,i #aaith ,,congress #ast ,session ,h4 ,r4 #ab ,,in ,,the ,,house ,,of ,,representatives ,june #bd1 #bjbe ,ms4 ,chu 7for herself1 ,ms4 ,lois ,frankel of ,florida1 ,ms4 ,pressley1 ,ms4 ,escobar1 ,ms4 ,adams1 ,mr4 ,aguilar1 ,mr4 ,amo1 ,ms4 ,ansari1 ,mr4 ,auchincloss1 ,ms4 ,balint1 ,ms4 ,barragn1 ,mrs4 ,beatty1 ,mr4 ,bell1 ,mr4 ,bera1 ,mr4 ,beyer1 ,mr4 ,bishop1 ,ms4 ,bonamici1 ,mr4 ,boyle of ,pennsylvania1 ,ms4 ,brown1 ,ms4 ,brownley1 ,ms4 ,budzinski1 ,ms4 ,bynum1 ,mr4 ,carbajal1 ,mr4 ,carter of ,louisiana1 ,mr4 ,casar1 ,mr4 ,case1 ,mr4 ,casten1 ,ms4 ,castor of ,florida1 ,mr4 ,castro of ,texas1 ,mrs4 ,cherfilus-,mc,cormick1 ,ms4 ,clark of ,massachusetts1 ,ms4 ,clarke of ,new ,york1 ,mr4 ,cleaver1 ,mr4 ,cohen1 ,mr4 ,conaway1 ,mr4 ,costa1 ,ms4 ,craig1 ,ms4 ,crockett1 ,mr4 ,crow1 ,ms4 ,davids of ,kansas1 ,mr4 ,davis of ,illinois1 ,ms4 ,dean of ,pennsylvania1 ,ms4 ,de,gette1 ,ms4 ,de,lauro1 ,ms4 ,del,bene1 ,mr4 ,deluzio1 ,mr4 ,de,saulnier1 ,ms4 ,dexter1 ,mrs4 ,dingell1 ,mr4 ,doggett1 ,ms4 ,elfreth1 ,mr4 ,evans of ,pennsylvania1 ,mr4 ,fields1 ,mrs4 ,fletcher1 ,mr4 ,foster1 ,mrs4 ,foushee1 ,ms4 ,friedman1 ,mr4 ,frost1 ,mr4 ,garamendi1 ,ms4 ,garcia of ,texas1 ,mr4 ,garcia of ,california1 ,mr4 ,garca of ,illinois1 ,ms4 ,perez1 ,mr4 ,golden of ,maine1 ,mr4 ,goldman of ,new ,york1 ,mr4 ,gomez1 ,ms4 ,goodlander1 ,mr4 ,gottheimer1 ,mr4 ,green of ,texas1 ,mrs4 ,hayes1 ,mr4 ,himes1 ,mr4 ,horsford1 ,ms4 ,houlahan1 ,ms4 ,hoyle of ,oregon1 ,mr4 ,huffman1 ,mr4 ,ivey1 ,ms4 ,jacobs1 ,ms4 ,jayapal1 ,mr4 ,jeffries1 ,ms4 ,johnson of ,texas1 ,mr4 ,johnson of ,georgia1 ,ms4 ,kamlager-,dove1 ,ms4 ,kaptur1 ,mr4 ,keating1 ,ms4 ,kelly of ,illinois1 ,mr4 ,kennedy of ,new ,york1 ,mr4 ,khanna1 ,mr4 ,krishnamoorthi1 ,mr4 ,landsman1 ,mr4 ,larsen of ,washington1 ,mr4 ,larson of ,connecticut1 ,mr4 ,latimer1 ,ms4 ,lee of ,pennsylvania1 ,ms4 ,lee of ,nevada1 ,ms4 ,leger ,fernandez1 ,mr4 ,levin1 ,mr4 ,liccardo1 ,mr4 ,lieu1 ,ms4 ,lofgren1 ,mr4 ,lynch1 ,mr4 ,magaziner1 ,mr4 ,mannion1 ,ms4 ,matsui1 ,mrs4 ,mc,bath1 ,ms4 ,mc,bride1 ,mrs4 ,mc,clain ,delaney1 ,ms4 ,mc,clellan1 ,ms4 ,mc,donald ,rivet1 ,mr4 ,mc,garvey1 ,mr4 ,mc,govern1 ,mrs4 ,mc,iver1 ,mr4 ,meeks1 ,mr4 ,menendez1 ,ms4 ,meng1 ,mr4 ,mfume1 ,ms4 ,moore of ,wisconsin1 ,mr4 ,morelle1 ,ms4 ,morrison1 ,mr4 ,moskowitz1 ,mr4 ,moulton1 ,mr4 ,mrvan1 ,mr4 ,mullin1 ,mr4 ,nadler1 ,mr4 ,norcross1 ,ms4 ,norton1 ,ms4 ,ocasio-,cortez1 ,mr4 ,olszewski1 ,ms4 ,omar1 ,mr4 ,pallone1 ,mr4 ,panetta1 ,mr4 ,pappas1 ,ms4 ,pelosi1 ,mr4 ,peters1 ,ms4 ,pettersen1 ,ms4 ,pingree1 ,mr4 ,pocan1 ,ms4 ,pou1 ,mr4 ,quigley1 ,mrs4 ,ramirez1 ,mr4 ,raskin1 ,mr4 ,riley of ,new ,york1 ,ms4 ,rivas1 ,ms4 ,ross1 ,mr4 ,ruiz1 ,mr4 ,ryan1 ,ms4 ,salinas1 ,ms4 ,scanlon1 ,ms4 ,schakowsky1 ,mr4 ,schneider1 ,ms4 ,scholten1 ,ms4 ,schrier1 ,mr4 ,scott of ,virginia1 ,mr4 ,david ,scott of ,georgia1 ,ms4 ,sewell1 ,mr4 ,sherman1 ,ms4 ,sherrill1 ,ms4 ,simon1 ,mr4 ,smith of ,washington1 ,mr4 ,sorensen1 ,mr4 ,soto1 ,ms4 ,stansbury1 ,mr4 ,stanton1 ,ms4 ,stevens1 ,ms4 ,strickland1 ,mr4 ,subramanyam1 ,mr4 ,swalwell1 ,mrs4 ,sykes1 ,mr4 ,takano1 ,mr4 ,thanedar1 ,mr4 ,thompson of ,california1 ,mr4 ,thompson of ,mississippi1 ,ms4 ,titus1 ,ms4 ,tlaib1 ,ms4 ,tokuda1 ,mr4 ,tonko1 ,mrs4 ,torres of ,california1 ,mrs4 ,trahan1 ,mr4 ,tran1 ,ms4 ,underwood1 ,mr4 ,vargas1 ,mr4 ,vasquez1 ,mr4 ,veasey1 ,ms4 ,velzquez1 ,mr4 ,vindman1 ,ms4 ,wasserman ,schultz1 ,mrs4 ,watson ,coleman1 ,mr4 ,whitesides1 ,ms4 ,williams of ,georgia1 ,ms4 ,wilson of ,florida1 ,mr4 ,torres of ,new ,york1 ,mr4 ,correa1 ,mr4 ,espaillat1 ,ms4 ,gillen1 ,mr4 ,min1 ,mr4 ,courtney1 ,mr4 ,cisneros1 ,ms4 ,snchez1 ,mr4 ,neguse1 ,ms4 ,waters1 and ,ms4 ,mc,collum7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on the ,judiciary1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,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 #bjbe4 #b4 ,findings ,congress finds the following3 7#a7 ,abortion services are essential health care1 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 ,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#c7 ,abortion care1 like all health care1 is a human right that should not depend on one's ,,zip ,code or region1 age1 actual or perceived race1 national origin1 immigration status1 sex1 or disability status4 ,unfortunately1 this is the current reality for millions1 creating a patchwork of abortion access across the ,united ,states4 ,protecting the right to determine whether to continue or end a pregnancy1 and the right of health care providers to provide