II 

116TH CONGRESS 

1ST SESSION S. 183 

To amend the Public Health Service Act to prohibit governmental discrimination against providers of health services that are not involved in abortion. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 17, 2019 

Mr. LANKFORD (for himself, Mr. BARRASSO, Mr. RISCH, Mr. PORTMAN, Mr. 

HOEVEN, Mr. SASSE, Mr. MORAN, Mrs. HYDE-SMITH, Mr. CRAMER, Mr. 

KENNEDY, Mr. ENZI, Mrs. BLACKBURN, Mr. TILLIS, Mr. CASSIDY, Mr. 

BLUNT, Mr. INHOFE, Mr. SCOTT of South Carolina, Mr. ROBERTS, Ms. 

ERNST, and Mr. DAINES) introduced the following bill; which was read 

twice and referred to the Committee on Health, Education, Labor, and 

Pensions 

A BILL 

To amend the Public Health Service Act to prohibit governmental discrimination against providers of health services 

that are not involved in abortion. 

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 ‘‘Conscience Protection 

5 Act of 2019’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds as follows: 


pamtmann on DSKBFK8HB2PROD with BILLS
2 

•S 183 IS

1 (1) Thomas Jefferson stated a conviction com2 mon to our Nation’s founders when he declared in 

3 1809 that ‘‘[n]o provision in our Constitution ought 

4 to be dearer to man than that which protects the 

5 rights of conscience against the enterprises of the 

6 civil authority’’. 

7 (2) In 1973, the Supreme Court concluded that 

8 the government must leave the abortion decision ‘‘to 

9 the medical judgment of the pregnant woman’s at10 tending physician’’, recognizing that a physician may 

11 choose not to participate in abortion. Roe v. Wade, 

12 410 U.S. 113, 164 (1973). The Court cited with ap13 proval a policy that ‘‘neither physician, hospital, nor 

14 hospital personnel shall be required to perform any 

15 act violative of personally-held moral principles’’, 

16 410 U.S. at 143 n. 38, and cited State laws uphold17 ing this principle. Doe v. Bolton, 410 U.S. 179, 

18 197–8 (1973). 

19 (3) Congress’ enactments to protect this right 

20 of conscience in health care include the Church 

21 amendment of 1973 (42 U.S.C. 300a–7), the Coats/ 

22 Snowe amendment of 1996 (42 U.S.C. 238n), and 

23 the Weldon amendment approved by Congresses and 

24 Presidents of both parties every year since 2004. 


pamtmann on DSKBFK8HB2PROD with BILLS
3 

•S 183 IS

1 (4) None of these laws explicitly provides a 

2 ‘‘private right of action’’ so victims of discrimination 

3 can defend their conscience rights in court, and ad4 ministrative enforcement by the Department of 

5 Health and Human Services Office for Civil Rights 

6 has been lax, at times allowing cases to languish for 

7 years without resolution. 

8 (5) Defying the Federal Weldon amendment, 

9 California’s Department of Managed Health Care 

10 has mandated coverage for all elective abortions in 

11 all health plans under its jurisdiction. Other States 

12 such as New York and Washington have taken or 

13 considered similar action, and some States may go 

14 farther to require all physicians and hospitals to pro15 vide or facilitate abortions. On June 21, 2016, the 

16 Obama Administration concluded a nearly 2-year in17 vestigation of this matter by determining that Cali18 fornia’s decision to require insurance plans under 

19 the California Department for Managed Health Care 

20 authority to cover all legal abortion services did not 

21 violate the Weldon amendment. Until the new Ad22 ministration is able to reverse this finding, individ23 uals will have to choose between ignoring their con24 science or forgoing health care coverage. 


pamtmann on DSKBFK8HB2PROD with BILLS
4 

•S 183 IS

1 (6) The vast majority of medical professionals 

2 do not perform abortions, with 86 percent of ob/gyns 

3 unwilling to provide them in a recent study (Obstet4 rics & Gynecology, Sept. 2011) and the great major5 ity of hospitals choosing to do so in rare cases or not 

6 at all. 

