,,ii #aaith ,,congress #ast ,session ,s4 #agef ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ad1 #bjbe,mr4 ,lankford 7for himself1 ,mr4 ,cramer1 ,mr4 ,rounds1 ,mr4 ,risch1 ,ms4 ,lummis1 ,mr4 ,daines1 ,mrs4 ,hyde-,smith1 ,mr4 ,budd1 ,mr4 ,hawley1 ,mr4 ,young1 ,mr4 ,ricketts1 ,ms4 ,ernst1 ,mrs4 ,fischer1 ,mr4 ,lee1 ,mr4 ,banks1 and ,mr4 ,crapo7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,public ,health ,service ,act to prohibit discrimination against health care entities that do not participate in abortion1 and to strengthen implementation and enforcement of ,federal conscience laws4 #a4 ,short title ,this ,act may be cited as the ,conscience ,protection ,act of #bjbe4 #b4 ,findings ,congress finds as follows3 7#a7 ,thomas ,jefferson stated a conviction common to our ,nation's founders when he declared in #ahji that no provision in our ,constitution ought to be dearer to man than that which protects the rights of conscience against the enterprises of the civil authority4 7#b7 ,no health care entity should have to choose between giving up their religious1 moral1 ethical1 or medical convictions and abandoning a vital medical mission4 ,congress enacted more than two dozen provisions in ,federal statutes to protect such rights in health care1 which also protect ,states ability to operate in accordance with their laws to protect similar rights without fear of retaliation from the ,federal ,government4 ,such provisions of ,federal statutes include-- 7,a7 subsections 7b7 through 7e7 of section #dja of the ,health ,programs ,extension ,act of #aigc 7#db ,u4,s4,c4 #cjj;a-#g7 7commonly known1 and referred to in this section1 as the ,church ,amendments72 7,b7 section #bde of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bchn7 7commonly known as the ,coats-,snowe ,amendment72 7,c7 the ,weldon ,amendment approved by ,congresses and ,presidents of both parties every year since #bjjd 7including section #ejg7;d7 of the ,departments of ,labor1 ,health and ,human ,services1 and ,education1 and ,related ,agencies ,appropriations ,act1 #bjbc 7division ,h of the ,consolidated ,appropriations ,act1 #bjbc 7,public ,law #aag-cbh7772 and 7,d7 other conscience protections1 as outlined in the final rule issued by the ,secretary of ,health and ,human ,services entitled ,protecting ,statutory ,conscience ,rights in ,health ,care2 ,delegations of ,authority 7#hd ,fed4 ,reg4 #bcagj2 ,may #ba1 #bjai71 under the ,patient ,protection and ,affordable ,care ,act1 under the ,social ,security ,act1 and with respect to global health programs and advanced directives4 7#c7 ,courts have held that certain conscience protection statutes do not provide a private right of action for individuals or entities who have been discriminated against1 thereby leaving victims of discrimination unable to defend their own conscience rights in court4 ,at the same time1 administrative implementation and enforcement of these laws by the ,office for ,civil ,rights of the ,department of ,health and ,human ,services have been inconsistent and at times cases are allowed to languish for years or previously enacted enforcement measures are abandoned or reversed4 7#d7 ,defying the ,weldon ,amendment1 the ,california ,department of ,managed ,health ,care has mandated coverage for elective abortions in all health plans under its jurisdiction4 ,other ,states1 such as ,new ,york1 ,illinois1 and ,washington1 have taken or considered similar action1 and some ,states have required hospitals to provide or facilitate abortions4 ,on ,june #ba1 #bjaf1 the ,office for ,civil ,rights of the ,department of ,health and ,human ,services1 under the ,obama ,administration1 concluded a nearly #b-year investigation of this matter by determining that the decision of ,california to require insurance plans under the ,california ,department for ,managed ,health ,care authority to cover abortion services did not violate the ,weldon ,amendment4 ,at least #bh1jjj individuals and families subsequently lost abortion-free health plans as a result of this mandate in violation of their consciences and rights under the ,weldon ,amendment4 7#e7 ,on ,january #bd1 #bjbj1 the ,office for ,civil ,rights of the ,department of ,health and ,human ,services disavowed