abortion care1 is necessary and essential to achieving this human right1 and ultimately reproductive justice4 7#d7 ,on ,june #bd1 #bjbb1 in its decision in ,dobbs v4 ,jackson ,women's ,health ,organization1 the ,supreme ,court overruled ,roe v4 ,wade1 reversing decades of precedent recognizing a constitutional right to terminate a pregnancy before fetal viability4 7#e7 ,the effects of the ,dobbs decision were immediate and disastrous4 ,in the aftermath of the ,dobbs decision1 many ,states imposed near-total bans on abortion4 ,within #ajj days of the ruling1 #ff clinics across #ae ,states were forced to stop offering abortions4 ,as of ,january #bjbe1 abortion is unavailable in #ad ,states1 leaving #ag4ih million women of reproductive age 7ages #ae to #di7 as well as transgender and gender nonconforming individuals without access to abortion in their home ,state4 7#f7 ,travel time to an abortion clinic1 already a burden for abortion seekers under ,roe1 has quadrupled since ,dobbs4 ,as distance to an abortion facility increases1 so do the accompanying 7and potentially prohibitive7 burdens of time off work or school1 lost wages1 transportation costs1 lodging1 child care costs1 and other ancillary costs4 7#g7 ,even before the ,dobbs decision1 access to abortion services had long been obstructed across the ,united ,states in various ways1 including3 prohibitions of1 and restrictions on1 insurance coverage2 mandatory parental involvement laws2 restrictions that shame and stigmatize people seeking abortion services2 and medically unnecessary regulations that fail to further the safety of abortion services1 but instead cause harm people by delaying1 complicating access to1 and reducing the availability of1 abortion services4 7#h7 ,being denied an abortion can have serious consequences for people's physical1 mental1 and economic health and well-being1 and that of their families4 ,according to the ,turnaway ,study1 a longitudinal study published by ,advancing ,new ,standards ,in ,reproductive ,health 7,,ansirh7 in #bjai1 individuals who are denied a wanted abortion are more likely to experience economic insecurity than individuals who receive a wanted abortion4 ,after following participants for five years1 the study found that people who were denied abortion care were more likely to live in poverty1 experience debt1 and have lower credit scores for several years after the denial4 ,these findings demonstrate that when people have control over when to have children and how many children to have1 their children benefit through increased economic security and better maternal bonding4 7#i7 ,abortion bans and restrictions have repercussions for a broad range of health care beyond pregnancy termination1 including exacerbating the existing maternal health crisis facing the ,united ,states4 ,the ,united ,states has the highest maternal mortality rate of any industrialized nation1 and ,black women and birthing people face three times the risk of dying from pregnancy-related causes as their white counterparts4 ,even prior to ,dobbs1 research found that ,states that enacted abortion restrictions based on gestation increased their maternal mortality rate by #ch percent4 ,research has found that a nationwide ban would increase the ,united ,states maternal mortality rate by an additional #bd percent4 ,furthermore1 ,states that have banned1 are planning to ban1 or have severely restricted abortion care have fewer maternal health providers1 more maternity-care deserts1 higher rates of both maternal and infant mortality1 and greater racial inequity in health care4 7#aj7 ,abortion bans and restrictions additionally harm people's health by reducing access 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 care1 and adoption services4 7#aa7 ,this ripple effect has only worsened since the ,dobbs decision4 ,clinicians and pharmacists have denied access to essential medication for conditions1 including gastric ulcers and autoimmune diseases1 because those drugs are also used for medication abortion care4 ,patients are reporting being denied or delayed in their receipt of necessary and potentially lifesaving treatment for ectopic pregnancies and miscarriage management because of the newfound legal risks facing providers4 7#ab7 ,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 sterilizations1 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 ,latina_/x1 ,asian-,american and ,pacific ,islander1 and ,people of ,color 7,,bipoc7 