II 

113TH CONGRESS 

1ST SESSION S. 1204 

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. 

IN THE SENATE OF THE UNITED STATES 

JUNE 20, 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 

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, to 

amend the Public Health Service Act to prohibit certain 

abortion-related discrimination in governmental activities, 

and for other purposes. 

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 ‘‘Health Care Con5 science Rights Act’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds as follows: 

3 (1) As Thomas Jefferson declared to New Lon4 don Methodists in 1809, ‘‘[n]o provision in our Con5 stitution ought to be dearer to man than that which 

6 protects the rights of conscience against the enter7 prises of the civil authority’’. 

8 (2) Jefferson’s conviction on respect for con9 science is deeply embedded in the history and tradi10 tions of our Nation, and codified in numerous Fed11 eral laws approved by congressional majorities and 

12 Presidents of both parties, including in the Public 

13 Health Service Act (42 U.S.C. 201 et seq.); the 

14 United States Leadership Against HIV/AIDS, Tu15 berculosis, and Malaria Act of 2003 (22 U.S.C. 

16 7601 et seq.); the Religious Freedom Restoration 

17 Act of 1993 (42 U.S.C. 2000bb et seq.); long18 standing provisions on respect for conscience rights 

19 in the Federal Employees Health Benefits Program 

20 and District of Columbia appropriations; and laws to 

21 protect individuals from being forced to participate 

22 in Federal executions or prosecutions. 

23 (3) Following enactment of the Patient Protec24 tion and Affordable Care Act (Public Law 111–148, 

25 in this section referred to as ‘‘PPACA’’), the Fed26 eral Government has sought to impose specific reVerDate Mar 15 2010 22:07 Jun 25, 2013 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1204.IS S1204

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1 quirements that infringe on the rights of conscience 

2 of those who offer or purchase health coverage. 

3 (4) While PPACA provides an exemption for 

4 some religious groups that object to participation in 

5 health insurance generally, and exempts millions of 

6 Americans from most of the Act’s provisions, includ7 ing the preventive services mandate, it fails to pro8 vide statutory protection for those seeking to offer 

9 or to purchase health coverage who have a religious 

10 or moral objection only to specific items or services. 

11 (5) Nurses and other health care providers have 

12 increasingly been subjected to discrimination for 

13 abiding by their conscience rather than providing, 

14 paying for, or referring for abortion. 

15 (6) Conscience rights protections for health care 

16 providers are an important part of civil rights pro17 tections in Federal law and are indispensable to the 

18 continued viability of the health care system in the 

19 United States. The increasingly significant discrimi20 nation suffered by faith-based nonprofit health care 

21 providers risks undermining access to high-quality 

22 compassionate care for some of the most vulnerable 

23 populations in our country. 


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1 SEC. 3. APPLYING LONGSTANDING POLICY ON CON2 SCIENCE RIGHTS TO THE AFFORDABLE CARE 

3 ACT. 

4 (a) IN GENERAL.—Title I of the Patient Protection 

5 and Affordable Care Act (Public Law 111–148) is amend6 ed— 

7 (1) by redesignating the second section 1563 

8 (relating to conforming amendments and as redesig9 nated by section 10107(b)(1) of the Patient Protec10 tion and Affordable Care Act) as section 1564; 

11 (2) by redesignating the third section 1563 (re12 lating to the Sense of the Senate promoting fiscal 

13 responsibility) as section 1565; and 

14 (3) by adding at the end the following new sec15 tion: 

16 ‘‘SEC. 1566. RESPECTING CONSCIENCE RIGHTS IN HEALTH 

17 COVERAGE. 

18 ‘‘(a) IN GENERAL.—Notwithstanding any other pro19 vision of this title, no provision of this title (and no amend20 ment made by this title) shall— 

21 ‘‘(1) require an individual to purchase indi22 vidual health insurance coverage that includes cov23 erage of an abortion or other item or service to 

24 which such individual has a moral or religious objec25 tion, or prevent an issuer from offering or issuing, 


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1 to such individual, individual health insurance cov2 erage that excludes such item or service; 

3 ‘‘(2) require a sponsor (or, in the case of health 

4 insurance coverage offered to students through an 

5 institution of higher education, the institution of 

6 higher education offering such coverage) to sponsor, 

7 purchase, or provide any health benefits coverage or 

8 group health plan that includes coverage of an abor9 tion or other item or service to which such sponsor 

