I 

113TH CONGRESS 

1ST SESSION H. R. 940 

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 HOUSE OF REPRESENTATIVES 

MARCH 4, 2013 

Mrs. BLACK (for herself, Mr. FLEMING, Mr. FORTENBERRY, Mr. DAINES, Mr. 

BOUSTANY, Mr. JONES, Mr. CASSIDY, Mr. ROGERS of Alabama, Mr. 

NUNNELEE, Mr. LIPINSKI, Mr. HULTGREN, Mr. BONNER, Mr. CRAMER, 

Mr. BROUN of Georgia, Mr. JOHNSON of Ohio, Mr. WALBERG, Mr. 

TIBERI, Mr. KELLY, Mr. NEUGEBAUER, Mr. FLORES, Mrs. ELLMERS, 

Mr. GINGREY of Georgia, Mr. POMPEO, Mr. ROE of Tennessee, Mr. KING

of Iowa, Mr. MURPHY of Pennsylvania, Mr. BENTIVOLIO, Ms. FOXX, Mr. 

RODNEY DAVIS of Illinois, Mr. WILSON of South Carolina, Mr. POE of 

Texas, Mr. FINCHER, Mr. WESTMORELAND, Mr. GRAVES of Georgia, Mr. 

BACHUS, Mr. BARLETTA, Mr. JORDAN, Mrs. WAGNER, Mr. BENISHEK, 

Mrs. BLACKBURN, Mr. WENSTRUP, Mr. SOUTHERLAND, Mr. 

SCHWEIKERT, Mr. HUELSKAMP, Mr. HARRIS, Mrs. HARTZLER, Mr. MILLER of Florida, Mr. SMITH of New Jersey, Mr. ROSKAM, Mr. PEARCE, 

and Mrs. WALORSKI) introduced the following bill; which was referred to 

the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jurisdiction of the committee concerned 

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 

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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’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

8 (1) As Thomas Jefferson declared to New Lon9 don Methodists in 1809, ‘‘[n]o provision in our Con10 stitution ought to be dearer to man than that which 

11 protects the rights of conscience against the enter12 prises of the civil authority’’. 

13 (2) Jefferson’s conviction on respect for con14 science is deeply embedded in the history and tradi15 tions of our Nation, and codified in numerous Fed16 eral laws approved by congressional majorities and 

17 Presidents of both parties, including in the Public 

18 Health Service Act; the United States Leadership 

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

20 the Religious Freedom Restoration Act; long21 standing provisions on respect for conscience rights 

22 in the Federal Employees Health Benefits Program 

23 and District of Columbia appropriations; and laws to 

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1 protect individuals from being forced to participate 

2 in Federal executions or prosecutions. 

3 (3) Following enactment of the Patient Protec4 tion and Affordable Care Act (Public Law 111–148, 

5 in this section referred to as ‘‘PPACA’’), the Fed6 eral Government has sought to impose specific re7 quirements that infringe on the rights of conscience 

8 of those who offer or purchase health coverage. 

9 (4) While PPACA provides an exemption for 

10 some religious groups that object to participation in 

11 health insurance generally, and exempts millions of 

12 Americans from most of the Act’s provisions, includ13 ing the preventive services mandate, it fails to pro14 vide statutory protection for those seeking to offer 

15 and purchase health coverage who have a religious 

16 or moral objection only to specific items or services. 

17 (5) Nurses and other health care providers have 

18 increasingly been subjected to discrimination for 

19 abiding by their conscience rather than providing, 

20 paying for, or referring for abortion. 

21 (6) Conscience rights protections for health care 

22 providers are an important part of civil rights pro23 tections in Federal law and are indispensable to the 

24 continued viability of the health care system in the 

25 United States. The increasingly significant discrimimstockstill on DSK4VPTVN1PROD with BILLS

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1 nation suffered by faith-based nonprofit health care 

2 providers risks undermining access to high-quality 

3 compassionate care for some of the most vulnerable 

4 populations in our country. 

5 SEC. 3. APPLYING LONGSTANDING POLICY ON CON6 SCIENCE RIGHTS TO THE AFFORDABLE CARE 

7 ACT. 

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

9 and Affordable Care Act (Public Law 111–148) is amend10 ed— 

11 (1) by redesignating the second section 1563 

12 (relating to conforming amendments and as redesig13 nated by section 10107(b)(1) of the Patient Protec14 tion and Affordable Care Act) as section 1564; 

15 (2) by redesignating the third section 1563 (re16 lating to the Sense of the Senate promoting fiscal 

17 responsibility) as section 1565; and 

18 (3) by adding at the end the following new sec19 tion: 

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

21 COVERAGE. 

22 ‘‘(a) IN GENERAL.—Notwithstanding any other pro23 vision of this title, no provision of this title (and no amend24 ment made by any such provision) shall— 

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1 ‘‘(1) require an individual to purchase indi2 vidual health insurance coverage that includes cov3 erage of an abortion or other item or service to 

4 which such individual has a moral or religious objec5 tion, or prevent an issuer from offering or issuing, 

6 to such individual, individual health insurance cov7 erage that excludes such item or service; 