and their families4 7#ac7 ,the legacy of restrictions on reproductive health1 rights1 and justice is not a dated vestige of a dark history4 ,data show the harms of abortion-specific restrictions fall especially heavily on people with low incomes1 people of color1 immigrants1 young people1 people with disabilities1 and those living in rural and other medically underserved areas4 ,abortion bans and restrictions are compounded further by the ongoing criminalization of people who are pregnant1 including those who are incarcerated1 living with ,,hiv1 or with substance-use disorders4 ,these populations already experience health disparities due to social1 political1 and environmental inequities1 and restrictions on abortion services exacerbate these harms4 ,removing bans and 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#ad7 ,abortion bans and restrictions are tools of gender oppression1 as they target health care services that are used primarily by women4 ,these paternalistic bans and restrictions rely on and reinforce harmful stereotypes about gender roles and women's decisionmaking1 undermining their ability to control their own lives and well-being4 ,these restrictions harm the basic autonomy1 dignity1 and equality of women4 7#ae7 ,the terms woman and women are used in this bill to reflect the identity of the majority of people targeted and most directly affected by bans and restrictions on abortion services1 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 nonbinary individuals1 those who identify with a different gender1 and others--who are unjustly harmed by restrictions on abortion services4 7#af7 ,pregnant individuals will continue to experience a range of pregnancy outcomes1 including abortion1 miscarriage1 stillbirths1 and infant losses regardless of how the ,state attempts to exert power over their reproductive decisionmaking1 and will continue to need support for their health and well-being through their reproductive lifespans4 7#ag7 ,evidence from the ,united ,states and around the globe bears out that criminalizing abortion invariably leads to arrests1 investigations1 and imprisonment of people who end their pregnancies or experience pregnancy loss1 leading to violations of fundamental rights to liberty1 dignity1 bodily autonomy1 equality1 due process1 privacy1 health1 and freedom from cruel and inhumane treatment4 7#ah7 ,all major experts in public health and medicine1 such as the ,american ,medical ,association1 ,american ,public ,health ,association1 ,american ,academy of ,pediatrics1 ,american ,society of ,addiction ,medicine1 and ,american ,college of ,obstetricians and ,gynecologists1 oppose the criminalization of pregnancy outcomes because the threat of being subject to investigation or punishment through the criminal legal system when seeking health care threatens pregnant people's lives and undermines public health by deterring people from seeking care for obstetrical emergencies4 7#ai7 ,anti-abortion stigma that is compounded by abortion bans and restrictions also contributes to violence and harassment that put both people seeking and people providing abortion care at risk4 ,from #aigg to #bjbb1 there were #aa murders1 #db bombings1 #bjj acts of arson1 #eca assaults1 #cge burglaries1 and thousands of other incidents of criminal activity directed at abortion seekers1 providers1 volunteers1 and clinic staff4 ,this violence existed under ,roe and has been steadily escalating for years4 ,the presence of dangerous protestors and organized extremists acts as yet another barrier to abortion care1 and this threat has become even more urgent as abortion bans proliferate and stigma around abortion care increases4 7#bj7 ,abortion is 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 ,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 ,such abortion-specific restrictions1 as well as broader ,state bans1 conflict with medical standards and are not supported by the recommendations and guidelines issued by leading reproductive health care professional organizations1 including the ,american ,college of ,obstetricians and ,gynecologists1 the ,society of ,family ,planning1 the ,national ,abortion ,federation1 the ,world ,health ,organization1 and others4 7#ba7 ,for over #bj years1 medication abortion care has been available in the ,united ,states as a safe1 effective1 ,food and ,drug ,administration 7,,fda7-approved treatment to end an early pregnancy4 ,today1 medication abortion