its prior findings and issued a notice of violation of the ,weldon ,amendment to ,california4 ,after the ,state's continued noncompliance with the ,weldon ,amendment1 the ,centers for ,medicare ,medicaid ,services1 on ,december #af1 #bjbj1 announced the disallowance of #bjj1jjj1jjj per quarter in ,federal funds to ,california beginning in the first quarter of #bjba4 7#f7 ,although ,california had taken no action to come into compliance with the ,weldon ,amendment1 on ,august #ac1 #bjba1 the ,office for ,civil ,rights of the ,department of ,health and ,human ,services under the ,biden ,administration withdrew the notice of violation and closed the complaints filed with the ,department4 ,as a result1 individuals continue to be coerced contrary to law into choosing between violating their consciences or forgoing health care coverage for themselves1 their employees1 and their families4 7#g7 7,a7 ,on ,august #bh1 #bjai1 the ,office for ,civil ,rights of the ,department of ,health and ,human ,services under the ,trump ,administration issued a notice of violation against the ,university of ,vermont ,medical ,center for violation of the ,church ,amendments after it was found to have scheduled approximately #aj nurses who had registered conscience objections to abortion to assist with approximately #bj abortion procedures and for maintaining policies that explicitly required employees with conscience objections to participate in procedures with which they disagreed to ensure that patient care is not negatively impacted4 ,such practices were found to be part of an ongoing pattern1 practice1 and policy of discriminating against health care providers who believe that the performance1 or the assistance in the performance1 of abortions is contrary to their religious beliefs or moral convictions4 7,b7 ,after the ,university of ,vermont ,medical ,center refused to come into compliance with the law1 the ,department of ,justice brought an enforcement action in ,federal court against the medical center on ,december #af1 #bjbj4 7,c7 ,on ,july #cj1 #bjba1 the ,department of ,justice under the ,biden ,administration voluntarily dismissed the case1 without any binding settlement or requirement that the ,university of ,vermont ,medical ,center remedy its unlawful policies or make restitution to the employees whose rights it violated4 7#h7 ,on ,may #ba1 #bjai1 the ,secretary of ,health and ,human ,services issued the final rule entitled ,protecting ,statutory ,conscience ,rights in ,health ,care2 ,delegations of ,authority 7#hd ,fed4 ,reg4 #bcagj2 ,may #ba1 #bjai7 to implement #be ,federal conscience protection provisions governing programs funded under the ,department of ,health and ,human ,services and provide mechanisms to enforce conscience laws to ensure that the government and government-funded entities are not unlawfully discriminating against health care entities4 ,despite this regulation providing for enforcement of laws passed by ,congress1 the rule faced numerous legal challenges and was vacated4 7#i7 ,on ,january #aa1 #bjbd1 the ,department of ,health and ,human ,services published a final rule that fails to equip the ,department with the tools necessary for effective enforcement of ,federal statutory protections of rights of conscience4 7#aj7 ,congress has acted numerous times to expand access to health care and has also acted numerous times to provide unqualified statutorily protected rights of conscience to individuals and entities in certain circumstances4 ,a health care entity's decision not to participate in an abortion1 assisted suicide1 procedures that can result in sterilization1 or other interventions erects no barrier to those legally seeking to perform or undergo such interventions elsewhere4 7#aa7 ,the vast majority of medical professionals do not perform abortions4 ,ninety-three percent of obstetricians_/gynecologists in private practice report that they did not provide abortions 7,national ,library of ,medicine1 ,april #bjah7 and the great majority of hospitals choose to do so only in rare cases or not at all4 7#ab7 ,in the landmark #bjbb decision1 ,dobbs v4 ,jackson ,women's ,health ,organization1 the ,supreme ,court held that the ,constitution does not confer a right to