119-hr3411

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3411 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3411

 To amend the Public Health Service Act to prohibit discrimination 
 against health care entities that do not participate in abortion, and 
 to strengthen implementation and enforcement of Federal conscience 
 laws.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 May 14, 2025

 Mr. Pfluger (for himself, Mr. Webster of Florida, Mr. Moolenaar, Mr. 
Crenshaw, Mrs. Luna, Mr. Smith of Nebraska, Mr. Bacon, Mr. Williams of 
 Texas, Mrs. Biggs of South Carolina, and Mr. Gosar) introduced the 
 following bill; which was referred to the Committee on Energy and 
 Commerce

_______________________________________________________________________

 A BILL

 To amend the Public Health Service Act to prohibit discrimination 
 against health care entities that do not participate in abortion, and 
 to strengthen implementation and enforcement of Federal conscience 
 laws.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Conscience Protection Act of 2025''.

SEC. 2. FINDINGS.

 Congress finds as follows:

    (1) Thomas Jefferson stated a conviction common to our 
 Nation's founders when he declared in 1809 that ``[n]o 
 provision in our Constitution ought to be dearer to man than 
 that which protects the rights of conscience against the 
 enterprises of the civil authority''.

    (2) No health care entity should have to choose between 
 giving up their religious, moral, ethical, or medical 
 convictions and abandoning a vital medical mission. Congress 
 enacted more than two dozen provisions in Federal statutes to 
 protect such rights in health care, which also protect States' 
 ability to operate in accordance with their laws to protect 
 similar rights without fear of retaliation from the Federal 
 Government. Such provisions of Federal statutes include--
        (A) subsections

    (b) through

    (e) of 

section 401 of 
 the Health Programs Extension Act of 1973 (42 U.S.C. 
 300a-7) (commonly known, and referred to in this 
 section, as the ``Church Amendments'');
        (B) section 245 of the Public Health Service Act 
 (42 U.S.C. 238n) (commonly known as the ``Coats-Snowe 
 Amendment'');
            (C) the Weldon Amendment approved by Congresses and 
 Presidents of both parties every year since 2004 
 (including 

section 507
            (d) of the Departments of Labor, 
 Health and Human Services, and Education, and Related 
 Agencies Appropriations Act, 2023 (division H of the 
 Consolidated Appropriations Act, 2023 (Public Law 117-
 328))); and
            (D) other conscience protections, as outlined in 
 the final rule issued by the Secretary of Health and 
 Human Services entitled ``Protecting Statutory 
 Conscience Rights in Health Care; Delegations of 
 Authority'' (84 Fed. Reg. 23170; May 21, 2019), under 
 the Patient Protection and Affordable Care Act, under 
 the Social Security Act, and with respect to global 
 health programs and advanced directives.

    (3) Courts have held that certain conscience protection 
 statutes do not provide a ``private right of action'' for 
 individuals or entities who have been discriminated against, 
 thereby leaving victims of discrimination unable to defend 
 their own conscience rights in court. At the same time, 
 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 reversed.

    (4) Defying the Weldon Amendment, the California Department 
 of Managed Health Care has mandated coverage for elective 
 abortions in all health plans under its jurisdiction. Other 
 States, such as New York, Illinois, and Washington, have taken 
 or considered similar action, and some States have required 
 hospitals to provide or facilitate abortions. On June 21, 2016, 
 the Office for Civil Rights of the Department of Health and 
 Human Services, under the Obama Administration, concluded a 
 nearly 2-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 Amendment. 
 At least 28,000 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 
 Amendment.

    (5) On January 24, 2020, 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 California. After the State's continued 
 noncompliance with the Weldon Amendment, the Centers for 
 Medicare & Medicaid Services, on December 16, 2020, announced 
 the disallowance of $200,000,000 per quarter in Federal funds 
 to California beginning in the first quarter of 2021.

    (6) Although California had taken no action to come into 
 compliance with the Weldon Amendment, on August 13, 2021, 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 Department. 
 As a result, individuals continue to be coerced contrary to law 
 into choosing between violating their consciences or forgoing 
 health care coverage for themselves, their employees, and their 
 families.

    (7)
        (A) On August 28, 2019, 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 10 nurses who had registered conscience 
 objections to abortion to assist with approximately 20 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 impacted''. Such practices were found to 
 be part of an ``ongoing pattern, practice, and policy of 
 discriminating against health care providers who believe that 
 the performance, or the assistance in the performance, of 
 abortions is contrary to their religious beliefs or moral 
 convictions''.
        (B) After the University of Vermont Medical Center refused 
 to come into compliance with the law, the Department of Justice 
 brought an enforcement action in Federal court against the 
 medical center on December 16, 2020.
            (C) On July 30, 2021, the Department of Justice under the 
 Biden Administration voluntarily dismissed the case, 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 violated.