care accounts for #fc percent of all pregnancy terminations in the ,united ,states2 however1 significant barriers to access remain in place1 particularly in ,states that have imposed onerous restrictions that conflict with ,,fda's regulation of medication abortion4 ,additionally1 opponents of abortion are now deploying new tactics to limit access to this ,,fda-approved medication that would set a dangerous precedent for the ,federal regulation of medication products and have national repercussions4 7#bb7 ,health care providers are subject to licensing laws in various jurisdictions1 which are not affected by this ,act except as expressly provided in this ,act4 7#bc7 ,international human rights law recognizes that access to abortion is intrinsically linked to the rights to life1 health1 equality and nondiscrimination1 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 condemned criminalization of abortion and medically unnecessary barriers to abortion services1 including mandatory waiting periods1 biased counseling requirements1 and third-party authorization requirements4 7#bd7 ,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 ,international ,covenant on ,civil and ,political ,rights 7,,iccpr71 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 are at risk1 or when carrying a pregnancy to term would otherwise cause substantial pain or suffering4 ,the ,committee stated that governments must not impose restrictions on abortion that 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 ,the ,committee stated that governments should not apply criminal sanctions to women and girls who undergo abortion or to medical service providers who assist them in doing so4 ,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#be7 ,international human rights experts have condemned the ,dobbs decision and regression on abortion rights in the ,united ,states more generally as a violation of human rights4 ,immediately upon release of the decision1 then-,,un ,high ,commissioner for ,human ,rights ,michelle ,bachelet reiterated human rights protections for abortion and the impact that the decision will have on the fundamental rights of millions within the ,united ,states1 particularly people with low incomes and people belonging to racial and ethnic minorities4 ,,un independent human rights experts1 including the ,,un ,working ,group on discrimination against women and girls1 the ,,un ,special ,rapporteur on the right to health1 and the ,,un ,special ,rapporteur on violence against women and girls1 similarly denounced the decision4 ,at the conclusion of a human rights review of the ,united ,states in ,august #bjbb1 the ,,un ,committee on the ,elimination of ,racial ,discrimination noted deep concerns with the ,dobbs decision and recommended that the ,united ,states address the disparate impact that it will have on racial and ethnic minorities1 ,indigenous women1 and those with low incomes4 7#bf7 ,abortion bans and 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 care4 ,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#bg7 ,legal limitations and requirements imposed upon health care providers or patients invariably affect commerce over which the ,united ,states has jurisdiction4 ,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#bh7 ,abortion bans and 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 commerce1 including by traveling across ,state lines4 ,individuals engage in interstate commerce by obtaining abortion services1 including medicine and telemedicine services offered in the interstate market1 and traveling across ,state lines to obtain abortion services or assist others in obtaining such services4 7#bi7 ,as a result of the ,dobbs decision and attendant increase in abortion prohibitions and restrictions in a subset of ,states1 there has been a significant increase in the burden on interstate commerce4 ,in just the first calendar year after ,dobbs1 an estimated #aga1jjj people traveled across ,state lines to obtain abortion care1 more than doubling the estimated #gc1ajj people that traveled across ,state lines in #bjai4 7#cj7 ,congress has the authority to enact this ,act to protect access to 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#ca7 ,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#cb7 ,congressional action is necessary to put an end to harmful restrictions1 to protect access to abortion services for everyone regardless of where they live1 to protect the ability