Sec. 2. Findings

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A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Congress finds as follows: 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 . 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— 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 ); section 245 of the Public Health Service Act ( 42 U.S.C. 238n ) (commonly known as the Coats-Snowe Amendment ); 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 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. 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. 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. 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. 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. 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 . 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. 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. 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. 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. 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. 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. 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 . 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. 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). 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.

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