7 (7) A health care provider’s decision not to par8 ticipate in an abortion, like Congress’ decision not to 

9 fund most abortions, erects no new barrier to those 

10 seeking to perform or undergo abortions but leaves 

11 each party free to act as he or she wishes. 

12 (8) Such protection poses no conflict with other 

13 Federal laws, such as the law requiring emergency 

14 stabilizing treatment for a pregnant woman and her 

15 unborn child when either is in distress (Emergency 

16 Medical Treatment and Active Labor Act). As the 

17 previous Administration has said, these areas of law 

18 have operated side by side for many years and both 

19 should be fully enforced (76 Fed. Reg. 9968–77 

20 (2011) at 9973). 

21 (9) Reaffirming longstanding Federal policy on 

22 conscience rights and providing a right of action in 

23 cases where it is violated allows longstanding and 

24 widely supported Federal laws to work as intended. 


pamtmann on DSKBFK8HB2PROD with BILLS
5 

•S 183 IS

1 SEC. 3. PROHIBITING GOVERNMENTAL DISCRIMINATION 

2 AGAINST PROVIDERS OF HEALTH SERVICES 

3 THAT ARE NOT INVOLVED IN ABORTION. 

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

5 202 et seq.) is amended by inserting after section 245 the 

6 following: 

7 ‘‘SEC. 245A. PROHIBITING GOVERNMENTAL DISCRIMINA8 TION AGAINST PROVIDERS OF HEALTH SERV9 ICES THAT ARE NOT INVOLVED IN ABORTION. 

10 ‘‘(a) IN GENERAL.—Notwithstanding any other law, 

11 the Federal Government, and any State or local govern12 ment that receives Federal financial assistance, may not 

13 penalize, retaliate against, or otherwise discriminate 

14 against a health care provider on the basis that the pro15 vider does not— 

16 ‘‘(1) perform, refer for, pay for, or otherwise 

17 participate in abortion; 

18 ‘‘(2) provide or sponsor abortion coverage; or 

19 ‘‘(3) facilitate or make arrangements for any of 

20 the activities specified in this subsection. 

21 ‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec22 tion shall be construed— 

23 ‘‘(1) to prevent any health care provider from 

24 voluntarily electing to participate in abortions or 

25 abortion referrals; 


pamtmann on DSKBFK8HB2PROD with BILLS
6 

•S 183 IS

1 ‘‘(2) to prevent any health care provider from 

2 voluntarily electing to provide or sponsor abortion 

3 coverage or health benefits coverage that includes 

4 abortion; 

5 ‘‘(3) to prevent an accrediting agency, the Fed6 eral Government, or a State or local government 

7 from establishing standards of medical competency 

8 applicable only to those who have knowingly, volun9 tarily, and specifically elected to perform abortions, 

10 or from enforcing contractual obligations applicable 

11 only to those who, as part of such contract, know12 ingly, voluntarily, and specifically elect to provide 

13 abortions; 

14 ‘‘(4) to affect, or be affected by, section 1867 

15 of the Social Security Act (42 U.S.C. 1395dd, com16 monly referred to as the ‘Emergency Medical Treat17 ment and Active Labor Act’); or 

18 ‘‘(5) to supersede any law enacted by any State 

19 for the purpose of regulating insurance, except as 

20 specified in subsection (a). 

21 ‘‘(c) ADMINISTRATION.—The Secretary shall des22 ignate the Director of the Office for Civil Rights of the 

23 Department of Health and Human Services— 

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

25 this section, section 245 of this Act, or any of subVerDate Sep 11 2014 23:52 Jan 25, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S183.IS S183

pamtmann on DSKBFK8HB2PROD with BILLS
7 

•S 183 IS

1 sections (b) through (e) of section 401 of the Health 

2 Programs Extension Act of 1973; and 

3 ‘‘(2) to pursue the investigation of such com4 plaints in coordination with the Attorney General. 

5 ‘‘(d) DEFINITIONS.—For purposes of this section: 

6 ‘‘(1) FEDERAL FINANCIAL ASSISTANCE.—The 

7 term ‘Federal financial assistance’ means Federal 

8 payments to cover the cost of health care services or 

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

10 to promote or otherwise facilitate health-related ac11 tivities. 