    (8) On May 21, 2019, the Secretary of Health and Human 
 Services issued the final rule entitled ``Protecting Statutory 
 Conscience Rights in Health Care; Delegations of Authority'' 
 (84 Fed. Reg. 23170; May 21, 2019) to implement 25 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 entities. Despite this 
 regulation providing for enforcement of laws passed by 
 Congress, the rule faced numerous legal challenges and was 
 vacated.

    (9) On January 11, 2024, 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 conscience.

    (10) 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 circumstances. A health 
 care entity's decision not to participate in an abortion, 
 assisted suicide, procedures that can result in sterilization, 
 or other interventions erects no barrier to those legally 
 seeking to perform or undergo such interventions elsewhere.

    (11) The vast majority of medical professionals do not 
 perform abortions. Ninety-three percent of obstetricians/
 gynecologists in private practice report that they did not 
 provide abortions (National Library of Medicine, April 2018) 
 and the great majority of hospitals choose to do so only in 
 rare cases or not at all.

    (12) In the landmark 2022 decision, Dobbs v. Jackson 
 Women's Health Organization, the Supreme Court held that ``the 
 Constitution does not confer a right to abortion''.

    (13) On July 13, 2022, the Department of Health and Human 
 Services issued guidance to retail pharmacies in the United 
 States. Such guidance purported to address their obligations 
 under Federal nondiscrimination laws, 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 law.

    (14) Conscience protections pose no conflict with other 
 Federal laws, such as the law requiring stabilizing treatment 
 for a ``pregnant woman . . . or her unborn child'' when either 
 needs emergency care (Emergency Medical Treatment and Active 
 Labor Act). As previous Administrations have said, these areas 
 of law have operated side by side for many years and both 
 should be fully enforced (76 Fed. Reg. 9968-77

    (2011) at 9973).

    (15) 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 intended.

SEC. 3. PROHIBITING DISCRIMINATION AGAINST HEALTH CARE ENTITIES THAT DO 
 NOT PARTICIPATE IN ABORTION.

 Title II of the Public Health Service Act (42 U.S.C. 202 et seq.) 
is amended by inserting after 

section 245 the following:

``

SEC. 245A. PROHIBITING DISCRIMINATION AGAINST HEALTH CARE ENTITIES 
 THAT DO NOT PARTICIPATE IN ABORTION.

 ``

    (a) In General.--Notwithstanding any other law, the Federal 
Government, and any individual or entity that receives Federal 
financial assistance, including any State or local government, may not 
penalize, retaliate against, or otherwise discriminate against a health 
care entity on the basis that such health care entity does not or 
declines to--
 ``

    (1) provide, perform, refer for, pay for, or otherwise 
 participate in abortion;
 ``

    (2) provide or sponsor abortion coverage; or
 ``

    (3) facilitate or make arrangements for any of the 
 activities specified in this subsection.
 ``

    (b) Rule of Construction.--Nothing in this section shall be 
construed--
 ``

    (1) to prevent any health care entity from voluntarily 
 electing to participate in abortions or abortion referrals 
 where not prohibited by any other law;
 ``

    (2) 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 law;
 ``

    (3) to prevent an accrediting agency, the Federal 
 Government, or a State or local government from establishing 
 standards of medical competency applicable only to those who 
 have knowingly, voluntarily, and specifically elected to 
 perform abortions, or from enforcing contractual obligations 
 applicable only to those who, as part of such contract, 
 knowingly, voluntarily, and specifically elect to provide 
 abortions;
 ``

    (4) to affect, or be affected by, any Federal law that 
 requires stabilizing treatment for a pregnant woman or her 
 unborn child when either needs emergency care; or
 ``

    (5) to supersede any law enacted by any State for the 
 purpose of regulating insurance, except as specified in 
 subsection

    (a) .
 ``
            (c) === Definitions. ===
-For purposes of this section:
 ``

    (1) Federal financial assistance.--The term `Federal 
 financial assistance' means Federal payments to cover the cost 
 of health care services or benefits, or other Federal payments, 
 grants, or loans to promote or otherwise facilitate health-
 related activities.
 ``

