II 

112TH CONGRESS 

1ST SESSION S. 1467 

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. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 2, 2011 

Mr. BLUNT (for himself, Mr. RUBIO, and Ms. AYOTTE) 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. 

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 ‘‘Respect for Rights of 

5 Conscience Act of 2011’’. 

6 SEC. 2. FINDINGS AND PURPOSES. 

7 (a) FINDINGS.—Congress finds the following: 

8 (1) As Thomas Jefferson declared to New Lon9 don Methodists in 1809, ‘‘[n]o provision in our ConVerDate Mar 15 2010 03:06 Aug 04, 2011 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1467.IS S1467

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1 stitution ought to be dearer to man than that which 

2 protects the rights of conscience against the enter3 prises of the civil authority’’. 

4 (2) Jefferson’s statement expresses a conviction 

5 on respect for conscience that is deeply embedded in 

6 the history and traditions of our Nation and codified 

7 in numerous State and Federal laws, including laws 

8 on health care. 

9 (3) Until enactment of the Patient Protection 

10 and Affordable Care Act (Public Law 111–148, in 

11 this section referred to as ‘‘PPACA’’), the Federal 

12 Government has not sought to impose specific cov13 erage or care requirements that infringe on the 

14 rights of conscience of insurers, purchasers of insur15 ance, plan sponsors, beneficiaries, and other stake16 holders, such as individual or institutional health 

17 care providers. 

18 (4) PPACA creates a new nationwide require19 ment for health plans to cover ‘‘essential health ben20 efits’’ and ‘‘preventive services’’ (including a distinct 

21 set of ‘‘preventive services for women’’), delegating 

22 to the Department of Health and Human Services 

23 the authority to provide a list of detailed services 

24 under each category, and imposes other new requireVerDate Mar 15 2010 03:06 Aug 04, 2011 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1467.IS S1467

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1 ments with respect to the provision of health care 

2 services. 

3 (5) While PPACA provides an exemption for 

4 some religious groups that object to participation in 

5 Government health programs generally, it does not 

6 allow purchasers, plan sponsors, and other stake7 holders with religious or moral objections to specific 

8 items or services to decline providing or obtaining 

9 coverage of such items or services, or allow health 

10 care providers with such objections to decline to pro11 vide them. 

12 (6) By creating new barriers to health insur13 ance and causing the loss of existing insurance ar14 rangements, these inflexible mandates in PPACA 

15 jeopardize the ability of individuals to exercise their 

16 rights of conscience and their ability to freely par17 ticipate in the health insurance and health care mar18 ketplace. 

19 (b) PURPOSES.—The purposes of this Act are— 

20 (1) to ensure that health care stakeholders re21 tain the right to provide, purchase, or enroll in 

22 health coverage that is consistent with their religious 

23 beliefs and moral convictions, without fear of being 

24 penalized or discriminated against under PPACA; 

25 and 


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1 (2) to ensure that no requirement in PPACA 

2 creates new pressures to exclude those exercising 

3 such conscientious objection from health plans or 

4 other programs under PPACA. 

5 SEC. 3. RESPECT FOR RIGHTS OF CONSCIENCE. 

6 (a) IN GENERAL.—Section 1302(b) of the Patient 

7 Protection and Affordable Care Act (Public Law 111–148; 

8 42 U.S.C. 18022(b)) is amended by adding at the end the 

9 following new paragraph: 

10 ‘‘(6) RESPECTING RIGHTS OF CONSCIENCE

11 WITH REGARD TO SPECIFIC ITEMS OR SERVICES.— 

12 ‘‘(A) FOR HEALTH PLANS.—A health plan 

13 shall not be considered to have failed to provide 

14 the essential health benefits package described 

15 in subsection (a) (or preventive health services 

16 described in section 2713 of the Public Health 

17 Service Act), to fail to be a qualified health 

18 plan, or to fail to fulfill any other requirement 

19 under this title on the basis that it declines to 

20 provide coverage of specific items or services be21 cause— 

22 ‘‘(i) providing coverage (or, in the 

23 case of a sponsor of a group health plan, 

24 paying for coverage) of such specific items 

25 or services is contrary to the religious beVerDate Mar 15 2010 03:06 Aug 04, 2011 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1467.IS S1467

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1 liefs or moral convictions of the sponsor, 

2 issuer, or other entity offering the plan; or 

3 ‘‘(ii) such coverage (in the case of in4 dividual coverage) is contrary to the reli5 gious beliefs or moral convictions of the 

6 purchaser or beneficiary of the coverage. 

