. 4. STRENGTHENING ENFORCEMENT OF FEDERAL 

14 CONSCIENCE LAWS. 

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

16 202 et seq.), as amended by section 3, is further amended 

17 by inserting after section 245A the following: 

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

19 CONSCIENCE LAWS. 

20 ‘‘(a) REGULATIONS.— 

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

22 Secretary may issue regulations under any provision 

23 of law described in paragraph (2). 


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

2 law described in this paragraph are each of the fol3 lowing: 

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

5 520E(f) of this Act. 

6 ‘‘(B) The Religious Freedom Restoration 

7 Act of 1993, with respect to any program or ac8 tivity funded, administered, or conducted by the 

9 Department of Health and Human Services. 

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

11 section 401 of the Health Programs Extension 

12 Act of 1973 (commonly known as the ‘Church 

13 Amendments’), only with respect to an objection 

14 based on a religious belief or moral conviction. 

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

16 Labor, Health and Human Services, and Edu17 cation, and Related Agencies Appropriations 

18 Act, 2023 (division H of the Consolidated Ap19 propriations Act, 2023 (Public Law 117–328)) 

20 (commonly known as the ‘Weldon Amendment’) 

21 and any subsequent substantially similar provi22 sion in an appropriations Act, to the extent ad23 ministered by the Secretary. 

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

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1 cation, and Related Agencies Appropriations 

2 Act, 2023 (division H of the Consolidated Ap3 propriations Act, 2023 (Public Law 117–328)) 

4 and any subsequent substantially similar provi5 sion in an appropriations Act, to the extent ad6 ministered by the Secretary. 

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

8 (1)(A) of section 1303(b) of the Patient Protec9 tion and Affordable Care Act (only with respect 

10 to a determination not to provide coverage of 

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

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

13 Protection and Affordable Care Act (other than 

14 with respect to an exemption as an Indian or a 

15 hardship exemption) and section 

16 5000A(d)(2)(A) of the Internal Revenue Code 

17 of 1986. 

18 ‘‘(H) Section 1553 of the Patient Protec19 tion and Affordable Care Act. 

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

21 1861(e), 1861(y)(1), and 1861(ss) of the Social 

22 Security Act, and the first paragraph of the 

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

24 Act, each of such provisions only with respect 


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1 to protections for religious nonmedical health 

2 care institutions. 

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

4 1902(w)(3), 1902(w)(5), 1907, 

5 1928(c)(2)(B)(ii) (with respect to a religious or 

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

7 of such Act. 

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

9 Budget Reconciliation Act of 1990. 

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

11 Funding Restriction Act of 1997. 

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

13 Prevention and Treatment Act. 

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

15 Leadership Against HIV/AIDS, Tuberculosis, 

16 and Malaria Act of 2003 to the extent adminis17 tered by the Secretary. 

18 ‘‘(O) The third sentence of section 

19 20(a)(5) of the Occupational Safety and Health 

20 Act of 1970. 

21 ‘‘(P) Section 104(f)(1) of the Foreign As22 sistance Act of 1961 (commonly known as the 

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

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1 tions of such section, to the extent administered 

2 by the Secretary. 

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

4 ‘Global Health Programs’ under the heading 

5 ‘Funds Appropriated to the President’ under 

6 title III of the Department of State, Foreign 

7 Operations, and Related Programs Appropria8 tions Act, 2023 (division K of the Consolidated 

9 Appropriations Act, 2023 (Public Law 117– 

10 328)) and any subsequent substantially similar 

11 provision in an appropriations Act to the extent 

12 administered by the Secretary. 

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

14 the exercise of conscience or religious freedom 

15 under programs or activities funded, adminis16 tered, or conducted by the Department of 

17 Health and Human Services. 

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

19 shall designate the Director of the Office for Civil Rights 

20 of the Department of Health and Human Services— 

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

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

23 and 


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

2 issue findings, and require corrective action in cases 

3 of such a violation. 

4 ‘‘(c) ENFORCEMENT.— 

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

6 permitted under law (including the Constitution of 

7 the United States), induce compliance of an indi8 vidual or entity, including a State or local govern9 ment, failing to comply with any provision of law de10 scribed in subsection (a)(2), by terminating, in whole 

11 or in part, any Federal financial assistance provided 

12 by the Secretary to such individual or entity. 

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

14 Secretary determines necessary for inducing compli15 ance with a provision described in paragraph (1), 

16 refer a violation of such a provision to the Attorney 

17 General for a civil action in accordance with section 

18 245C. 

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

20 CONSCIENCE LAWS. 

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

22 action, obtain relief described in subsection (e) with re23 spect to a designated violation. 

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


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1 ‘‘(1) DESIGNATED VIOLATION.—The term ‘des2 ignated violation’ means an actual or threatened vio3 lation of any provision of law described in section 

4 245B(a)(2). 

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

6 party’ means— 

7 ‘‘(A) the Attorney General; or 

8 ‘‘(B) any individual or entity adversely af9 fected by the designated violation without re10 gard to whether such individual or entity is a 

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

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

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

14 may be granted, without regard to whether the party com15 mencing the action has sought or exhausted any available 

16 administrative remedies. 

17 ‘‘(d) DEFENDANTS IN ACTIONS UNDER THIS SEC18 TION MAY INCLUDE GOVERNMENTAL ENTITIES AS WELL

19 AS OTHERS.— 

20 ‘‘(1) IN GENERAL.—An action under this sec21 tion may be maintained against any individual or en22 tity receiving Federal financial assistance (as defined 

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

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1 clude money damages even if the defendant is a gov2 ernmental entity. 

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

4 subsection, the term ‘State governmental entity’ 

5 means a State, a local government within a State, 

6 and any agency or other governmental unit or sub7 division of a State, or of such a local government. 

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

9 section, the court shall grant— 

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

11 relief, declaratory relief, and compensatory damages 

12 to prevent the occurrence, continuance, or repetition 

13 of the designated violation and to compensate for 

14 losses resulting from the designated violation; and 

15 ‘‘(2) to a prevailing plaintiff, reasonable attor16 neys’ fees and litigation costs.’’. 

17 SEC. 5. SEVERABILITY. 

18 If any provision of this Act or an amendment made 

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

20 amendment to any individual, entity, government, or cir21 cumstance, is held to be unconstitutional, the remainder 

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

23 the application of such provision or amendment to any 


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1 other individual, entity, government, or circumstance, 

2 shall not be affected. 

Æ 


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