,,ii ,calendar ,no4 #aci #aagth ,,congress #ast ,session ,h4 ,r4 #cgee ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #bg1 #bjba,received ,september #bh1 #bjba,read the first time ,september #bi1 #bjba,read the second time and placed on the calendar ,,an ,,act ,to protect a person's ability to determine whether to continue or end a pregnancy1 and to protect a health care provider's ability to provide abortion services4 #a4 ,short title ,this ,act may be cited as the ,women's ,health ,protection ,act of #bjba4 #b4 ,findings and purpose 7a7 ,findings ,congress finds the following3 7#a7 ,abortion services are essential to health care and access to those services is central to people's ability to participate equally in the economic and social life of the ,united ,states4 ,abortion access allows people who are pregnant to make their own decisions about their pregnancies1 their families1 and their lives4 7#b7 ,since #aigc1 the ,supreme ,court repeatedly has recognized the constitutional right to terminate a pregnancy before fetal viability1 and to terminate a pregnancy after fetal viability where it is necessary1 in the good-faith medical judgment of the treating health care professional1 for the preservation of the life or health of the person who is pregnant4 7#c7 ,nonetheless1 access to abortion services has been obstructed across the ,united ,states in various ways1 including blockades of health care facilities and associated violence1 prohibitions of1 and restrictions on1 insurance coverage2 parental involvement laws 7notification and consent72 restrictions that shame and stigmatize people seeking abortion services2 and medically unnecessary regulations that neither confer any health benefit nor further the safety of abortion services1 but which harm people by delaying1 complicating access to1 and reducing the availability of1 abortion services4 7#d7 ,reproductive justice requires every individual to have the right to make their own decisions about having children regardless of their circumstances and without interference and discrimination4 ,reproductive ,justice is a human right that can and will be achieved when all people1 regardless of actual or perceived race1 color1 national origin1 immigration status1 sex 7including gender identity1 sex stereotyping1 or sexual orientation71 age1 or disability status have the economic1 social1 and political power and resources to define and make decisions about their bodies1 health1 sexuality1 families1 and communities in all areas of their lives1 with dignity and self-determination4 7#e7 ,reproductive justice seeks to address restrictions on reproductive health1 including abortion1 that perpetuate systems of oppression1 lack of bodily autonomy1 white supremacy1 and anti-,black racism4 ,this violent legacy has manifested in policies including enslavement1 rape1 and experimentation on ,black women2 forced sterilizations2 medical experimentation on low-income women's reproductive systems2 and the forcible removal of ,indigenous children4 ,access to equitable reproductive health care1 including abortion services1 has always been deficient in the ,united ,states for ,black1 ,indigenous1 and other ,people of ,color 7,,bipoc7 and their families4 7#f7 ,the legacy of restrictions on reproductive health1 rights1 and justice is not a dated vestige of a dark history4 ,presently1 the harms of abortion-specific restrictions fall especially heavily on people with low incomes1 ,,bipoc1 immigrants1 young people1 people with disabilities1 and those living in rural and other medically underserved areas4 ,abortion-specific restrictions are even more compounded by the ongoing criminalization of people who are pregnant1 including those who are incarcerated1 living with ,,hiv1 or with substance-use disorders4 ,these communities already experience health disparities due to social1 political1 and environmental inequities1 and restrictions on abortion services exacerbate these harms4 ,removing medically unjustified restrictions on abortion services would constitute one important step on the path toward realizing ,reproductive ,justice by ensuring that the full range of reproductive health care is accessible to all who need it4 7#g7 ,abortion-specific restrictions are a tool of gender oppression1 as they target health care services that are used primarily by women4 ,these paternalistic restrictions rely on and reinforce harmful stereotypes about gender roles1 women's decision-making1 and women's need for protection instead of support1 undermining their ability to control their own lives and well-being4 ,these restrictions harm the basic autonomy1 dignity1 and equality of women1 and their ability to participate in the social and economic life of the ,nation4 7#h7 ,the terms 8woman0 and 8women0 are used in this bill to reflect the identity of the majority of people targeted and affected by restrictions on abortion services1 and to address squarely the targeted restrictions on abortion1 which are rooted in misogyny4 ,however1 access to abortion services is critical to the health of every person capable of becoming pregnant4 ,this ,act is intended to protect all people with the capacity for pregnancy--cisgender women1 transgender men1 non-binary individuals1 those who identify with a different gender1 and others--who are unjustly harmed by restrictions on abortion services4 7#i7 ,since #bjaa1 ,states and local governments have passed nearly #ejj restrictions singling out health care providers who offer abortion services1 interfering with their ability to provide those services and the patients' ability to obtain those services4 7#aj7 ,many ,state and local governments have imposed restrictions on the provision of abortion services 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#aa7 ,abortion is essential health care and one of the safest medical procedures in the ,united ,states4 ,an independent1 comprehensive review of the state of science on the safety and quality of abortion services1 published by the ,national ,academies of ,sciences1 ,engineering1 