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. MIL-
LER 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 Com-
mittee 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 require-
ments 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Care Con-
science Rights Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) As Thomas Jefferson declared to New Lon-
don Methodists in 1809, ‘‘[n]o provision in our Con-
stitution ought to be dearer to man than that which 
protects the rights of conscience against the enter-
prises of the civil authority’’. 
(2) Jefferson’s conviction on respect for con-
science is deeply embedded in the history and tradi-
tions of our Nation, and codified in numerous Fed-
eral laws approved by congressional majorities and 
Presidents of both parties, including in the Public 
Health Service Act; the United States Leadership 
Against HIV/AIDS, Tuberculosis, and Malaria Act; 
the Religious Freedom Restoration Act; long-
standing provisions on respect for conscience rights 
in the Federal Employees Health Benefits Program 
and District of Columbia appropriations; and laws to 
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protect individuals from being forced to participate 
in Federal executions or prosecutions. 
(3) Following enactment of the Patient Protec-
tion and Affordable Care Act (Public Law 111–148, 
in this section referred to as ‘‘PPACA’’), the Fed-
eral Government has sought to impose specific re-
quirements that infringe on the rights of conscience 
of those who offer or purchase health coverage. 
(4) While PPACA provides an exemption for 
some religious groups that object to participation in 
health insurance generally, and exempts millions of 
Americans from most of the Act’s provisions, includ-
ing the preventive services mandate, it fails to pro-
vide statutory protection for those seeking to offer 
and purchase health coverage who have a religious 
or moral objection only to specific items or services. 
(5) Nurses and other health care providers have 
increasingly been subjected to discrimination for 
abiding by their conscience rather than providing, 
paying for, or referring for abortion. 
(6) Conscience rights protections for health care 
providers are an important part of civil rights pro-
tections in Federal law and are indispensable to the 
continued viability of the health care system in the 
United States. The increasingly significant discrimi-
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nation suffered by faith-based nonprofit health care 
providers risks undermining access to high-quality 
compassionate care for some of the most vulnerable 
populations in our country. 
SEC. 
3. 
APPLYING 
LONGSTANDING 
POLICY 
ON 
CON-
SCIENCE RIGHTS TO THE AFFORDABLE CARE 
ACT. 
(a) IN GENERAL.—Title I of the Patient Protection 
and Affordable Care Act (Public Law 111–148) is amend-
ed— 
(1) by redesignating the second section 1563 
(relating to conforming amendments and as redesig-
nated by section 10107(b)(1) of the Patient Protec-
tion and Affordable Care Act) as section 1564; 
(2) by redesignating the third section 1563 (re-
lating to the Sense of the Senate promoting fiscal 
responsibility) as section 1565; and 
(3) by adding at the end the following new sec-
tion: 
‘‘SEC. 1566. RESPECTING CONSCIENCE RIGHTS IN HEALTH 
COVERAGE. 
‘‘(a) IN GENERAL.—Notwithstanding any other pro-
vision of this title, no provision of this title (and no amend-
ment made by any such provision) shall— 
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‘‘(1) require an individual to purchase indi-
vidual health insurance coverage that includes cov-
erage of an abortion or other item or service to 
which such individual has a moral or religious objec-
tion, or prevent an issuer from offering or issuing, 
to such individual, individual health insurance cov-
erage that excludes such item or service; 
‘‘(2) require a sponsor (or, in the case of health 
insurance coverage offered to students through an 
institution of higher education, the institution of 
higher education offering such coverage) to sponsor, 
purchase, or provide any health benefits coverage or 
group health plan that includes coverage of an abor-
tion or other item or service to which such sponsor 
or institution, respectively, has a moral or religious 
objection, or prevent an issuer from offering or 
issuing to such sponsor or institution, respectively, 
health insurance coverage that excludes such item or 
service; 
‘‘(3) require an issuer of health insurance cov-
erage or the sponsor of a group health plan to in-
clude, in any such coverage or plan, coverage of an 
abortion or other item or service to which such 
issuer or sponsor has a moral or religious objection; 
or 
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‘‘(4) authorize the imposition of a tax, penalty, 
fee, fine, or other sanction, or the imposition of cov-
erage of the item or service to which there is a moral 
or religious objection, in relation to health insurance 
coverage or a group health plan that excludes an 
item or service pursuant to this section. 
