,,ii #aafth ,,congress #ast ,session ,s4 #afde ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #bc 7legislative day1 ,may #bb71 #bjai,mr4 ,blumenthal 7for himself1 ,ms4 ,baldwin1 ,mr4 ,menendez1 ,mr4 ,brown1 ,ms4 ,harris1 ,mr4 ,merkley1 ,mr4 ,whitehouse1 ,mr4 ,bennet1 ,mr4 ,markey1 ,ms4 ,warren1 ,mr4 ,cardin1 ,mr4 ,heinrich1 ,ms4 ,stabenow1 ,ms4 ,klobuchar1 ,mr4 ,tester1 ,ms4 ,rosen1 ,mr4 ,coons1 ,ms4 ,cortez ,masto1 ,mrs4 ,shaheen1 ,mr4 ,sanders1 ,ms4 ,hirono1 ,ms4 ,hassan1 ,mr4 ,schatz1 ,mr4 ,king1 ,ms4 ,smith1 ,mrs4 ,murray1 ,mr4 ,peters1 ,mr4 ,wyden1 ,mrs4 ,feinstein1 ,mrs4 ,gillibrand1 ,mr4 ,murphy1 ,mr4 ,leahy1 ,ms4 ,duckworth1 ,mr4 ,van ,hollen1 ,mr4 ,carper1 ,ms4 ,cantwell1 ,mr4 ,booker1 ,mr4 ,warner1 ,mr4 ,udall1 ,mr4 ,schumer1 ,mr4 ,kaine1 ,mr4 ,durbin1 and ,ms4 ,sinema7 introduced the following bill2 which was read twice and referred to the ,committee on the ,judiciary ,a ,,bill ,to protect a woman's ability to determine whether and when to bear a child or end a pregnancy1 and to protect a health care provider's ability to provide reproductive health care services1 including abortion services4 #a4 ,short title ,this ,act may be cited as the ,women's ,health ,protection ,act of #bjai4 #b4 ,findings and purpose 7a7 ,findings ,congress finds the following3 7#a7 ,access to safe1 legal abortion services is essential to women's health and central to women's ability to participate equally in the economic and social life of the ,united ,states4 7#b7 ,since #aigc1 the ,supreme ,court repeatedly has recognized the constitutional right of a woman to decide to terminate her pregnancy before fetal viability1 and to terminate her pregnancy after fetal viability where it is necessary1 in the good-faith medical judgment of the treating health care professional1 for the preservation of her life or health4 7#c7 ,nonetheless1 access to safe1 legal abortion services has been hindered across the ,united ,states in various ways1 including blockades of health care facilities and associated violence1 prohibitions of and restrictions on insurance coverage1 restrictions which shame and stigmatize women seeking abortion services1 and medically unnecessary regulations which neither confer any health benefit nor further the safety of abortion services1 but which harm women by delaying access to1 and reducing the availability of1 services4 ,since #bjaj1 ,states and local governments have passed more than #djj such restrictions singling out health care providers who offer abortion services and interfering with health care providers' ability to provide reproductive health care services and the ability of patients to obtain those services4 7#d7 ,many ,state and local governments have imposed restrictions on the provision of abortion that are neither evidence-based nor generally applicable to the medical profession or to other medically comparable outpatient gynecological procedures1 such as endometrial ablations1 dilation and curettage for reasons other than abortion1 hysteroscopies1 loop electrosurgical excision procedures1 or other analogous non-gynecological procedures performed in similar outpatient settings including vasectomy1 sigmoidoscopy1 and colonoscopy4 7#e7 ,legal abortion is one of the safest medical procedures in the ,united ,states4 ,an independent review of research on the safety and quality of abortion services in the ,united ,states1 published by the ,national ,academies of ,sciences1 ,engineering1 and ,medicine in #bjah1 found that abortion in all forms is safe and effective and that the biggest threats to the quality of abortion services in the ,united ,states are ,state regulations that create barriers to care4 ,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 ,gynecologists1 the ,society of ,family ,planning1 the ,national ,abortion ,federation1 the ,world ,health ,organization1 and others4 7#f7 ,many abortion-specific restrictions do not confer any health or safety benefits on the patient4 ,instead1 these restrictions have the purpose and effect of unduly burdening women's personal and private medical decisions to end their pregnancies by making access to abortion services more difficult1 invasive1 and costly1 forcing women to travel significant distances and make multiple unnecessary visits to the provider1 and in some cases1 foreclosing the option altogether4 ,for example1 a #bjah report from the ,university of ,california ,san ,francisco's ,advancing ,new ,standards in ,reproductive ,health research group found that in #bg cities across the ,united ,states1 people have to travel more than #ajj miles in any direction to reach an