of health care providers to provide these services in a safe and accessible manner1 and to eliminate unwarranted burdens on commerce and the right to travel4 #c4 ,purposes ,the purposes of this ,act are as follows3 7#a7 ,to permit people to seek and obtain abortion services1 and to permit health care providers to provide abortion services1 without harmful or unwarranted limitations or requirements that-- 7,a7 single out the provision of abortion services for restrictions that are more burdensome than those restrictions imposed on medically comparable procedures2 7,b7 do not1 on the basis of the weight of established clinical practice guidelines consistent with medical evidence1 significantly advance reproductive health or the safety of abortion services2 or 7,c7 make abortion services more difficult to access4 7#b7 ,to promote access to abortion services and thereby protect women's ability to participate equally in the economic and social life of the ,united ,states4 7#c7 ,to protect people's ability to make decisions about their bodies1 medical care1 family1 and life's course4 7#d7 ,to eliminate unwarranted burdens on commerce and the right to travel4 ,abortion bans and restrictions invariably affect commerce over which the ,united ,states has jurisdiction4 ,health care providers engage in economic and commercial activity when they provide abortion services4 ,moreover1 there is an interstate market for abortion services and1 in order to provide such services1 health care providers engage in interstate commerce to purchase medicine1 medical equipment1 and other necessary goods and services2 to obtain and provide training2 and to employ and obtain commercial services from health care personnel1 many of whom themselves engage in interstate commerce1 including by traveling across ,state lines4 ,individuals engage in the interstate market by purchasing abortion services1 including the purchase1 use1 and consumption of medicine1 medical equipment1 and other necessary goods and services transited in the stream of interstate commerce1 the receipt of telemedicine services1 and traveling across ,state lines to purchase and receive abortion services or assist others in purchasing or receiving such services4 ,the increase in abortion prohibitions and restrictions in a subset of ,states since #bjbb cause women to travel to other ,states for abortion care1 which1 in turn1 affects the health care systems of those ,states that provide the treatment and has exponentially increased the burden on interstate commerce and the instrumentalities of interstate commerce4 ,congress has the authority to enact this ,act to protect access to 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 #d4 ,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 7including any hospital1 clinic1 or pharmacy 7whether physical1 mobile1 or virtual77 or individual 7including any physician1 certified nurse-midwife1 nurse practitioner1 advanced practice clinician1 registered nurse1 pharmacist1 or physician assistant7 that-- 7,a7 is engaged or seeks to engage 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 services-- 7i7 is so licensed or certified2 or 7ii7 would be so licensed or certified but for their past1 present1 or potential provision of abortion services protected by section #e4 7#d7 ,medically comparable procedures ,the term medically comparable procedures means medical procedures that are similar1 on the basis of the established clinical practice guidelines consistent with medical evidence1 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 and 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 #e4 ,protected activities and services 7a7 ,general rules 7#a7 ,pre-viability ,a health care provider has a right under this ,act to provide such abortion services1 and a patient has a corresponding right under this ,act to terminate a pregnancy prior to viability1 without being subject to any of the following limitations or requirements3 7,a7 ,a prohibition on abortion prior to viability1 including a prohibition or restriction on a particular abortion procedure or method1 or a prohibition on providing or obtaining such abortions4 7,b7 ,a limitation on a health care provider's ability to prescribe or dispense drugs that could be used for reproductive health purposes based on current evidence-based regimens or the provider's good-faith medical judgment1 or a limitation on a patient's ability to receive or use such drugs1 other than