I 

112TH CONGRESS 

1ST SESSION H. R. 1179 

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 HOUSE OF REPRESENTATIVES 

MARCH 17, 2011 

Mr. FORTENBERRY (for himself, Mr. BOREN, Mrs. MCMORRIS RODGERS, Mr. 

SCALISE, Mr. TIBERI, Mr. CONAWAY, Mr. LAMBORN, Mr. WALBERG, and 

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

Committee on Energy and Commerce 

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: 


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1 (1) As Thomas Jefferson declared to New Lon2 don Methodists in 1809, ‘‘[n]o provision in our Con3 stitution ought to be dearer to man than that which 

4 protects the rights of conscience against the enter5 prises of the civil authority’’. 

6 (2) Jefferson’s statement expresses a conviction 

7 on respect for conscience that is deeply embedded in 

8 the history and traditions of our Nation and codified 

9 in numerous State and Federal laws, including laws 

10 on health care. 

11 (3) Until enactment of the Patient Protection 

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

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

14 Government has not sought to impose specific cov15 erage or care requirements that infringe on the 

16 rights of conscience of insurers, purchasers of insur17 ance, plan sponsors, beneficiaries, and other stake18 holders, such as individual or institutional health 

19 care providers. 

20 (4) PPACA creates a new nationwide require21 ment for health plans to cover ‘‘essential health ben22 efits’’ and ‘‘preventive services’’ (including a distinct 

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

24 to the Department of Health and Human Services 

25 the authority to provide a list of detailed services 


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1 under each category, and imposes other new require2 ments with respect to the provision of health care 

3 services. 

4 (5) While PPACA provides an exemption for 

5 some religious groups that object to participation in 

6 Government health programs generally, it does not 

7 allow purchasers, plan sponsors, and other stake8 holders with religious or moral objections to specific 

9 items or services to decline providing or obtaining 

10 coverage of such items or services, or allow health 

11 care providers with such objections to decline to pro12 vide them. 

13 (6) By creating new barriers to health insur14 ance and causing the loss of existing insurance ar15 rangements, these inflexible mandates in PPACA 

16 jeopardize the ability of individuals to exercise their 

17 rights of conscience and their ability to freely par18 ticipate in the health insurance and health care mar19 ketplace. 

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

21 (1) to ensure that health care stakeholders re22 tain the right to provide, purchase, or enroll in 

23 health coverage that is consistent with their religious 

24 beliefs and moral convictions, without fear of being 


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1 penalized or discriminated against under PPACA; 

2 and 

3 (2) to ensure that no requirement in PPACA 

4 creates new pressures to exclude those exercising 

5 such conscientious objection from health plans or 

6 other programs under PPACA. 

7 SEC. 3. RESPECT FOR RIGHTS OF CONSCIENCE. 

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

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

10 42 U.S.C. 18022(b)) is amended by adding at the end the 

11 following new paragraph: 

12 ‘‘(6) RESPECTING RIGHTS OF CONSCIENCE

13 WITH REGARD TO SPECIFIC ITEMS OR SERVICES.— 

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

15 shall not be considered to have failed to provide 

16 the essential health benefits package described 

17 in subsection (a) (or preventive health services 

18 described in section 2713 of the Public Health 

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

20 plan, or to fail to fulfill any other requirement 

21 under this title on the basis that it declines to 

22 provide coverage of specific items or services be23 cause— 

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

25 case of a sponsor of a group health plan, 


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1 paying for coverage) of such specific items 

2 or services is contrary to the religious be3 liefs or moral convictions of the sponsor, 

4 issuer, or other entity offering the plan; or 

5 ‘‘(ii) such coverage (in the case of in6 dividual coverage) is contrary to the reli7 gious beliefs or moral convictions of the 

8 purchaser or beneficiary of the coverage. 

9 ‘‘(B) FOR HEALTH CARE PROVIDERS.— 

10 Nothing in this title (or any amendment made 

11 by this title) shall be construed to require an 

12 individual or institutional health care provider, 

13 or authorize a health plan to require a provider, 

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

15 item or service contrary to the provider’s reli16 gious beliefs or moral convictions. Notwith17 standing any other provision of this title, a 

18 health plan shall not be considered to have 

19 failed to provide timely or other access to items 

20 or services under this title (or any amendment 

21 made by this title) or to fulfill any other re22 quirement under this title because it has re23 spected the rights of conscience of such a pro24 vider pursuant to this paragraph. 


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1 ‘‘(C) NONDISCRIMINATION IN EXERCISING

2 RIGHTS OF CONSCIENCE.—No Exchange or 

3 other official or entity acting in a governmental 

4 capacity in the course of implementing this title 

5 (or any amendment made by this title) shall 

6 discriminate against a health plan, plan spon7 sor, health care provider, or other person be8 cause of such plan’s, sponsor’s, provider’s, or 

9 person’s unwillingness to provide coverage of, 

10 participate in, or refer for, specific items or 

11 services pursuant to this paragraph. 

12 ‘‘(D) CONSTRUCTION.—Nothing in sub13 paragraph (A) or (B) shall be construed to per14 mit a health plan or provider to discriminate in 

15 a manner inconsistent with subparagraphs (B) 

16 and (D) of paragraph (4). 

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

18 various protections of conscience in this para19 graph constitute the protection of individual 

20 rights and create a private cause of action for 

21 those persons or entities protected. Any person 

22 or entity may assert a violation of this para23 graph as a claim or defense in a judicial pro24 ceeding. 

25 ‘‘(F) REMEDIES.— 


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1 ‘‘(i) FEDERAL JURISDICTION.—The 

2 Federal courts shall have jurisdiction to 

3 prevent and redress actual or threatened 

4 violations of this paragraph by granting all 

5 forms of legal or equitable relief, including, 

6 but not limited to, injunctive relief, declar7 atory relief, damages, costs, and attorney 

8 fees. 

9 ‘‘(ii) INITIATING PARTY.—An action 

10 under this paragraph may be instituted by 

11 the Attorney General of the United States, 

12 or by any person or entity having standing 

13 to complain of a threatened or actual viola14 tion of this paragraph, including, but not 

15 limited to, any actual or prospective plan 

16 sponsor, issuer, or other entity offering a 

17 plan, any actual or prospective purchaser 

18 or beneficiary of a plan, and any individual 

19 or institutional health care provider. 

20 ‘‘(iii) INTERIM RELIEF.—Pending 

21 final determination of any action under 

22 this paragraph, the court may at any time 

23 enter such restraining order or prohibi24 tions, or take such other actions, as it 

25 deems necessary. 


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

2 Civil Rights of the Department of Health and 

3 Human Services is designated to receive com4 plaints of discrimination based on this para5 graph and coordinate the investigation of such 

6 complaints. 

7 ‘‘(H) ACTUARIAL EQUIVALENCE.—Nothing 

8 in this paragraph shall prohibit the Secretary 

9 from issuing regulations or other guidance to 

10 ensure that health plans excluding specific 

11 items or services under this paragraph shall 

12 have an aggregate actuarial value at least 

13 equivalent to that of plans at the same level of 

14 coverage that do not exclude such items or serv15 ices.’’. 

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

17 subsection (a) shall be effective as if included in the enact18 ment of Public Law 111–148. 

Æ 


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