abortion provider4 7#g7 ,these restrictions additionally harm women's health by reducing access not only to abortion services but also to the other essential health care services offered by the providers targeted by the restrictions1 including-- 7,a7 contraceptive services1 which advance women's health and provide a range of benefits1 including preventing unintended pregnancies and reducing the need for abortion2 and 7,b7 screenings for cervical cancer and sexually transmitted infections4 7#h7 ,the cumulative effect of these numerous restrictions has been to severely limit the availability of abortion services in some areas1 creating a patchwork system where access to abortion services is more available in some ,states than in others4 ,a #bjai report from the ,government ,accountability ,office examining ,state ,medicaid compliance with abortion coverage requirements analyzed #g key challenges 7identified both by health care providers and research literature7 and their effect on abortion access1 and found that access to abortion services varied across the ,states and even within a ,state4 7#i7 ,the harms of these abortion-specific restrictions fall especially heavily on low-income women1 women of color1 immigrants1 young people1 and women living in rural and other medically underserved areas4 7#aj7 ,abortion-specific restrictions single out health services used by women1 and rely on and reinforce stereotypes about women's roles1 women's decisionmaking1 and women's need for protection4 ,these restrictions harm the basic autonomy1 dignity1 equality1 and ability of women to participate in the social and economic life of the ,nation4 7#aa7 ,not all people who become pregnant or need abortion services identify as women4 ,access to abortion services is critical to the health of every person regardless of actual or perceived race1 color1 national origin1 immigration status1 sex 7including gender identity1 sex stereotyping1 or sexual orientation71 age1 or disability status4 ,this ,act's protection is inclusive of all pregnant people4 7#ab7 ,these restrictions affect the cost and availability of abortion services1 and the settings in which abortion services are delivered4 ,women travel across ,state lines and otherwise engage in interstate commerce to access this important medical care1 and more would be forced to do so absent this ,act4 ,likewise1 health care providers travel across ,state lines and otherwise engage in interstate commerce in order to provide reproductive health services to patients1 and more would be forced to do so absent this ,act4 7#ac7 ,health care providers1 including those who provide abortion services1 engage in a form of economic and commercial activity when they provide abortion services1 and there is an interstate market for abortion services4 7#ad7 ,to provide abortion services1 health care providers engage in interstate commerce to purchase medicine1 medical equipment1 and other necessary goods and services4 ,to provide and assist others in providing abortion services1 health care providers engage in interstate commerce to obtain and provide training4 ,to provide abortion services1 health care providers employ and obtain commercial services from doctors1 nurses1 and other personnel who engage in interstate commerce and travel across ,state lines4 ,abortion restrictions substantially affect interstate commerce in numerous ways4 7#ae7 ,it is difficult and time consuming for clinics to challenge ,state laws that burden or impede abortion services4 ,litigation that blocks one abortion restriction may not prevent a ,state from adopting other abortion restrictions or using different methods to burden or impede abortion services4 ,there is a history and pattern of ,states passing successive and different laws that impede and unduly burden abortion services4 7#af7 ,when a health care provider ceases providing abortion services as a result of burdensome and medically unnecessary regulations1 it is often difficult or impossible for that health care provider to recommence providing those abortion services1 and difficult or impossible for other health care providers to provide abortion services that restore or replace the ceased abortion services4 7#ag7 ,an overwhelming majority of abortions in the ,united ,states are provided in clinics1 not hospitals4 ,the large majority of ,united ,states counties have no clinics that provide abortion4 7#ah7 ,congress has the authority to enact this ,act to protect abortion services pursuant to-- 7,a7 its powers under the commerce clause of section #h of article ,i of the ,constitution of the ,united ,states2 7,b7 its powers under section #e of the ,fourteenth ,amendment to the ,constitution of the ,united ,states to enforce the provisions of section #a of the ,fourteenth ,amendment2 and 7,c7 its powers under the necessary and proper clause of section #h of article ,i of the ,constitution of the ,united ,states4 7#ai7 ,congress has used its authority in the past to protect women's ability to access abortion services and health care providers' ability to provide abortion services4 ,in the early #aiijs1 protests and blockades at health care facilities where abortion services were provided1 and associated violence1 increased dramatically and reached crisis level1 requiring congressional action4 ,congress passed the ,freedom of ,access to ,clinic ,entrances ,act 7,public ,law #ajc-bei2 #ajh ,stat4 #fid7 to address that situation and protect physical access to abortion services4 7#bj7 ,congressional action is necessary to put an end to harmful restrictions1 to federally protect access to abortion services for all women regardless of where they live1 and to protect the ability of reproductive health care providers to provide these services in a safe and accessible manner4 7b7 ,purpose ,it is the purpose of this ,act-- 7#a7 to permit health care providers to provide abortion services without limitations or requirements that single out the provision of abortion services for restrictions that are more burdensome than those restrictions imposed on medically comparable procedures1 do not significantly advance women's health or the safety of abortion services1 and make abortion services more difficult to access2 7#b7 to promote women's health and women's ability to participate equally in the economic and social life of the ,united ,states2 and 7#c7 to invoke congressional authority1 including the powers of ,congress under the commerce clause of section #h of article ,i of the ,constitution of the ,united ,states1 its powers under section #e of the ,fourteenth ,amendment to the ,constitution of the ,united ,states to enforce the provisions of section #a of the ,fourteenth ,amendment1 and its powers under the necessary and proper clause of section #h of article ,i of the ,constitution of the ,united ,states4 #c4 ,definitions ,in this ,act3 7#a7 ,abortion services ,the term abortion services means an abortion and any medical or non-medical services related to and provided in conjunction with an abortion 7whether or not provided at the same time or on the same day as the abortion74 7#b7 ,health care provider ,the term health care provider means any entity or individual 7including any physician1 certified nurse-midwife1 nurse practitioner1 and physician assistant7 that is-- 7,a7 engaged in the delivery of health care services1 including abortion services2 and 7,b7 if required by law or regulation to be licensed or certified to engage in the delivery of such services1 is so licensed or certified4 7#c7 ,medically comparable procedures ,the term medically comparable procedures means medical procedures that are similar in terms of health and safety risks to the patient1 complexity1 or the clinical setting that is indicated4 7#d7 ,pregnancy ,the term pregnancy refers to the period of the human reproductive process beginning with the implantation of a fertilized egg4 7#e7 ,viability ,the term viability means the point in a pregnancy at which1 in the good-faith medical judgment of the treating health care provider1 based on the particular facts of the case before the health care provider1 there is a reasonable likelihood of sustained fetal survival outside the uterus with or without artificial support4 #d4 ,permitted services 7a7 ,general rule ,a health care provider has a statutory right under this ,act to provide abortion services1 and may provide abortion services1 and that provider's patient has a corresponding right to receive such services1 without any of the following limitations or requirements3 7#a7 ,a requirement that a health care provider perform specific tests or medical procedures in connection with the provision of abortion services1 unless generally required for the provision of medically comparable procedures4 7#b7 ,a requirement that the same health care provider who provides abortion services also perform specified tests1 services1 or procedures prior to or subsequent to the abortion4 7#c7 ,a requirement that a health care provider offer or provide the patient seeking abortion services medically inaccurate information in advance of or during abortion services4 7#d7 ,a limitation on a health care provider's ability to prescribe or dispense drugs based