a limitation generally applicable to the prescription1 dispensing1 or distribution of drugs4 7,c7 ,a limitation on a health care provider's ability to provide1 or a patient's ability to receive1 abortion services via telemedicine1 other than a limitation generally applicable to the provision of medically comparable services via telemedicine4 7,d7 ,a limitation or prohibition on a patient's ability to receive1 or a provider's ability to provide1 abortion services in a ,state based on the ,state of residency of the patient1 or a prohibition or limitation on the ability of any individual to assist or support a patient seeking abortion4 7,e7 ,a requirement that a health care provider perform specific tests or medical procedures in connection with the provision of abortion services 7including prior to or subsequent to the abortion71 unless such tests or procedures are standard to established clinical practice guidelines consistent with medical evidence pertaining to abortion services4 7,f7 ,a requirement that a health care provider offer or provide a patient seeking abortion services medically inaccurate information that is not compatible with established clinical practice guidelines4 7,g7 ,a limitation or requirement 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,h7 ,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,i7 ,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 life or health4 7,j7 ,a requirement that a patient seeking abortion services at any point or points in time prior to viability disclose the patient's reason or reasons for seeking abortion services1 or a limitation on providing or obtaining abortion services at any point or points in time prior to 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 actual or constructive knowledge of such reason or reasons4 7#b7 ,post-viability 7,a7 ,in general ,a health care provider has a right under this ,act to provide abortion services and a patient has a corresponding right under this ,act to terminate a pregnancy after viability when1 in the good-faith medical judgement of the treating health care provider1 it is necessary to protect the life or health of the patient4 ,this subparagraph shall not otherwise apply after viability4 7,b7 ,additional circumstances ,a ,state may provide additional circumstances under which post-viability abortions are permitted4 7,c7 ,limitation ,in the case where a termination of a pregnancy after viability1 in the good-faith medical judgement of the treating health care provider1 is necessary to protect the life or health of the patient1 none of the limitations or requirements described in paragraph 7#a7 shall be imposed by law4 7b7 ,other limitations or requirements ,the rights described in subsection 7a7 shall not be limited or otherwise infringed through any other limitation or requirement that-- 7#a7 expressly1 effectively1 implicitly1 or as implemented1 targets abortion1 the provision of abortion services1 individuals who seek abortion services or who provide assistance and support to those seeking 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 ,a court may consider the following factors1 among others1 in determining whether a limitation or requirement impedes access to abortion services for purposes of subsection 7b77#b73 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 a patient 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 such as costs associated with travel1 child care1 or time off work4 7#d7 ,whether the limitation or requirement is reasonably likely to have the effect of necessitating patient travel that would not otherwise have been required1 including by making it necessary for a patient to travel out of ,state to obtain services4 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 limitations or requirements4 7d7 ,exception ,to defend against a claim that a limitation or requirement violates a health care provider's or patient's rights under subsection 7b7 a party must establish1 by clear and convincing evidence1 that the limitation or requirement is essential to significantly advance the safety of abortion services or the health of patients and that the safety or health objective cannot be accomplished by a different means that does not interfere with the right protected under subsection 7b74 #f4 ,protection of the right to travel ,a person has a fundamental right under the ,constitution of the ,united ,states and this ,act to travel to a ,state other than the