II 

114TH CONGRESS 

1ST SESSION S. 1919 

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 

AUGUST 4, 2015 

Mr. LANKFORD (for himself, Mr. PORTMAN, Mr. MCCAIN, Mr. INHOFE, Mr. 

CASSIDY, Mr. CRUZ, Mr. BLUNT, Mr. BOOZMAN, Mr. CORKER, Mr. 

COATS, Mr. DAINES, Mr. SASSE, Mr. ISAKSON, and Mr. MORAN) 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Health Care Con3 science Rights Act’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds the following: 

6 (1) As Thomas Jefferson declared to New Lon7 don Methodists in 1809, ‘‘[n]o provision in our Con8 stitution ought to be dearer to man than that which 

9 protects the rights of conscience against the enter10 prises of the civil authority’’. 

11 (2) Jefferson’s conviction on respect for con12 science is deeply embedded in the history and tradi13 tions of our Nation, and codified in numerous Fed14 eral laws approved by congressional majorities and 

15 Presidents of both parties, including in the Public 

16 Health Service Act; the United States Leadership 

17 Against HIV/AIDS, Tuberculosis, and Malaria Act; 

18 the Religious Freedom Restoration Act; long19 standing provisions on respect for conscience rights 

20 in the Federal Employees Health Benefits Program 

21 and District of Columbia appropriations; and laws to 

22 protect individuals from being forced to participate 

23 in Federal executions or prosecutions. 

24 (3) Following enactment of the Patient Protec25 tion and Affordable Care Act (Public Law 111–148, 

26 in this section referred to as ‘‘PPACA’’), the FedVerDate Sep 11 2014 06:08 Aug 05, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1919.IS S1919

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1 eral Government has sought to impose specific re2 quirements that infringe on the rights of conscience 

3 of those who offer or purchase health coverage. 

4 (4) While PPACA provides an exemption for 

5 some religious groups that object to participation in 

6 health insurance generally, and exempts millions of 

7 Americans from most of the Act’s provisions, includ8 ing the preventive services mandate, it fails to pro9 vide statutory protection for those seeking to offer 

10 and purchase health coverage who have a religious 

11 or moral objection only to specific items or services. 

12 (5) Nurses and other health care providers have 

13 increasingly been subjected to discrimination for 

14 abiding by their conscience rather than providing, 

15 paying for, or referring for abortion. 

16 (6) Conscience rights protections for health care 

17 providers are an important part of civil rights pro18 tections in Federal law and are indispensable to the 

19 continued viability of the health care system in the 

20 United States. The increasingly significant discrimi21 nation suffered by faith-based nonprofit health care 

22 providers risks undermining access to high-quality 

23 compassionate care for some of the most vulnerable 

24 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 re13 sponsibility) 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 any such provision) 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 such provision) or law, regulation, guideline or other 

6 governmental action that implements such provision or 

7 amendment, or derives its authority therefrom, shall be 

8 given 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; 

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 such provision) or a law, regulation, guideline, or 

20 other governmental action that implements such pro21 vision or amendment or derives its authority there22 from. 

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

24 this section shall be construed to prohibit the Secretary 

25 from issuing regulations or other guidance to ensure that 


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1 health insurance coverage or group health plans excluding 

2 abortion or other items or services under this section shall 

3 have an aggregate actuarial value at least equivalent to 

4 that of health insurance coverage or group health plans 

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

6 items or services. 

7 ‘‘(e) CONTINUED APPLICATION OF NONDISCRIMINA8 TION RULES.—Nothing in this section shall be construed 

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

10 other health care provider to act in a manner inconsistent 

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

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

13 of the Patient Protection and Affordable Care Act (Public 

14 Law 111–148) is amended— 

15 (1) by striking the following items: 

‘‘1562. Conforming amendments. 

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

16 and 

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

18 section 1561 relating to health information tech19 nology enrollment standards and protocols the fol20 lowing items: 

‘‘1562. GAO study regarding the rate of denial of coverage and enrollment by 

health insurance issuers and group health plans. 

‘‘1563. Small business procurement. 