12 ‘‘(2) HEALTH CARE PROVIDER.—The term 

13 ‘health care provider’ means— 

14 ‘‘(A) an individual physician, nurse, or 

15 other health care professional; 

16 ‘‘(B) a hospital, health system, or other 

17 health care facility or organization (including a 

18 party to a proposed merger or other collabo19 rative arrangement relating to health services, 

20 and an entity resulting therefrom); 

21 ‘‘(C) a provider-sponsored organization, an 

22 accountable care organization, or a health 

23 maintenance organization; 


pamtmann on DSKBFK8HB2PROD with BILLS
8 

•S 183 IS

1 ‘‘(D) a social services provider that pro2 vides or authorizes referrals for health care 

3 services; 

4 ‘‘(E) a program of training in the health 

5 professions or an applicant to or participant in 

6 such a program; 

7 ‘‘(F) an issuer of health insurance cov8 erage; or 

9 ‘‘(G) a group health plan or student health 

10 plan, or a sponsor or administrator thereof. 

11 ‘‘(3) STATE OR LOCAL GOVERNMENT THAT RE12 CEIVES FEDERAL FINANCIAL ASSISTANCE.—The 

13 term ‘State or local government that receives Fed14 eral financial assistance’ includes every agency and 

15 other governmental unit and subdivision of a State 

16 or local government, if such State or local govern17 ment, or any agency or governmental unit or sub18 division thereof, receives Federal financial assist19 ance. 

20 ‘‘SEC. 245B. CIVIL ACTION FOR CERTAIN VIOLATIONS. 

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

22 action, obtain appropriate relief with regard to a des23 ignated violation. 

24 ‘‘(b) DEFINITIONS.—For purposes of this section: 


pamtmann on DSKBFK8HB2PROD with BILLS
9 

•S 183 IS

1 ‘‘(1) QUALIFIED PARTY.—The term ‘qualified 

2 party’ means— 

3 ‘‘(A) the Attorney General of the United 

4 States; or 

5 ‘‘(B) any person or entity adversely af6 fected by the designated violation. 

7 ‘‘(2) DESIGNATED VIOLATION.—The term ‘des8 ignated violation’ means an actual or threatened vio9 lation of— 

10 ‘‘(A) section 245 or 245A of this Act; or 

11 ‘‘(B) any of subsections (b) through (e) of 

12 section 401 of the Health Programs Extension 

13 Act of 1973 regarding an objection to abortion. 

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

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

16 may be granted, without regard to whether the party com17 mencing the action has sought or exhausted available ad18 ministrative remedies. 

19 ‘‘(d) DEFENDANTS IN ACTIONS UNDER THIS SEC20 TION MAY INCLUDE GOVERNMENTAL ENTITIES AS WELL

21 AS OTHERS.— 

22 ‘‘(1) IN GENERAL.—An action under this sec23 tion may be maintained against, among others, a 

24 party that is a Federal or State governmental entity. 

25 Relief in an action under this section may include 


pamtmann on DSKBFK8HB2PROD with BILLS
10 

•S 183 IS

1 money damages even if the defendant is such a gov2 ernmental entity. 

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

4 subsection, the term ‘State governmental entity’ 

5 means a State, a local government within a State, 

6 and any agency or other governmental unit or sub7 division of a State or of such a local government. 

8 ‘‘(e) NATURE OF RELIEF.—In an action under this 

9 section, the court shall grant— 

10 ‘‘(1) all necessary equitable and legal relief, in11 cluding, where appropriate, declaratory relief and 

12 compensatory damages, to prevent the occurrence, 

13 continuance, or repetition of the designated violation 

14 and to compensate for losses resulting from the des15 ignated violation; and 

16 ‘‘(2) to a prevailing plaintiff, reasonable attor17 neys’ fees and litigation expenses as part of the 

18 costs.’’. 

Æ 


pamtmann on DSKBFK8HB2PROD with BILLS