tive and that the biggest threats to the quality of 
abortion services in the United States are State reg-
ulations that create barriers to care. These abortion- 
specific restrictions conflict with medical standards 
and are not supported by the recommendations and 
guidelines issued by leading reproductive health care 
professional organizations including the American 
College of Obstetricians and Gynecologists, the Soci-
ety of Family Planning, the National Abortion Fed-
eration, the World Health Organization, and others. 
(12) Many abortion-specific restrictions do not 
confer any health or safety benefits on the patient. 
Instead, these restrictions have the purpose and ef-
fect of unduly burdening people’s personal and pri-
vate medical decisions to end their pregnancies by 
making access to abortion services more difficult, 
invasive, and costly, often forcing people to travel 
significant distances and make multiple unnecessary 
visits to the provider, and in some cases, foreclosing 
the option altogether. For example, a 2018 report 
from the University of California San Francisco’s 
Advancing New Standards in Reproductive Health 
research group found that in 27 cities across the 
United States, people have to travel more than 100 
miles in any direction to reach an abortion provider.
(13) An overwhelming majority of abortions in 
the United States are provided in clinics, not hos-
pitals, but the large majority of counties throughout 
the United States have no clinics that provide abor-
tion. 
(14) These restrictions additionally harm peo-
ple’s health by reducing access not only to abortion 
services but also to other essential health care serv-
ices offered by many of the providers targeted by the 
restrictions, including— 
(A) screenings and preventive services, in-
cluding contraceptive services; 
(B) testing and treatment for sexually 
transmitted infections; 
(C) LGBTQ health services; and 
(D) referrals for primary care, intimate 
partner violence prevention, prenatal care and 
adoption services. 
(15) The cumulative effect of these numerous 
restrictions has been to severely limit the availability 
of abortion services in some areas, creating a patch-
work system where access to abortion services is 
more available in some States than in others. A 
2019 report from the Government Accountability Of-
fice examining State Medicaid compliance with abor-
tion coverage requirements analyzed seven key chal-
lenges (identified both by health care providers and 
research literature) and their effect on abortion ac-
cess, and found that access to abortion services var-
ied across the States and even within a State. 
(16) International human rights law recognizes 
that access to abortion is intrinsically linked to the 
rights to life, health, equality and non-discrimina-
tion, privacy, and freedom from ill-treatment. United 
Nations (UN) human rights treaty monitoring bod-
ies have found that legal abortion services, like other 
reproductive health care services, must be available, 
accessible, affordable, acceptable, and of good qual-
ity. UN human rights treaty bodies have likewise 
condemned medically unnecessary barriers to abor-
tion services, including mandatory waiting periods, 
biased counseling requirements, and third-party au-
thorization requirements. 
(17) Core human rights treaties ratified by the 
United States protect access to abortion. For exam-
ple, in 2018, the UN Human Rights Committee, 
which oversees implementation of the ICCPR, made 
clear that the right to life, enshrined in Article 6 of 
the ICCPR, at a minimum requires governments to 
provide safe, legal, and effective access to abortion
where a person’s life and health is at risk, or when 
carrying a pregnancy to term would cause substan-
tial pain or suffering. The Committee stated that 
governments must not impose restrictions on abor-
tion which subject women and girls to physical or 
mental pain or suffering, discriminate against them, 
arbitrarily interfere with their privacy, or place them 
at risk of undertaking unsafe abortions. Further-
more, the Committee stated that governments should 
remove existing barriers that deny effective access to 
safe and legal abortion, refrain from introducing 
new barriers to abortion, and prevent the stigmatiza-
tion of those seeking abortion. 
(18) UN independent human rights experts 
have expressed particular concern about barriers to 
abortion services in the United States. For example, 
at the conclusion of his 2017 visit to the United 
States, the UN Special Rapporteur on extreme pov-
erty and human rights noted concern that low-in-
come women face legal and practical obstacles to ex-
ercising their constitutional right to access abortion 
services, trapping many women in cycles of poverty. 
Similarly, in May 2020, the UN Working Group on 
discrimination against women and girls, along with 
other human rights experts, expressed concern that
some states had manipulated the COVID–19 crisis 
to restrict access to abortion, which the experts rec-
ognized as ‘‘the latest example illustrating a pattern 
of restrictions and retrogressions in access to legal 
abortion care across the country’’ and reminded 
U.S. authorities that abortion care constitutes essen-
tial health care that must remain available during 
and after the pandemic. They noted that barriers to 
abortion access exacerbate systemic inequalities and 
cause particular harm to marginalized communities, 
including low-income people, people of color, immi-
grants, people with disabilities, and LGBTQ people. 