abortion4 7#ac7 ,on ,july #ac1 #bjbb1 the ,department of ,health and ,human ,services issued guidance to retail pharmacies in the ,united ,states4 ,such guidance purported to address their obligations under ,federal nondiscrimination laws1 but in actuality orders pharmacies to stock and dispense abortion pills despite the fact that pharmacies and pharmacists have a right to not violate their conscience by participating in abortion under existing law4 7#ad7 ,conscience protections pose no conflict with other ,federal laws1 such as the law requiring stabilizing treatment for a pregnant woman ''' or her unborn child when either needs emergency care 7,emergency ,medical ,treatment and ,active ,labor ,act74 ,as previous ,administrations have said1 these areas of law have operated side by side for many years and both should be fully enforced 7#gf ,fed4 ,reg4 #iifh-gg 7#bjaa7 at #iigc74 7#ae7 ,reaffirming longstanding ,federal policy on conscience rights and providing a private right of action in cases where it is violated allows longstanding and widely supported ,federal laws to work as intended4 #c4 ,prohibiting discrimination against health care entities that do not participate in abortion ,title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjb et seq47 is amended by inserting after section #bde the following3 #bde;,a4 ,prohibiting discrimination against health care entities that do not participate in abortion 7a7 ,in general ,notwithstanding any other law1 the ,federal ,government1 and any individual or entity that receives ,federal financial assistance1 including any ,state or local government1 may not penalize1 retaliate against1 or otherwise discriminate against a health care entity on the basis that such health care entity does not or declines to-- 7#a7 provide1 perform1 refer for1 pay for1 or otherwise participate in abortion2 7#b7 provide or sponsor abortion coverage2 or 7#c7 facilitate or make arrangements for any of the activities specified in this subsection4 7b7 ,rule of construction ,nothing in this section shall be construed-- 7#a7 to prevent any health care entity from voluntarily electing to participate in abortions or abortion referrals where not prohibited by any other law2 7#b7 to prevent any health care entity from voluntarily electing to provide or sponsor abortion coverage or health benefits coverage that includes abortion where not prohibited by any other law2 7#c7 to prevent an accrediting agency1 the ,federal ,government1 or a ,state or local government from establishing standards of medical competency applicable only to those who have knowingly1 voluntarily1 and specifically elected to perform abortions1 or from enforcing contractual obligations applicable only to those who1 as part of such contract1 knowingly1 voluntarily1 and specifically elect to provide abortions2 7#d7 to affect1 or be affected by1 any ,federal law that requires stabilizing treatment for a pregnant woman or her unborn child when either needs emergency care2 or 7#e7 to supersede any law enacted by any ,state for the purpose of regulating insurance1 except as specified in subsection 7a74 7c7 ,definitions ,for purposes of this section3 7#a7 ,federal financial assistance ,the term ,federal financial assistance means ,federal payments to cover the cost of health care services or benefits1 or other ,federal payments1 grants1 or loans to promote or otherwise facilitate health-related activities4 7#b7 ,health care entity ,the term health care entity includes-- 7,a7 an individual physician1 health care assistant1 nurse1 pharmacist1 health researcher1 or other health care personnel2 7,b7 a hospital1 laboratory1 pharmacy1 health system1 or other health care or medical research facility or organization 7including a party to a proposed merger or other collaborative arrangement relating to health services1 and an entity resulting therefrom72 7,c7 a provider-sponsored organization1 an accountable care organization1 or a health maintenance organization2 7,d7 a social services provider that provides or authorizes referrals for health care services2 7,e7 a program of training or education in the health professions or medical research1 a participant in such a program1 or any individual applying or otherwise