‘‘1564. Conforming amendments. 

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

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


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1 SEC. 4. ABORTION NONDISCRIMINATION FOR HEALTH 

2 CARE PROVIDERS. 

3 Section 245 of the Public Health Service Act (42 

4 U.S.C. 238n) is amended— 

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

6 LICENSING OF PHYSICIANS’’ and inserting ‘‘, LI7 CENSING, AND PRACTICE OF PHYSICIANS AND

8 OTHER HEALTH CARE ENTITIES’’; 

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

10 (1) to read as follows: 

11 ‘‘(1) the entity refuses— 

12 ‘‘(A) to undergo training in the perform13 ance of induced abortions; 

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

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

16 coverage of, or pay for induced abortions; or 

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

18 or such abortions;’’; 

19 (3) in subsection (b)(1), by striking ‘‘stand20 ards’’ and inserting ‘‘standard’’; 

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

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

23 ‘‘(1) The term ‘financial assistance’, with re24 spect to a government program, means governmental 

25 payments to cover the cost of health care services or 

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


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1 to promote or otherwise facilitate health-related ac2 tivities. 

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

4 individual physician or other health professional, a 

5 postgraduate physician training program, a partici6 pant in a program of training in the health profes7 sions, a hospital, a provider-sponsored organization 

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

9 Act, a health maintenance organization, an account10 able care organization, an issuer of health insurance 

11 coverage, any other kind of health care facility, orga12 nization, or plan, and an entity that provides or au13 thorizes referrals for health care services.’’; 

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

15 following new paragraph: 

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

17 receives Federal financial assistance’ includes any 

18 agency or other governmental unit of a State or 

19 local government if such government receives Fed20 eral financial assistance.’’; 

21 (6) by redesignating subsection (c) as sub22 section (d); and 

23 (7) by inserting after subsection (b) the fol24 lowing new subsection: 


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1 ‘‘(c) ADMINISTRATION.—The Secretary shall des2 ignate the Director of the Office for Civil Rights of the 

3 Department of Health and Human Services— 

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

5 this section, section 1566 of the Patient Protection 

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

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

8 Extension Act of 1973; and 

9 ‘‘(2) to pursue the investigation of such com10 plaints, in coordination with the Attorney General.’’. 

11 SEC. 5. REMEDIES FOR VIOLATIONS OF FEDERAL CON12 SCIENCE LAWS. 

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

14 202 et seq.) is amended by inserting after section 245 the 

15 following: 

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

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

18 action, obtain appropriate relief with regard to a des19 ignated violation. 

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

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

22 ‘‘(A) the Attorney General; or 

23 ‘‘(B) any person or entity adversely af24 fected by the designated violation; and 


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

2 actual or threatened violation of section 245 of this 

3 Act, section 1566 of the Patient Protection and Af4 fordable Care Act, or any of subsections (b) through 

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

6 Act of 1973. 

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

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

9 may be granted, without regard to whether the party com10 mencing the action has sought or exhausted available ad11 ministrative remedies. 

12 ‘‘(d) DEFENDANTS IN ACTIONS UNDER THIS SEC13 TION MAY INCLUDE GOVERNMENTAL ENTITIES AS WELL

14 AS OTHERS.— 

15 ‘‘(1) IN GENERAL.—An action under this sec16 tion may be maintained against, among others, a 

17 party that is a Federal or State governmental entity. 

18 Relief in an action under this section may include 

19 money damages even if the defendant is such a gov20 ernmental entity. 

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

22 subsection, the term ‘State governmental entity’ 

23 means a State, a local government within a State, 

24 or any agency or other governmental unit or author25 ity of a State or of such a local government. 


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

2 ‘‘(1) all necessary equitable and legal relief, in3 cluding, where appropriate, declaratory relief and 

4 compensatory damages, to prevent the occurrence, 

5 continuance, or repetition of the designated violation 

6 and to compensate for losses resulting from the des7 ignated violation; and 

8 ‘‘(2) to a prevailing plaintiff, reasonable attor9 neys’ fees and litigation expenses as part of the 

10 costs.’’. 

Æ 


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