and ,medicine in #bjah1 found that abortion in the ,united ,states 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#ab7 ,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 people's personal and private medical decisions to end their pregnancies by making access to abortion services more difficult1 invasive1 and costly1 often forcing people 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#ac7 ,an overwhelming majority of abortions in the ,united ,states are provided in clinics1 not hospitals1 but the large majority of counties throughout the ,united ,states have no clinics that provide abortion4 7#ad7 ,these restrictions additionally harm people's health by reducing access not only to abortion services but also to other essential health care services offered by many of the providers targeted by the restrictions1 including-- 7,a7 screenings and preventive services1 including contraceptive services2 7,b7 testing and treatment for sexually transmitted infections2 7,c7 ,,lgbtq health services2 and 7,d7 referrals for primary care1 intimate partner violence prevention1 prenatal care and adoption services4 7#ae7 ,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 seven 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#af7 ,international human rights law recognizes that access to abortion is intrinsically linked to the rights to life1 health1 equality and non-discrimination1 privacy1 and freedom from ill-treatment4 ,united ,nations 7,,un7 human rights treaty monitoring bodies have found that legal abortion services1 like other reproductive health care services1 must be available1 accessible1 affordable1 acceptable1 and of good quality4 ,,un human rights treaty bodies have likewise condemned medically unnecessary barriers to abortion services1 including mandatory waiting periods1 biased counseling requirements1 and third-party authorization requirements4 7#ag7 ,core human rights treaties ratified by the ,united ,states protect access to abortion4 ,for example1 in #bjah1 the ,,un ,human ,rights ,committee1 which oversees implementation of the ,,iccpr1 made clear that the right to life1 enshrined in ,article #f of the ,,iccpr1 at a minimum requires governments to provide safe1 legal1 and effective access to abortion where a person's life and health is at risk1 or when carrying a pregnancy to term would cause substantial pain or suffering4 ,the ,committee stated that governments must not impose restrictions on abortion which subject women and girls to physical or mental pain or suffering1 discriminate against them1 arbitrarily interfere with their privacy1 or place them at risk of undertaking unsafe abortions4 ,furthermore1 the ,committee stated that governments should remove existing barriers that deny effective access to safe and legal abortion1 refrain from introducing new barriers to abortion1 and prevent the stigmatization of those seeking abortion4 7#ah7 ,,un independent human rights experts have expressed particular concern about barriers to abortion services in the ,united ,states4 ,for example1 at the conclusion of his #bjag visit to the ,united ,states1 the ,,un ,special ,rapporteur on extreme poverty and human rights noted concern that low-income women face legal and practical obstacles to exercising their constitutional right to access abortion services1 trapping many women in cycles of poverty4 ,similarly1 in ,may #bjbj1 the ,,un ,working ,group on discrimination against women and girls1 along with other human rights experts1 expressed concern that some states had manipulated the ,,covid-#ai crisis to restrict access to abortion1 which the experts recognized as 8the latest example illustrating a pattern of restrictions and retrogressions in access to legal abortion care across the country0 and reminded ,u4,s4 authorities that abortion care constitutes essential health care that must remain available during and after the pandemic4 ,they noted that barriers to abortion access exacerbate systemic inequalities and cause particular harm to marginalized communities1 including low-income people1 people of color1 immigrants1 people with disabilities1 and ,,lgbtq people4 7#ai7 ,abortion-specific restrictions affect the cost and availability of abortion services1 and the settings in which abortion services are delivered4 ,people travel across ,state lines and otherwise engage in interstate commerce to access this essential 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 abortion services to patients1 and more would be forced to do so absent this ,act4 7#bj7 ,health care providers engage in a form of economic and commercial activity when they provide abortion services1 and there is an interstate market for abortion services4 7#ba7 ,abortion restrictions substantially affect interstate commerce in numerous ways4 ,for example1 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 7#bb7 ,it is difficult and time and resource-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 similarly burdensome 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 unduly burden abortion services4 7#bc7 ,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#bd7 ,health care providers are subject to license laws in various jurisdictions1 which are not affected by this ,act except as provided in this ,act4 7#be7 ,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#bf7 ,congress has used its authority in the past to protect access to 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#bg7 ,congressional action is necessary to put an end to harmful restrictions1 to federally protect access to abortion services for everyone regardless of where they live1 and to protect the ability of 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 reproductive health or the safety of abortion services1 and make abortion services more difficult to access2 7#b7 to promote access to abortion services 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 ,government ,the term government includes each branch1 department1 agency1 instrumentality1 and official of the ,united ,states or a ,state4 