aspiring to participate in such a program2 7,f7 an issuer of health insurance coverage or of a health plan2 7,g7 a health care sharing ministry2 7,h7 a health insurance plan1 including group1 individual1 or student health plans1 or a sponsor or administrator thereof2 or 7,i7 any other health care organization1 program1 facility1 or plan4 7#c7 ,state or local government ,the term ,state or local government includes every agency and other governmental unit and subdivision of a ,state or local government1 if such ,state or local government1 or any agency or governmental unit or subdivision thereof1 receives ,federal financial assistance4 4 #d4 ,strengthening enforcement of ,federal conscience laws ,title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjb et seq471 as amended by section #c1 is further amended by inserting after section #bde;,a the following3 #bde;,b4 ,administrative enforcement of ,federal conscience laws 7a7 ,regulations 7#a7 ,in general ,under this section1 the ,secretary may issue regulations under any provision of law described in paragraph 7#b74 7#b7 ,provisions of law ,the provisions of law described in this paragraph are each of the following3 7,a7 ,sections #bde1 #bde;,a1 #cii,m7d71 and #ebj;,e7f7 of this ,act4 7,b7 ,the ,religious ,freedom ,restoration ,act of #aiic1 with respect to any program or activity funded1 administered1 or conducted by the ,department of ,health and ,human ,services4 7,c7 ,any of subsections 7b7 through 7e7 of section #dja of the ,health ,programs ,extension ,act of #aigc 7commonly known as the ,church ,amendments71 only with respect to an objection based on a religious belief or moral conviction4 7,d7 ,section #ejg7;d7 of the ,departments of ,labor1 ,health and ,human ,services1 and ,education1 and ,related ,agencies ,appropriations ,act1 #bjbc 7division ,h of the ,consolidated ,appropriations ,act1 #bjbc 7,public ,law #aag-cbh77 7commonly known as the ,weldon ,amendment7 and any subsequent substantially similar provision in an appropriations ,act1 to the extent administered by the ,secretary4 7,e7 ,section #bji of the ,departments of ,labor1 ,health and ,human ,services1 and ,education1 and ,related ,agencies ,appropriations ,act1 #bjbc 7division ,h of the ,consolidated ,appropriations ,act1 #bjbc 7,public ,law #aag-cbh77 and any subsequent substantially similar provision in an appropriations ,act1 to the extent administered by the ,secretary4 7,f7 ,clauses 7i7 and 7ii7 of paragraph 7#a77;,a7 of section #acjc7;b7 of the ,patient ,protection and ,affordable ,care ,act 7only with respect to a determination not to provide coverage of abortion71 and paragraph 7#d7 of such section4 7,g7 ,section #adaa7;b77#e77;,a7 of the ,patient ,protection and ,affordable ,care ,act 7other than with respect to an exemption as an ,indian or a hardship exemption7 and section #ejjj;,a7d77#b77;,a7 of the ,internal ,revenue ,code of #aihf4 7,h7 ,section #aeec of the ,patient ,protection and ,affordable ,care ,act4 7,i7 ,sections #aabb7;h71 #aafb1 #ahba1 #ahfa7;e71 #ahfa7y77#a71 and #ahfa7ss7 of the ,social ,security ,act1 and the first paragraph of the matter following section #aijb7;a77#hg77;,d7 of such ,act1 each of such provisions only with respect to protections for religious nonmedical health care institutions4 7,j7 ,sections #aheb7;j77#c77;,b71 #ahff7;f77#d71 #aijb7w77#c71 #aijb7w77#e71 #aijg1 #aibh7;c77#b77;,b77ii7 7with respect to a religious or other exemption71 #aicb7;b77#c77;,b71 and #bjab7;b7 of such ,act4 7,k7 ,section #dbjf7;c7 of the ,omnibus ,budget ,reconciliation ,act of #aiij4 7,l7 ,section #g of the ,assisted ,suicide ,funding ,restriction ,act of #aiig4 7,m7 ,section #aac7;a7 of the ,child ,abuse ,prevention and ,treatment ,act4 7,n7 ,section #cja7;d7 of the ,united ,states ,leadership ,against ,,hiv_/,,aids1 ,tuberculosis1 and ,malaria ,act of #bjjc to the extent administered by the ,secretary4 7,o7 ,the third sentence of section #bj7;a77#e7 of the ,occupational ,safety and ,health ,act of #aigj4 7,p7 ,section #ajd7;f77#a7 of the ,foreign ,assistance ,act of #aifa 7commonly known as the ,helms ,amendment71 and any provision of an appropriations ,act or other ,federal law that restates or incorporates by reference the protections