10 or institution, respectively, has a moral or religious 

11 objection, or prevent an issuer from offering or 

12 issuing to such sponsor or institution, respectively, 

13 health insurance coverage that excludes such item or 

14 service; 

15 ‘‘(3) require an issuer of health insurance cov16 erage or the sponsor of a group health plan to in17 clude, in any such coverage or plan, coverage of an 

18 abortion or other item or service to which such 

19 issuer or sponsor has a moral or religious objection; 

20 or 

21 ‘‘(4) authorize the imposition of a tax, penalty, 

22 fee, fine, or other sanction, or the imposition of cov23 erage of the item or service to which there is a moral 

24 or religious objection, in relation to health insurance 


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1 coverage or a group health plan that excludes an 

2 item or service pursuant to this section. 

3 ‘‘(b) RESTRICTION ON CONTRARY GOVERNMENTAL

4 ACTION.—No provision in this title (or amendment made 

5 by this title) or law, regulation, guideline or other govern6 mental action that implements such provision or amend7 ment, or derives its authority therefrom, shall be given 

8 legal effect to the extent that it violates this section. 

9 ‘‘(c) NO EFFECT ON OTHER LAWS.—Nothing in this 

10 section shall be construed to preempt, modify, or otherwise 

11 have any effect on— 

12 ‘‘(1) the Civil Rights Act of 1964; 

13 ‘‘(2) the Americans with Disabilities Act of 

14 1990; 

15 ‘‘(3) the Pregnancy Discrimination Act of 1978; 

16 ‘‘(4) the Mental Health Parity Act of 1996; or 

17 ‘‘(5) any other State or Federal law, other than 

18 a provision in this title (or an amendment made by 

19 this title) or a law, regulation, guideline or other 

20 governmental action that implements such provision 

21 or amendment or derives its authority therefrom. 

22 ‘‘(d) AGGREGATE ACTUARIAL VALUE.—Nothing in 

23 this section shall be construed to prohibit the Secretary 

24 from issuing regulations or other guidance to ensure that 

25 health insurance coverage or group health plans excluding 


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1 abortion or other items or services under this section shall 

2 have an aggregate actuarial value at least equivalent to 

3 that of health insurance coverage or group health plans 

4 at the same level of coverage that do not exclude such 

5 items or services. 

6 ‘‘(e) CONTINUED APPLICATION OF NONDISCRIMINA7 TION RULES.—Nothing in this section shall be construed 

8 to permit a health insurance issuer, group health plan, or 

9 other health care provider to act in a manner inconsistent 

10 with subparagraph (B) or (D) of section 1302(b)(4).’’. 

11 (b) CLERICAL AMENDMENT.—The table of contents 

12 of the Patient Protection and Affordable Care Act (Public 

13 Law 111–148) is amended— 

14 (1) by striking the following items: 

‘‘1563. Conforming amendments. 

‘‘1563. Sense of the Senate promoting fiscal responsibility.’’; 

15 and 

16 (2) by inserting after the item relating to the 

17 section 1563 relating to small business procurement 

18 the following items: 

‘‘1564. Conforming amendments. 

‘‘1565. Sense of the Senate promoting fiscal responsibility. 

‘‘1566. Respecting conscience rights in health coverage.’’. 

19 SEC. 4. ABORTION NONDISCRIMINATION FOR HEALTH 

20 CARE PROVIDERS. 

21 Section 245 of the Public Health Service Act (42 

22 U.S.C. 238n) is amended— 


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1 (1) in the section heading, by striking ‘‘AND

2 LICENSING OF PHYSICIANS’’ and inserting ‘‘, LI3 CENSING, AND PRACTICE OF PHYSICIANS AND

4 OTHER HEALTH CARE ENTITIES’’; 

5 (2) in subsection (a), by amending paragraph 

6 (1) to read as follows: 

7 ‘‘(1) the entity refuses— 

8 ‘‘(A) to undergo training in the perform9 ance of induced abortions; 

10 ‘‘(B) to require or provide such training; 

11 ‘‘(C) to perform, participate in, provide 

12 coverage of, or pay for induced abortions; or 

13 ‘‘(D) to provide referrals for such training 

14 or such abortions;’’; 

15 (3) in subsection (b)(1), by striking ‘‘stand16 ards’’ and inserting ‘‘standard’’; 

17 (4) in subsection (c), by amending paragraphs 

18 (1) and (2) to read as follows: 

19 ‘‘(1) The term ‘financial assistance’, with re20 spect to a government program, means governmental 

21 payments to cover the cost of health care services or 

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

23 to promote or otherwise facilitate health-related ac24 tivities. 