(19) Abortion-specific restrictions affect the 
cost and availability of abortion services, and the 
settings in which abortion services are delivered. 
People travel across State lines and otherwise en-
gage in interstate commerce to access this essential 
medical care, and more would be forced to do so ab-
sent this Act. Likewise, health care providers travel 
across State lines and otherwise engage in interstate 
commerce in order to provide abortion services to 
patients, and more would be forced to do so absent 
this Act. 
(20) Health care providers engage in a form of 
economic and commercial activity when they provide
abortion services, and there is an interstate market 
for abortion services. 
(21) Abortion restrictions substantially affect 
interstate commerce in numerous ways. For exam-
ple, to provide abortion services, health care pro-
viders engage in interstate commerce to purchase 
medicine, medical equipment, and other necessary 
goods and services. To provide and assist others in 
providing abortion services, health care providers en-
gage in interstate commerce to obtain and provide 
training. To provide abortion services, health care 
providers employ and obtain commercial services 
from doctors, nurses, and other personnel who en-
gage in interstate commerce and travel across State 
lines. 
(22) It is difficult and time and resource-con-
suming for clinics to challenge State laws that bur-
den or impede abortion services. Litigation that 
blocks one abortion restriction may not prevent a 
State from adopting other similarly burdensome 
abortion restrictions or using different methods to 
burden or impede abortion services. There is a his-
tory and pattern of States passing successive and 
different laws that unduly burden abortion services.
(3) HEALTH
CARE
PROVIDER.—The term 
‘‘health care provider’’ means any entity or indi-
vidual (including any physician, certified nurse-mid-
wife, nurse practitioner, and physician assistant) 
that— 
(A) is engaged or seeks to engage in the 
delivery of health care services, including abor-
tion services, and 
(B) if required by law or regulation to be 
licensed or certified to engage in the delivery of 
such services— 
(i) is so licensed or certified, or 
(ii) would be so licensed or certified 
but for their past, present, or potential 
provision of abortion services permitted by 
section 4. 
(4) MEDICALLY
COMPARABLE
PROCEDURE.— 
The term ‘‘medically comparable procedures’’ means 
medical procedures that are similar in terms of 
health and safety risks to the patient, complexity, or 
the clinical setting that is indicated. 
(5) PREGNANCY.—The term ‘‘pregnancy’’ refers 
to the period of the human reproductive process be-
ginning with the implantation of a fertilized egg.
(6) STATE.—The term ‘‘State’’ includes the 
District of Columbia, the Commonwealth of Puerto 
Rico, and each territory and possession of the 
United States, and any subdivision of any of the 
foregoing, including any unit of local government, 
such as a county, city, town, village, or other general 
purpose political subdivision of a State. 
(7) VIABILITY.—The term ‘‘viability’’ means 
the point in a pregnancy at which, in the good-faith 
medical judgment of the treating health care pro-
vider, based on the particular facts of the case be-
fore the health care provider, there is a reasonable 
likelihood of sustained fetal survival outside the 
uterus with or without artificial support. 
SEC. 4. PERMITTED SERVICES. 
(a) GENERAL RULE.—A health care provider has a 
statutory right under this Act to provide abortion services, 
and may provide abortion services, and that provider’s pa-
tient has a corresponding right to receive such services, 
without any of the following limitations or requirements: 
(1) A requirement that a health care provider 
perform specific tests or medical procedures in con-
nection with the provision of abortion services, un-
less generally required for the provision of medically 
comparable procedures.
(2) A requirement that the same health care 
provider who provides abortion services also perform 
specified tests, services, or procedures prior to or 
subsequent to the abortion. 
(3) A requirement that a health care provider 
offer or provide the patient seeking abortion services 
medically inaccurate information in advance of or 
during abortion services. 
(4) A limitation on a health care provider’s abil-
ity to prescribe or dispense drugs based on current 
evidence-based regimens or the provider’s good-faith 
medical judgment, other than a limitation generally 
applicable to the medical profession. 
(5) A limitation on a health care provider’s abil-
ity to provide abortion services via telemedicine, 
other than a limitation generally applicable to the 
provision of medical services via telemedicine. 
(6) A requirement or limitation concerning the 
physical plant, equipment, staffing, or hospital 
transfer arrangements of facilities where abortion 
services are provided, or the credentials or hospital 
privileges or status of personnel at such facilities, 
that is not imposed on facilities or the personnel of 
facilities where medically comparable procedures are 
performed.