on current evidence-based regimens or the provider's good-faith medical judgment1 other than a limitation generally applicable to the medical profession4 7#e7 ,a limitation on a health care provider's ability to provide abortion services via telemedicine1 other than a limitation generally applicable to the provision of medical services via telemedicine4 7#f7 ,a requirement or limitation concerning the physical plant1 equipment1 staffing1 or hospital transfer arrangements of facilities where abortion services are provided1 or the credentials or hospital privileges or status of personnel at such facilities1 that is not imposed on facilities or the personnel of facilities where medically comparable procedures are performed4 7#g7 ,a requirement that1 prior to obtaining an abortion1 a patient make one or more medically unnecessary in-person visits to the provider of abortion services or to any individual or entity that does not provide abortion services4 7#h7 ,a prohibition on abortion prior to fetal viability1 including a prohibition or restriction on a particular abortion procedure4 7#i7 ,a prohibition on abortion after fetal viability when1 in the good-faith medical judgment of the treating health care provider1 continuation of the pregnancy would pose a risk to the pregnant patient's life or health4 7#aj7 ,a limitation on a health care provider's ability to provide immediate abortion services when that health care provider believes1 based on the good-faith medical judgment of the provider1 that delay would pose a risk to the patient's health4 7#aa7 ,a requirement that a patient seeking abortion services prior to fetal viability state the patient's reasons for seeking abortion services1 or a limitation on the provision of abortion services prior to fetal viability based on the patient's reasons or perceived reasons for obtaining abortion services4 7b7 ,other limitations or requirements ,a health care provider has a statutory right to provide abortion services1 and may provide abortion services1 and that provider's patient has a corresponding right to receive such services1 without a limitation or requirement that-- 7#a7 is the same as or similar to one or more of the limitations or requirements described in subsection 7a72 or 7#b7 both-- 7,a7 singles out the provision of abortion services1 health care providers who provide abortion services1 or facilities in which abortion services are provided2 and 7,b7 impedes access to abortion services based on one or more of the factors described in subsection 7c74 7c7 ,factors for consideration ,factors for a court to consider in determining whether a limitation or requirement impedes access to abortion services for purposes of subsection 7b77#b77;,b7 include the following3 7#a7 ,whether the limitation or requirement interferes with a health care provider's ability to provide care and render services in accordance with the provider's good-faith medical judgment4 7#b7 ,whether the limitation or requirement is reasonably likely to delay some patients in accessing abortion services4 7#c7 ,whether the limitation or requirement is reasonably likely to directly or indirectly increase the cost of providing abortion services or the cost for obtaining abortion services 7including costs associated with travel1 childcare1 or time off work74 7#d7 ,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 required4 7#e7 ,whether the limitation or requirement is reasonably likely to result in a decrease in the availability of abortion services in a given ,state or geographic region4 7#f7 ,whether the limitation or requirement imposes penalties that are not imposed on other health care providers for comparable conduct or failure to act1 or that are more severe than penalties imposed on other health care providers for comparable conduct or failure to act4 7#g7 ,the cumulative impact of the limitation or requirement combined with other new or existing limitations or requirements4 7d7 ,exception ,to defend against a claim that a limitation or requirement violates a health care provider's or patient's statutory rights under subsection 7b71 a party must establish1 by clear and convincing evidence1 that-- 7#a7 the limitation or requirement significantly advances the safety of abortion services or the health of patients2 and 7#b7 the safety of abortion services or the health of patients cannot be advanced by a less restrictive alternative measure or action4 7e7 ,applicability 7#a7 ,general relationship to ,federal law ,except as stated in paragraph 7#b71 this ,act supersedes and applies to all ,federal law1 and the implementation of