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

9 insurance coverage offered to students through an 

10 institution of higher education, the institution of 

11 higher education offering such coverage) to sponsor, 

12 purchase, or provide any health benefits coverage or 

13 group health plan that includes coverage of an abor14 tion or other item or service to which such sponsor 

15 or institution, respectively, has a moral or religious 

16 objection, or prevent an issuer from offering or 

17 issuing to such sponsor or institution, respectively, 

18 health insurance coverage that excludes such item or 

19 service; 

20 ‘‘(3) require an issuer of health insurance cov21 erage or the sponsor of a group health plan to in22 clude, in any such coverage or plan, coverage of an 

23 abortion or other item or service to which such 

24 issuer or sponsor has a moral or religious objection; 

25 or 

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

2 fee, fine, or other sanction, or the imposition of cov3 erage of the item or service to which there is a moral 

4 or religious objection, in relation to health insurance 

5 coverage or a group health plan that excludes an 

6 item or service pursuant to this section. 

7 ‘‘(b) RESTRICTION ON CONTRARY GOVERNMENTAL

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

9 by such provision) or law, regulation, guideline or other 

10 governmental action that implements such provision or 

11 amendment, or derives its authority therefrom, shall be 

12 given legal effect to the extent that it violates this section. 

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

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

15 have any effect on— 

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

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

18 1990; 

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

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

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

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

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

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1 vision or amendment or derives its authority there2 from. 

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

4 this section shall be construed to prohibit the Secretary 

5 from issuing regulations or other guidance to ensure that 

6 health insurance coverage or group health plans excluding 

7 abortion or other items or services under this section shall 

8 have an aggregate actuarial value at least equivalent to 

9 that of health insurance coverage or group health plans 

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

11 items or services. 

12 ‘‘(e) CONTINUED APPLICATION OF NONDISCRIMINA13 TION RULES.—Nothing in this section shall be construed 

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

15 other health care provider to act in a manner inconsistent 

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

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

18 of the Patient Protection and Affordable Care Act (Public 

19 Law 111–148) is amended— 

20 (1) by striking the following items: 

‘‘1563. Conforming amendments. 

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

21 and 

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

23 section 1563 relating to small business procurement 

24 the following items: 

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‘‘1564. Conforming amendments. 

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

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

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 

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1 payments to cover the cost of health care services or 

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

3 to promote or otherwise facilitate health-related ac4 tivities. 

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

6 individual physician or other health professional, a 

7 postgraduate physician training program, a partici8 pant in a program of training in the health profes9 sions, a hospital, a provider-sponsored organization 

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

11 Act, a health maintenance organization, an account12 able care organization, an issuer of health insurance 

13 coverage, any other kind of health care facility, orga14 nization, or plan, and an entity that provides or au15 thorizes referrals for health care services.’’; 

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

17 following new paragraph: 

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

19 receives Federal financial assistance’ includes any 

20 agency or other governmental unit of a State or 

21 local government if such government receives Fed22 eral financial assistance.’’; 

23 (6) by redesignating subsection (c) as sub24 section (d); and 

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1 (7) by inserting after subsection (b) the fol2 lowing new subsection: 

3 ‘‘(c) ADMINISTRATION.—The Secretary shall des4 ignate the Director of the Office for Civil Rights of the 

5 Department of Health and Human Services— 

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

7 this section, section 1566 of the Patient Protection 

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

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

10 Extension Act of 1973; and 

11 ‘‘(2) to pursue the investigation of such com12 plaints, in coordination with the Attorney General.’’. 

13 SEC. 5. REMEDIES FOR VIOLATIONS OF FEDERAL CON14 SCIENCE LAWS. 

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

16 202 et seq.) is amended by inserting after section 245 the 

17 following: 

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

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

20 action, obtain appropriate relief with regard to a des21 ignated violation. 

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

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

24 ‘‘(A) the Attorney General; or 

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1 ‘‘(B) any person or entity adversely af2 fected by the designated violation; and 

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

4 actual or threatened violation of section 245 of this 

5 Act, section 1566 of the Patient Protection and Af6 fordable Care Act, or any of subsections (b) through 

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

8 Act of 1973. 

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

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

11 may be granted, without regard to whether the party com12 mencing the action has sought or exhausted available ad13 ministrative remedies. 

14 ‘‘(d) DEFENDANTS IN ACTIONS UNDER THIS SEC15 TION MAY INCLUDE GOVERNMENTAL ENTITIES AS WELL

16 AS OTHERS.— 

17 ‘‘(1) IN GENERAL.—An action under this sec18 tion may be maintained against, among others, a 

19 party that is a Federal or State governmental entity. 

20 Relief in an action under this section may include 

21 money damages even if the defendant is such a gov22 ernmental entity. 

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

24 subsection, the term ‘State governmental entity’ 

25 means a State, a local government within a State, 

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1 or any agency or other governmental unit or author2 ity of a State or of such a local government. 

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

4 ‘‘(1) all necessary equitable and legal relief, in5 cluding, where appropriate, declaratory relief and 

6 compensatory damages, to prevent the occurrence, 

7 continuance, or repetition of the designated violation 

8 and to compensate for losses resulting from the des9 ignated violation; and 

10 ‘‘(2) to a prevailing plaintiff, reasonable attor11 neys’ fees and litigation expenses as part of the 

12 costs.’’. 

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