(7) A requirement that, prior to obtaining an 
abortion, a patient make one or more medically un-
necessary in-person visits to the provider of abortion 
services or to any individual or entity that does not 
provide abortion services. 
(8) A prohibition on abortion at any point or 
points in time prior to fetal viability, including a 
prohibition or restriction on a particular abortion 
procedure. 
(9) A prohibition on abortion after fetal viabil-
ity when, in the good-faith medical judgment of the 
treating health care provider, continuation of the 
pregnancy would pose a risk to the pregnant pa-
tient’s life or health. 
(10) A limitation on a health care provider’s 
ability to provide immediate abortion services when 
that health care provider believes, based on the 
good-faith medical judgment of the provider, that 
delay would pose a risk to the patient’s health. 
(11) A requirement that a patient seeking abor-
tion services at any point or points in time prior to 
fetal viability disclose the patient’s reason or reasons 
for seeking abortion services, or a limitation on the 
provision or obtaining of abortion services at any 
point or points in time prior to fetal viability based
on any actual, perceived, or potential reason or rea-
sons of the patient for obtaining abortion services, 
regardless of whether the limitation is based on a 
health care provider’s degree of actual or construc-
tive knowledge of such reason or reasons. 
(b) OTHER LIMITATIONS OR REQUIREMENTS.—The 
statutory right specified in subsection (a) shall not be lim-
ited or otherwise infringed through, in addition to the limi-
tations and requirements specified in paragraphs (1) 
through (11) of subsection (a), any limitation or require-
ment that— 
(1) is the same as or similar to one or more of 
the limitations or requirements described in sub-
section (a); or 
(2) both— 
(A) expressly, effectively, implicitly, or as 
implemented singles out the provision of abor-
tion services, health care providers who provide 
abortion services, or facilities in which abortion 
services are provided; and 
(B) impedes access to abortion services. 
(c) FACTORS FOR CONSIDERATION.—Factors a court 
may consider in determining whether a limitation or re-
quirement impedes access to abortion services for purposes 
of subsection (b)(2)(B) include the following:
(1) Whether the limitation or requirement, in a 
provider’s good-faith medical judgment, interferes 
with a health care provider’s ability to provide care 
and render services, or poses a risk to the patient’s 
health or safety. 
(2) Whether the limitation or requirement is 
reasonably likely to delay or deter some patients in 
accessing abortion services. 
(3) Whether the limitation or requirement is 
reasonably likely to directly or indirectly increase the 
cost of providing abortion services or the cost for ob-
taining abortion services (including costs associated 
with travel, childcare, or time off work). 
(4) Whether the limitation or requirement is 
reasonably likely to have the effect of necessitating 
a trip to the offices of a health care provider that 
would not otherwise be required. 
(5) Whether the limitation or requirement is 
reasonably likely to result in a decrease in the avail-
ability of abortion services in a given State or geo-
graphic region. 
(6) Whether the limitation or requirement im-
poses penalties that are not imposed on other health 
care providers for comparable conduct or failure to 
act, or that are more severe than penalties imposed
on other health care providers for comparable con-
duct or failure to act. 
(7) The cumulative impact of the limitation or 
requirement combined with other new or existing 
limitations or requirements. 
(d) EXCEPTION.—To defend against a claim that a 
limitation or requirement violates a health care provider’s 
or patient’s statutory rights under subsection (b), a party 
must establish, by clear and convincing evidence, that— 
(1) the limitation or requirement significantly 
advances the safety of abortion services or the health 
of patients; and 
(2) the safety of abortion services or the health 
of patients cannot be advanced by a less restrictive 
alternative measure or action. 
SEC. 5. APPLICABILITY AND PREEMPTION. 
(a) IN GENERAL.— 
(1) Except as stated under subsection (b), this 
Act supersedes and applies to the law of the Federal 
Government and each State government, and the im-
plementation of such law, whether statutory, com-
mon law, or otherwise, and whether adopted before 
or after the date of enactment of this Act, and nei-
ther the Federal Government nor any State govern-
ment shall administer, implement, or enforce any
law, rule, regulation, standard, or other provision 
having the force and effect of law that conflicts with 
any provision of this Act, notwithstanding any other 
provision of Federal law, including the Religious 
Freedom Restoration Act of 1993 (42 U.S.C. 
2000bb et seq.). 
(2) Federal statutory law adopted after the 
date of the enactment of this Act is subject to this 
Act unless such law explicitly excludes such applica-
tion by reference to this Act. 