that law1 whether statutory or otherwise1 and whether adopted before or after the date of enactment of this ,act1 notwithstanding any other provision of ,federal law1 including the ,religious ,freedom ,restoration ,act of #aiic 7#db ,u4,s4,c4 #bjjj;bb et seq474 7#b7 ,limitations ,the provisions of this ,act shall not supersede or apply to-- 7,a7 laws regulating physical access to clinic entrances2 7,b7 insurance or medical assistance coverage of abortion services2 7,c7 the procedure described in section #aeca7;b77#a7 of title #ah1 ,united ,states ,code2 or 7,d7 generally applicable ,state contract law4 #e4 ,relationship to ,state law and preemption ,no ,state1 territory1 or possession of the ,united ,states1 or the ,district of ,columbia1 or the ,commonwealth of ,puerto ,rico1 or subdivision1 branch1 department1 agency1 instrumentality1 or official 7or other person acting under color of law7 of any of the forgoing1 shall enact or enforce any law1 rule1 regulation1 standard1 or other provision having the force and effect of law that conflicts with any provision of this ,act4 #f4 ,effective date ,this ,act shall take effect immediately upon the date of enactment of this ,act4 ,this ,act shall apply to all restrictions on the provision of1 or access to1 abortion services whether the restrictions are enacted or imposed prior to or after the date of enactment of this ,act1 except as otherwise provided in this ,act4 #g4 ,liberal construction 7a7 ,liberal construction ,in interpreting the provisions of this ,act1 a court shall liberally construe such provisions to effectuate the purposes of the ,act4 7b7 ,rule of construction ,nothing in this ,act shall be construed to authorize any government to interfere with a woman's ability to terminate her pregnancy1 to diminish or in any way negatively affect a woman's constitutional right to terminate her pregnancy1 or to displace any other remedy for violations of the constitutional right to terminate a pregnancy4 #h4 ,enforcement 7a7 ,attorney general ,the ,attorney ,general may commence a civil action for prospective injunctive relief on behalf of the ,united ,states against any government official that is charged with implementing or enforcing any limitation or requirement that is challenged as a violation of a statutory right under this ,act4 ,the court shall hold unlawful and set aside the limitation or requirement if it is in violation of this ,act4 7b7 ,private right of action 7#a7 ,in general ,any individual or entity1 including any health care provider1 aggrieved by an alleged violation of this ,act may commence a civil action for prospective injunctive relief against the government official that is charged with implementing or enforcing the limitation or requirement that is challenged as a violation of a statutory right under this ,act4 ,the court shall hold unlawful and set aside the limitation or requirement if it is in violation of this ,act4 7#b7 ,health care provider ,a health care provider may commence an action for prospective injunctive relief on its own behalf and_/or on behalf of the provider's patients who are or may be adversely affected by an alleged violation of this ,act4 7c7 ,equitable relief ,in any action under this section1 the court may award appropriate equitable relief1 including temporary1 preliminary1 or permanent injunctive relief4 7d7 ,costs ,in any action under this section1 the court shall award costs of litigation1 as well as reasonable attorney fees1 to any prevailing plaintiff4 ,a plaintiff shall not be liable to a defendant for costs in any non-frivolous action under this section4 7e7 ,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 administrative or other remedies that may be provided for by law4 7f7 ,abrogation of state immunity ,a ,state shall not be immune under the ,eleventh ,amendment to the ,constitution of the ,united ,states from an action in ,federal or ,state court of competent jurisdiction for a violation of this ,act4 ,in any action against a ,state for a violation of the requirements of this ,act1 remedies 7including remedies both at law and in equity7 are available for such a violation to the same extent as such remedies are available for such a violation in an action against any public or private entity other than a ,state4 #i4 ,severability ,if any provision of this ,act1 or the application of such provision to any person1 entity1 government1 or circumstance1 is held to be unconstitutional1 the remainder of this ,act1 or the application of such provision to all other persons1 entities1 governments1 or circumstances1 shall not be affected thereby4