    (2) Health care entity.--The term `health care entity' 
 includes--
 ``
        (A) an individual physician, health care 
 assistant, nurse, pharmacist, health researcher, or 
 other health care personnel;
 ``
        (B) a hospital, laboratory, pharmacy, health 
 system, or other health care or medical research 
 facility or organization (including a party to a 
 proposed merger or other collaborative arrangement 
 relating to health services, and an entity resulting 
 therefrom);
 ``
            (C) a provider-sponsored organization, an 
 accountable care organization, or a health maintenance 
 organization;
 ``
            (D) a social services provider that provides or 
 authorizes referrals for health care services;
 ``
        (E) a program of training or education in the 
 health professions or medical research, a participant 
 in such a program, or any individual applying or 
 otherwise aspiring to participate in such a program;
 ``
        (F) an issuer of health insurance coverage or of 
 a health plan;
 ``
        (G) a health care sharing ministry;
 ``
        (H) a health insurance plan, including group, 
 individual, or student health plans, or a sponsor or 
 administrator thereof; or
 ``
            (I) any other health care organization, program, 
 facility, or plan.
 ``

    (3) State or local government.--The term `State or local 
 government' includes every agency and other governmental unit 
 and subdivision of a State or local government, if such State 
 or local government, or any agency or governmental unit or 
 subdivision thereof, receives Federal financial assistance.''.

SEC. 4. STRENGTHENING ENFORCEMENT OF FEDERAL CONSCIENCE LAWS.

 Title II of the Public Health Service Act (42 U.S.C. 202 et seq.), 
as amended by 

section 3, is further amended by inserting after 

section 245A the following:

``

SEC. 245B. ADMINISTRATIVE ENFORCEMENT OF FEDERAL CONSCIENCE LAWS.

 ``

    (a) Regulations.--
 ``

    (1) In general.--Under this section, the Secretary may 
 issue regulations under any provision of law described in 
 paragraph

    (2) .
 ``

    (2) Provisions of law.--The provisions of law described 
 in this paragraph are each of the following:
 ``
        (A) Sections 245, 245A, 399M
            (d) , and 520E

    (f) of 
 this Act.
 ``
        (B) The Religious Freedom Restoration Act of 
 1993, with respect to any program or activity funded, 
 administered, or conducted by the Department of Health 
 and Human Services.
 ``
            (C) Any of subsections

    (b) through

    (e) of 

section 401 of the Health Programs Extension Act of 1973 
 (commonly known as the `Church Amendments'), only with 
 respect to an objection based on a religious belief or 
 moral conviction.
 ``
            (D) Section 507
            (d) of the Departments of Labor, 
 Health and Human Services, and Education, and Related 
 Agencies Appropriations Act, 2023 (division H of the 
 Consolidated Appropriations Act, 2023 (Public Law 117-
 328)) (commonly known as the `Weldon Amendment') and 
 any subsequent substantially similar provision in an 
 appropriations Act, to the extent administered by the 
 Secretary.
 ``
        (E) Section 209 of the Departments of Labor, 
 Health and Human Services, and Education, and Related 
 Agencies Appropriations Act, 2023 (division H of the 
 Consolidated Appropriations Act, 2023 (Public Law 117-
 328)) and any subsequent substantially similar 
 provision in an appropriations Act, to the extent 
 administered by the Secretary.
 ``
        (F) Clauses
            (i) and
            (ii) of paragraph

    (1)
        (A) of 
 

section 1303

    (b) of the Patient Protection and 
 Affordable Care Act (only with respect to a 
 determination not to provide coverage of abortion), and 
 paragraph

    (4) of such section.
 ``
        (G) Section 1411

    (b)

    (5)
        (A) of the Patient 
 Protection and Affordable Care Act (other than with 
 respect to an exemption as an Indian or a hardship 
 exemption) and 

section 5000A
            (d) (2)
        (A) of the Internal 
 Revenue Code of 1986.
 ``
        (H) Section 1553 of the Patient Protection and 
 Affordable Care Act.
 ``
            (I) Sections 1122

    (h) , 1162, 1821, 1861

    (e) , 
 1861

    (y)

    (1) , and 1861

    (ss) of the Social Security Act, 
 and the first paragraph of the matter following 

section 1902

    (a)

    (87)
            (D) of such Act, each of such provisions 
 only with respect to protections for religious 
 nonmedical health care institutions.
 ``
        (J) Sections 1852

    (j)

    (3)
        (B) , 1866

    (f)

    (4) , 
 1902

    (w)

    (3) , 1902

    (w)

    (5) , 1907, 1928
            (c) (2)
        (B)
            (ii) (with 
 respect to a religious or other exemption), 
 1932

    (b)

    (3)
        (B) , and 2012

    (b) of such Act.
 ``
        (K) Section 4206
            (c) of the Omnibus Budget 
 Reconciliation Act of 1990.
 ``
            (L) Section 7 of the Assisted Suicide Funding 
 Restriction Act of 1997.
 ``
            (M) Section 113