7#c7 ,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-- 7,a7 is engaged or seeks to engage in the delivery of health care services1 including abortion services1 and 7,b7 if required by law or regulation to be licensed or certified to engage in the delivery of such services-- 7i7 is so licensed or certified1 or 7ii7 would be so licensed or certified but for their past1 present1 or potential provision of abortion services permitted by section #d4 7#d7 ,medically comparable procedure ,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#e7 ,pregnancy ,the term pregnancy refers to the period of the human reproductive process beginning with the implantation of a fertilized egg4 7#f7 ,state ,the term ,state includes the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico1 and each territory and possession of the ,united ,states1 and any subdivision of any of the foregoing1 including any unit of local government1 such as a county1 city1 town1 village1 or other general purpose political subdivision of a ,state4 7#g7 ,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 at any point or points in time 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 at any point or points in time prior to fetal viability disclose the patient's reason or reasons for seeking abortion services1 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 actual1 perceived1 or potential reason or reasons of the patient for obtaining abortion services1 regardless of whether the limitation is based on a health care provider's degree of actual or constructive knowledge of such reason or reasons4 7b7 ,other ,limitations or ,requirements ,the statutory right specified in subsection 7a7 shall not be limited or otherwise infringed through1 in addition to the limitations and requirements specified in paragraphs 7#a7 through 7#aa7 of subsection 7a71 any 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 expressly1 effectively1 implicitly1 or as implemented 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 services4 7c7 ,factors ,for ,consideration ,factors a court may 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 requirement1 in a provider's good-faith medical judgment1 interferes with a health care provider's ability to provide care and render services1 or poses a risk to the patient's health or safety4 7#b7 ,whether the limitation or requirement is reasonably likely to delay or deter 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 #e4 ,applicability and preemption 7a7 ,in general 7#a7 ,except as stated under subsection 7b71 this ,act supersedes and applies to the law of the ,federal ,government and each ,state government1 and the implementation of such law1 whether statutory1 common law1 or otherwise1 and whether adopted before or after the date of enactment of this ,act1 and neither the ,federal ,government nor any ,state government shall administer1 implement1 or enforce any law1 rule1 regulation1 standard1 or other provision having the force and effect of law that conflicts with any provision 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 ,federal statutory law adopted after the date of the enactment of this ,act is subject to this ,act unless such law explicitly excludes such application by reference to this ,act4 7b7 ,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 7c7 ,defense ,in any cause of action against an individual or entity who is subject to a limitation or requirement that violates this ,act1 in addition to the remedies specified in section #h1 this ,act shall also apply to1 and may be raised as a defense by1 such an individual or entity4 #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 ,rules of construction 7a7 ,in ,general ,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 person's ability to terminate a pregnancy1 to diminish or in any way negatively affect a person's constitutional right to terminate a pregnancy1 or to displace any other remedy for violations of the constitutional right to terminate a pregnancy4 7c7 ,other ,individuals ,considered as ,government ,officials ,any person who1 by operation of a provision of ,federal or ,state law1 is permitted to implement or enforce a limitation or requirement that violates section #d of this ,act shall be considered a government official for purposes of this ,act4 #h4 ,enforcement 7a7 ,attorney ,general ,the ,attorney ,general may commence a civil action on behalf of the ,united ,states against any ,state that violates1 or against any government official 7including a person described in section #g7;c77 that implements or enforces a limitation or requirement that violates1 section #d4 ,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 provider or patient1 adversely affected by an alleged violation of this ,act1 may commence a civil action against any ,state that violates1 or against any government official 7including a person described in section #g7;c77 that implements or enforces a limitation or requirement that violates1 section #d4 ,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 relief on its own behalf1 on behalf of the provider's staff1 and 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's fees1 to any prevailing plaintiff4 ,a plaintiff shall not be liable to a defendant for costs or attorney's fees 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 ,neither a ,state that enforces or maintains1 nor a government official 7including a person described in section #g7;c77 who is permitted to implement or enforce any limitation or requirement that violates section #d shall be immune under the ,tenth ,amendment to the ,constitution of the ,united ,states1 the ,eleventh ,amendment to the ,constitution of the ,united ,states1 or any other source of law1 from an action in a ,federal or ,state court of competent jurisdiction challenging that limitation or requirement4 #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 ,passed the ,house of ,representatives ,september #bd1 #bjba4;,cheryl ,l4 ,johnson1,clerk ,september #bi1 #bjba,read the second time and placed on the calendar