‘‘(b) RESTRICTION ON CONTRARY GOVERNMENTAL 
ACTION.—No provision in this title (or amendment made 
by such provision) or law, regulation, guideline or other 
governmental action that implements such provision or 
amendment, or derives its authority therefrom, shall be 
given legal effect to the extent that it violates this section. 
‘‘(c) NO EFFECT ON OTHER LAWS.—Nothing in this 
section shall be construed to preempt, modify, or otherwise 
have any effect on— 
‘‘(1) the Civil Rights Act of 1964; 
‘‘(2) the Americans with Disabilities Act of 
1990; 
‘‘(3) the Pregnancy Discrimination Act of 1978; 
‘‘(4) the Mental Health Parity Act of 1996; or 
‘‘(5) any other State or Federal law, other than 
a provision in this title (or an amendment made by 
such provision) or a law, regulation, guideline or 
other governmental action that implements such pro-
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vision or amendment or derives its authority there-
from. 
‘‘(d) AGGREGATE ACTUARIAL VALUE.—Nothing in 
this section shall be construed to prohibit the Secretary 
from issuing regulations or other guidance to ensure that 
health insurance coverage or group health plans excluding 
abortion or other items or services under this section shall 
have an aggregate actuarial value at least equivalent to 
that of health insurance coverage or group health plans 
at the same level of coverage that do not exclude such 
items or services. 
‘‘(e) CONTINUED APPLICATION OF NONDISCRIMINA-
TION RULES.—Nothing in this section shall be construed 
to permit a health insurance issuer, group health plan, or 
other health care provider to act in a manner inconsistent 
with subparagraph (B) or (D) of section 1302(b)(4).’’. 
(b) CLERICAL AMENDMENT.—The table of contents 
of the Patient Protection and Affordable Care Act (Public 
Law 111–148) is amended— 
(1) by striking the following items: 
‘‘1563. Conforming amendments. 
‘‘1563. Sense of the Senate promoting fiscal responsibility.’’; 
and 
(2) by inserting after the item relating to the 
section 1563 relating to small business procurement 
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.’’. 
SEC. 4. ABORTION NONDISCRIMINATION FOR HEALTH 
CARE PROVIDERS. 
Section 245 of the Public Health Service Act (42 
U.S.C. 238n) is amended— 
(1) in the section heading, by striking ‘‘AND 
LICENSING OF PHYSICIANS’’ and inserting ‘‘, LI-
CENSING, AND PRACTICE OF PHYSICIANS AND 
OTHER HEALTH CARE ENTITIES’’; 
(2) in subsection (a), by amending paragraph 
(1) to read as follows: 
‘‘(1) the entity refuses— 
‘‘(A) to undergo training in the perform-
ance of induced abortions; 
‘‘(B) to require or provide such training; 
‘‘(C) to perform, participate in, provide 
coverage of, or pay for induced abortions; or 
‘‘(D) to provide referrals for such training 
or such abortions;’’; 
(3) in subsection (b)(1), by striking ‘‘stand-
ards’’ and inserting ‘‘standard’’; 
(4) in subsection (c), by amending paragraphs 
(1) and (2) to read as follows: 
‘‘(1) The term ‘financial assistance’, with re-
spect to a government program, means governmental 
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payments to cover the cost of health care services or 
benefits, or other Federal payments, grants, or loans 
to promote or otherwise facilitate health-related ac-
tivities. 
‘‘(2) The term ‘health care entity’ includes an 
individual physician or other health professional, a 
postgraduate physician training program, a partici-
pant in a program of training in the health profes-
sions, a hospital, a provider-sponsored organization 
as defined in section 1855(d) of the Social Security 
Act, a health maintenance organization, an account-
able care organization, an issuer of health insurance 
coverage, any other kind of health care facility, orga-
nization, or plan, and an entity that provides or au-
thorizes referrals for health care services.’’; 
(5) by adding at the end of subsection (c) the 
following new paragraph: 
‘‘(4) The term ‘State or local government that 
receives Federal financial assistance’ includes any 
agency or other governmental unit of a State or 
local government if such government receives Fed-
eral financial assistance.’’; 
(6) by redesignating subsection (c) as sub-
section (d); and 
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