(b) LIMITATIONS.—The provisions of this Act shall 
not supersede or apply to— 
(1) laws regulating physical access to clinic en-
trances; 
(2) insurance or medical assistance coverage of 
abortion services; 
(3) 
the 
procedure 
described 
in 
section 
1531(b)(1) of title 18, United States Code; or 
(4) generally applicable State contract law. 
(c) DEFENSE.—In any cause of action against an in-
dividual or entity who is subject to a limitation or require-
ment that violates this Act, in addition to the remedies 
specified in section 8, this Act shall also apply to, and 
may be raised as a defense by, such an individual or entity.
SEC. 6. EFFECTIVE DATE. 
This Act shall take effect immediately upon the date 
of enactment of this Act. This Act shall apply to all re-
strictions on the provision of, or access to, abortion serv-
ices whether the restrictions are enacted or imposed prior 
to or after the date of enactment of this Act, except as 
otherwise provided in this Act. 
SEC. 7. RULES OF CONSTRUCTION. 
(a) IN GENERAL.—In interpreting the provisions of 
this Act, a court shall liberally construe such provisions 
to effectuate the purposes of the Act. 
(b) RULE OF CONSTRUCTION.—Nothing in this Act 
shall be construed to authorize any government to inter-
fere with a person’s ability to terminate a pregnancy, to 
diminish or in any way negatively affect a person’s con-
stitutional right to terminate a pregnancy, or to displace 
any other remedy for violations of the constitutional right 
to terminate a pregnancy. 
(c) OTHER INDIVIDUALS CONSIDERED AS GOVERN-
MENT OFFICIALS.—Any person who, by operation of a 
provision of Federal or State law, is permitted to imple-
ment or enforce a limitation or requirement that violates 
section 4 of this Act shall be considered a government offi-
cial for purposes of this Act.
SEC. 8. ENFORCEMENT. 
(a) ATTORNEY GENERAL.—The Attorney General 
may commence a civil action on behalf of the United 
States against any State that violates, or against any gov-
ernment official (including a person described in section 
7(c)) that implements or enforces a limitation or require-
ment that violates, section 4. The court shall hold unlawful 
and set aside the limitation or requirement if it is in viola-
tion of this Act. 
(b) PRIVATE RIGHT OF ACTION.— 
(1) IN GENERAL.—Any individual or entity, in-
cluding any health care provider or patient, ad-
versely affected by an alleged violation of this Act, 
may commence a civil action against any State that 
violates, or against any government official (includ-
ing a person described in section 7(c)) that imple-
ments or enforces a limitation or requirement that 
violates, section 4. The court shall hold unlawful and 
set aside the limitation or requirement if it is in vio-
lation of this Act. 
(2) HEALTH CARE PROVIDER.—A health care 
provider may commence an action for relief on its 
own behalf, on behalf of the provider’s staff, and on 
behalf of the provider’s patients who are or may be 
adversely affected by an alleged violation of this Act.
(c) EQUITABLE RELIEF.—In any action under this 
section, the court may award appropriate equitable relief, 
including temporary, preliminary, or permanent injunctive 
relief. 
(d) COSTS.—In any action under this section, the 
court shall award costs of litigation, as well as reasonable 
attorney’s fees, to any prevailing plaintiff. A plaintiff shall 
not be liable to a defendant for costs or attorney’s fees 
in any non-frivolous action under this section. 
(e) JURISDICTION.—The district courts of the United 
States shall have jurisdiction over proceedings under this 
Act and shall exercise the same without regard to whether 
the party aggrieved shall have exhausted any administra-
tive or other remedies that may be provided for by law. 
(f) ABROGATION OF STATE IMMUNITY.—Neither a 
State that enforces or maintains, nor a government official 
(including a person described in section 7(c)) who is per-
mitted to implement or enforce any limitation or require-
ment that violates section 4 shall be immune under the 
Tenth Amendment to the Constitution of the United 
States, the Eleventh Amendment to the Constitution of 
the United States, or any other source of law, from an 
action in a Federal or State court of competent jurisdic-
tion challenging that limitation or requirement.
SEC. 9. SEVERABILITY. 
If any provision of this Act, or the application of such 
provision to any person, entity, government, or cir-
cumstance, is held to be unconstitutional, the remainder 
of this Act, or the application of such provision to all other 
persons, entities, governments, or circumstances, shall not 
be affected thereby. 
Passed the House of Representatives September 24, 
2021. 
Attest: 
Clerk.
117TH CONGRESS 
1ST SESSION 
H. R. 3755 
AN ACT 
To protect a person’s ability to determine whether 
to continue or end a pregnancy, and to protect 
a health care provider’s ability to provide abor-
tion services.