person's ,state of residence1 including to obtain reproductive health services such as prenatal1 childbirth1 fertility1 and abortion services1 and a person has a right under this ,act to assist another person to obtain such services or otherwise exercise the right described in this section4 #g4 ,applicability and preemption 7a7 ,in general 7#a7 ,superseding inconsistent laws ,except as provided under subsection 7b71 this ,act shall supersede any inconsistent ,federal or ,state law1 and the implementation of such law1 whether statutory1 common law1 or otherwise1 and whether adopted prior to or after the date of enactment of this ,act4 ,a ,federal or ,state government official shall not 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 ,laws after date of enactment ,federal law enacted after the date of the enactment of this ,act shall be 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 entrances1 such as the ,freedom of ,access to ,clinic ,entrances ,act of #aiid 7#ah ,u4,s4,c4 #bdh72 7#b7 laws regulating 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 ,preemption defense ,in any legal or administrative action against a person or entity who has exercised or attempted to exercise a right protected by section #e or #f or against any person or entity who has taken any step to assist any such person or entity in exercising such right1 this ,act shall also apply to1 and may be raised as a defense by1 such person or entity1 in addition to the remedies specified in section #i4 #h4 ,rules of construction 7a7 ,liberal construction by courts ,in any action before a court under this ,act1 the court shall liberally construe the provisions of this ,act to effectuate the purposes of the ,act4 7b7 ,protection of life and health ,nothing in this ,act shall be construed to authorize any government official to interfere with1 diminish1 or negatively affect a person's ability to obtain or provide abortion services prior to viability1 or after 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 7c7 ,government officials ,any person who1 by operation of a provision of ,federal or ,state law1 including through the grant of a private cause of action1 is permitted to implement or enforce a limitation or requirement that violates section #e or #f shall be considered a government official for purposes of this ,act4 #i4 ,enforcement 7a7 ,attorney ,general ,the ,attorney ,general may commence a civil action on behalf of the ,united ,states in any district court of the ,united ,states against any ,state that violates1 or against any government official 7including a person described in section #h7;c77 who implements or enforces a limitation or requirement that violates1 section #e or #f4 ,the court shall declare unlawful the limitation or requirement if it is determined to be in violation of this ,act4 7b7 ,private right of action 7#a7 ,in general ,any individual or entity adversely affected by an alleged violation of this ,act1 including any person or health care provider1 may commence a civil action against any government official 7including a person described in section 7c77 that implements or enforces a limitation or requirement that violates section #e or #f4 ,the court shall declare unlawful the limitation or requirement if it is determined to be 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 ,pre-,enforcement challenges ,a suit under subsection 7a7 or 7b7 may be brought to prevent enforcement or implementation of a ,state limitation or requirement that is inconsistent with section #e or #f4 7d7 ,declaratory and equitable relief ,in any action under this section1 the court may award appropriate declaratory and equitable relief1 including temporary1 preliminary1 or permanent injunctive relief4 7e7 ,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 7f7 ,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 7g7 ,abrogation of ,state immunity ,neither a ,state that enforces or maintains1 nor a government official 7including a person described in section #h7;c77 who is permitted to implement or enforce any limitation or requirement that violates section #e or #f 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 requirement1 unless such immunity is required by clearly established ,federal law1 as determined by the ,supreme ,court of the ,united ,states4 #aj4 ,effective date ,this ,act shall take effect upon the date of enactment of this ,act4 #aa4 ,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