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1 ‘‘(2) The term ‘health care entity’ includes an 

2 individual physician or other health professional, a 

3 postgraduate physician training program, a partici4 pant in a program of training in the health profes5 sions, a hospital, a provider-sponsored organization 

6 as defined in section 1855(d) of the Social Security 

7 Act, a health maintenance organization, an account8 able care organization, an issuer of health insurance 

9 coverage, any other kind of health care facility, orga10 nization, or plan, and an entity that provides or au11 thorizes referrals for health care services.’’; 

12 (5) by adding at the end of subsection (c) the 

13 following new paragraph: 

14 ‘‘(4) The term ‘State or local government that 

15 receives Federal financial assistance’ includes any 

16 agency or other governmental unit of a State or 

17 local government if such government receives Fed18 eral financial assistance.’’; 

19 (6) by redesignating subsection (c) as sub20 section (d); and 

21 (7) by inserting after subsection (b) the fol22 lowing new subsection: 

23 ‘‘(c) ADMINISTRATION.—The Secretary shall des24 ignate the Director of the Office for Civil Rights of the 

25 Department of Health and Human Services— 


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

2 this section, section 1566 of the Patient Protection 

3 and Affordable Care Act, or any of subsections (b) 

4 through (e) of section 401 of the Health Programs 

5 Extension Act of 1973; and 

6 ‘‘(2) to pursue the investigation of such com7 plaints, in coordination with the Attorney General.’’. 

8 SEC. 5. REMEDIES FOR VIOLATIONS OF FEDERAL CON9 SCIENCE LAWS. 

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

11 202 et seq.) is amended by inserting after section 245 the 

12 following: 

13 ‘‘SEC. 245A. CIVIL ACTION FOR CERTAIN VIOLATIONS. 

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

15 action, obtain appropriate relief with regard to a des16 ignated violation. 

17 ‘‘(b) DEFINITIONS.—In this section— 

18 ‘‘(1) the term ‘qualified party’ means— 

19 ‘‘(A) the Attorney General; or 

20 ‘‘(B) any person or entity adversely af21 fected by the designated violation; and 

22 ‘‘(2) the term ‘designated violation’ means an 

23 actual or threatened violation of section 245 of this 

24 Act, section 1566 of the Patient Protection and Af25 fordable Care Act, or any of subsections (b) through 


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1 (e) of section 401 of the Health Programs Extension 

2 Act of 1973. 

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

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

5 may be granted, without regard to whether the party com6 mencing the action has sought or exhausted available ad7 ministrative remedies. 

8 ‘‘(d) DEFENDANTS IN ACTIONS UNDER THIS SEC9 TION MAY INCLUDE GOVERNMENTAL ENTITIES AS WELL

10 AS OTHERS.— 

11 ‘‘(1) IN GENERAL.—An action under this sec12 tion may be maintained against, among others, a 

13 party that is a Federal or State governmental entity. 

14 Relief in an action under this section may include 

15 money damages even if the defendant is such a gov16 ernmental entity. 

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

18 subsection, the term ‘State governmental entity’ 

19 means a State, a local government within a State, 

20 or any agency or other governmental unit or author21 ity of a State or of such a local government. 

22 ‘‘(e) NATURE OF RELIEF.—The court shall grant— 

23 ‘‘(1) all necessary equitable and legal relief, in24 cluding, where appropriate, declaratory relief and 

25 compensatory damages, to prevent the occurrence, 


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1 continuance, or repetition of the designated violation 

2 and to compensate for losses resulting from the des3 ignated violation; and 

4 ‘‘(2) to a prevailing plaintiff, reasonable attor5 neys’ fees and litigation expenses as part of the 

6 costs.’’. 

Æ 


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