of such section1 to the extent administered by the ,secretary4 7,q7 ,the ninth proviso under the heading ,global ,health ,programs under the heading ,funds ,appropriated to the ,president under title ,,iii of the ,department of ,state1 ,foreign ,operations1 and ,related ,programs ,appropriations ,act1 #bjbc 7division ,k of the ,consolidated ,appropriations ,act1 #bjbc 7,public ,law #aag-cbh77 and any subsequent substantially similar provision in an appropriations ,act to the extent administered by the ,secretary4 7,r7 ,any other provision of law protecting the exercise of conscience or religious freedom under programs or activities funded1 administered1 or conducted by the ,department of ,health and ,human ,services4 7b7 ,office for ,civil ,rights ,the ,secretary shall designate the ,director of the ,office for ,civil ,rights of the ,department of ,health and ,human ,services-- 7#a7 to receive complaints alleging a violation of any provision of law described in subsection 7a77#b72 and 7#b7 to promptly investigate such complaints1 issue findings1 and require corrective action in cases of such a violation4 7c7 ,enforcement 7#a7 ,in general ,the ,secretary shall1 as permitted under law 7including the ,constitution of the ,united ,states71 induce compliance of an individual or entity1 including a ,state or local government1 failing to comply with any provision of law described in subsection 7a77#b71 by terminating1 in whole or in part1 any ,federal financial assistance provided by the ,secretary to such individual or entity4 7#b7 ,referrals ,the ,secretary shall1 as the ,secretary determines necessary for inducing compliance with a provision described in paragraph 7#a71 refer a violation of such a provision to the ,attorney ,general for a civil action in accordance with section #bde;,c4 #bde;,c4 ,civil action for violations of ,federal conscience laws 7a7 ,in general ,a qualified party may1 in a civil action1 obtain relief described in subsection 7e7 with respect to a designated violation4 7b7 ,definitions ,for purposes of this section3 7#a7 ,designated violation ,the term designated violation means an actual or threatened violation of any provision of law described in section #bde;,b7a77#b74 7#b7 ,qualified party ,the term qualified party means-- 7,a7 the ,attorney ,general2 or 7,b7 any individual or entity adversely affected by the designated violation without regard to whether such individual or entity is a health care entity as defined in section #bde;,a7c74 7c7 ,administrative remedies not required ,an action under this section may be commenced1 and relief may be granted1 without regard to whether the party commencing the action has sought or exhausted any available administrative remedies4 7d7 ,defendants in actions under this section may include governmental entities as well as others 7#a7 ,in general ,an action under this section may be maintained against any individual or entity receiving ,federal financial assistance 7as defined in section #bde;,a7c771 including a ,state governmental entity4 ,relief in an action under this section may include money damages even if the defendant is a governmental entity4 7#b7 ,definition ,for the purposes of this subsection1 the term ,state governmental entity means a ,state1 a local government within a ,state1 and any agency or other governmental unit or subdivision of a ,state1 or of such a local government4 7e7 ,nature of relief ,in an action under this section1 the court shall grant-- 7#a7 all appropriate relief1 including injunctive relief1 declaratory relief1 and compensatory damages to prevent the occurrence1 continuance1 or repetition of the designated violation and to compensate for losses resulting from the designated violation2 and 7#b7 to a prevailing plaintiff1 reasonable attorneys' fees and litigation costs4 4 #e4 ,severability ,if any provision of this ,act or an amendment made by this ,act1 or the application of such a provision or amendment to any individual1 entity1 government1 or circumstance1 is held to be unconstitutional1 the remainder of this ,act and the amendments made by this ,act1 and the application of such provision or amendment to any other individual1 entity1 government1 or circumstance1 shall not be affected4