    (a) of the Child Abuse Prevention 
 and Treatment Act.
 ``
        (N) Section 301
            (d) of the United States 
 Leadership Against HIV/AIDS, Tuberculosis, and Malaria 
 Act of 2003 to the extent administered by the 
 Secretary.
 ``
        (O) The third sentence of 

section 20

    (a)

    (5) of the 
 Occupational Safety and Health Act of 1970.
 ``
        (P) Section 104

    (f)

    (1) of the Foreign Assistance 
 Act of 1961 (commonly known as the `Helms Amendment'), 
 and any provision of an appropriations Act or other 
 Federal law that restates or incorporates by reference 
 the protections of such section, to the extent 
 administered by the Secretary.
 ``
        (Q) The ninth proviso under the heading `Global 
 Health Programs' under the heading `Funds Appropriated 
 to the President' under title III of the Department of 
 State, Foreign Operations, and Related Programs 
 Appropriations Act, 2023 (division K of the 
 Consolidated Appropriations Act, 2023 (Public Law 117-
 328)) and any subsequent substantially similar 
 provision in an appropriations Act to the extent 
 administered by the Secretary.
 ``
        (R) Any other provision of law protecting the 
 exercise of conscience or religious freedom under 
 programs or activities funded, administered, or 
 conducted by the Department of Health and Human 
 Services.
 ``

    (b) Office for Civil Rights.--The Secretary shall designate the 
Director of the Office for Civil Rights of the Department of Health and 
Human Services--
 ``

    (1) to receive complaints alleging a violation of any 
 provision of law described in subsection

    (a)

    (2) ; and
 ``

    (2) to promptly investigate such complaints, issue 
 findings, and require corrective action in cases of such a 
 violation.
 ``
            (c) Enforcement.--
 ``

    (1) In general.--The Secretary shall, as permitted under 
 law (including the Constitution of the United States), induce 
 compliance of an individual or entity, including a State or 
 local government, failing to comply with any provision of law 
 described in subsection

    (a)

    (2) , by terminating, in whole or in 
 part, any Federal financial assistance provided by the 
 Secretary to such individual or entity.
 ``

    (2) Referrals.--The Secretary shall, as the Secretary 
 determines necessary for inducing compliance with a provision 
 described in paragraph

    (1) , refer a violation of such a 
 provision to the Attorney General for a civil action in 
 accordance with 

section 245C.

``

SEC. 245C. CIVIL ACTION FOR VIOLATIONS OF FEDERAL CONSCIENCE LAWS.

 ``

    (a) In General.--A qualified party may, in a civil action, obtain 
relief described in subsection

    (e) with respect to a designated 
violation.
 ``

    (b) 

=== Definitions. ===
-For purposes of this section:
 ``

    (1) Designated violation.--The term `designated 
 violation' means an actual or threatened violation of any 
 provision of law described in 

section 245B

    (a)

    (2) .
 ``

    (2) Qualified party.--The term `qualified party' means--
 ``
        (A) the Attorney General; or
 ``
        (B) 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 245A
            (c) .
 ``
            (c) Administrative Remedies Not Required.--An action under this 
section may be commenced, and relief may be granted, without regard to 
whether the party commencing the action has sought or exhausted any 
available administrative remedies.
 ``
            (d) Defendants in Actions Under This Section May Include 
Governmental Entities as Well as Others.--
 ``

    (1) In general.--An action under this section may be 
 maintained against any individual or entity receiving Federal 
 financial assistance (as defined in 

section 245A
            (c) ), including 
 a State governmental entity. Relief in an action under this 
 section may include money damages even if the defendant is a 
 governmental entity.
 ``

    (2) === Definition. ===
-For the purposes of this subsection, the 
 term `State governmental entity' means a State, a local 
 government within a State, and any agency or other governmental 
 unit or subdivision of a State, or of such a local government.
 ``

    (e) Nature of Relief.--In an action under this section, the court 
shall grant--
 ``

    (1) all appropriate relief, including injunctive relief, 
 declaratory relief, and compensatory damages to prevent the 
 occurrence, continuance, or repetition of the designated 
 violation and to compensate for losses resulting from the 
 designated violation; and
 ``

    (2) to a prevailing plaintiff, reasonable attorneys' fees 
 and litigation costs.''.

SEC. 5. SEVERABILITY.

 If any provision of this Act or an amendment made by this Act, or 
the application of such a provision or amendment to any individual, 
entity, government, or circumstance, is held to be unconstitutional, 
the remainder of this Act and the amendments made by this Act, and the 
application of such provision or amendment to any other individual, 
entity, government, or circumstance, shall not be affected.
 <all>