7 ‘‘(B) FOR HEALTH CARE PROVIDERS.— 

8 Nothing in this title (or any amendment made 

9 by this title) shall be construed to require an 

10 individual or institutional health care provider, 

11 or authorize a health plan to require a provider, 

12 to provide, participate in, or refer for a specific 

13 item or service contrary to the provider’s reli14 gious beliefs or moral convictions. Notwith15 standing any other provision of this title, a 

16 health plan shall not be considered to have 

17 failed to provide timely or other access to items 

18 or services under this title (or any amendment 

19 made by this title) or to fulfill any other re20 quirement under this title because it has re21 spected the rights of conscience of such a pro22 vider pursuant to this paragraph. 

23 ‘‘(C) NONDISCRIMINATION IN EXERCISING

24 RIGHTS OF CONSCIENCE.—No Exchange or 

25 other official or entity acting in a governmental 


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1 capacity in the course of implementing this title 

2 (or any amendment made by this title) shall 

3 discriminate against a health plan, plan spon4 sor, health care provider, or other person be5 cause of such plan’s, sponsor’s, provider’s, or 

6 person’s unwillingness to provide coverage of, 

7 participate in, or refer for, specific items or 

8 services pursuant to this paragraph. 

9 ‘‘(D) CONSTRUCTION.—Nothing in sub10 paragraph (A) or (B) shall be construed to per11 mit a health plan or provider to discriminate in 

12 a manner inconsistent with subparagraphs (B) 

13 and (D) of paragraph (4). 

14 ‘‘(E) PRIVATE RIGHTS OF ACTION.—The 

15 various protections of conscience in this para16 graph constitute the protection of individual 

17 rights and create a private cause of action for 

18 those persons or entities protected. Any person 

19 or entity may assert a violation of this para20 graph as a claim or defense in a judicial pro21 ceeding. 

22 ‘‘(F) REMEDIES.— 

23 ‘‘(i) FEDERAL JURISDICTION.—The 

24 Federal courts shall have jurisdiction to 

25 prevent and redress actual or threatened 


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1 violations of this paragraph by granting all 

2 forms of legal or equitable relief, including, 

3 but not limited to, injunctive relief, declar4 atory relief, damages, costs, and attorney 

5 fees. 

6 ‘‘(ii) INITIATING PARTY.—An action 

7 under this paragraph may be instituted by 

8 the Attorney General of the United States, 

9 or by any person or entity having standing 

10 to complain of a threatened or actual viola11 tion of this paragraph, including, but not 

12 limited to, any actual or prospective plan 

13 sponsor, issuer, or other entity offering a 

14 plan, any actual or prospective purchaser 

15 or beneficiary of a plan, and any individual 

16 or institutional health care provider. 

17 ‘‘(iii) INTERIM RELIEF.—Pending 

18 final determination of any action under 

19 this paragraph, the court may at any time 

20 enter such restraining order or prohibi21 tions, or take such other actions, as it 

22 deems necessary. 

23 ‘‘(G) ADMINISTRATION.—The Office for 

24 Civil Rights of the Department of Health and 

25 Human Services is designated to receive comVerDate Mar 15 2010 03:06 Aug 04, 2011 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1467.IS S1467

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1 plaints of discrimination based on this para2 graph and coordinate the investigation of such 

3 complaints. 

4 ‘‘(H) ACTUARIAL EQUIVALENCE.—Nothing 

5 in this paragraph shall prohibit the Secretary 

6 from issuing regulations or other guidance to 

7 ensure that health plans excluding specific 

8 items or services under this paragraph shall 

9 have an aggregate actuarial value at least 

10 equivalent to that of plans at the same level of 

11 coverage that do not exclude such items or serv12 ices.’’. 

13 (b) EFFECTIVE DATE.—The amendment made by 

14 subsection (a) shall be effective as if included in the enact15 ment of Public Law 111–148. 

Æ 


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