I
118THCONGRESS
1
STSESSION H. R. 12
To protect a person’s ability to determine whether to continue or end a
pregnancy, and to protect a health care provider’s ability to provide
abortion services.
IN THE HOUSE OF REPRESENTATIVES
MARCH30, 2023
Ms. C
HU(for herself, Ms. ADAMS, Mr. AGUILAR, Mr. ALLRED, Mr.
A
UCHINCLOSS, Ms. BALINT, Ms. BARRAGA´N, Mrs. BEATTY, Mr. BERA,
Mr. B
EYER, Mr. BLUMENAUER, Ms. BLUNTROCHESTER, Ms. BONAMICI,
Mr. B
OWMAN, Ms. BROWN, Ms. BROWNLEY, Ms. BUDZINSKI, Ms. BUSH,
Ms. C
ARAVEO, Mr. CARBAJAL, Mr. CA´RDENAS, Mr. CARSON, Mr. CARTER
of Louisiana, Mr. C
ARTWRIGHT, Mr. CASAR, Mr. CASTEN, Ms. CASTOR
of Florida, Mr. C
ASTROof Texas, Mr. CICILLINE, Ms. CLARKEof New
York, Mr. C
LEAVER, Mr. COHEN, Mr. CONNOLLY, Mr. COURTNEY, Ms.
C
RAIG, Ms. CROCKETT, Mr. CROW, Ms. DAVIDSof Kansas, Mr. DAVIS
of Illinois, Ms. D
EANof Pennsylvania, Ms. DEGETTE, Ms. DELAURO,
Ms. D
ELBENE, Mr. DELUZIO, Mr. DESAULNIER, Mrs. DINGELL, Mr.
D
OGGETT, Ms. ESCOBAR, Mr. ESPAILLAT, Mr. EVANS, Mrs. FLETCHER,
Mr. F
OSTER, Ms. LOISFRANKELof Florida, Mr. FROST, Mr.
G
ARAMENDI, Ms. GARCIAof Texas, Mr. ROBERTGARCIAof California,
Mr. G
ARCI´Aof Illinois, Ms. PEREZ, Mr. GOLDMANof New York, Mr.
G
OMEZ, Mr. GOTTHEIMER, Mr. GREENof Texas, Mr. GRIJALVA, Mr.
H
IMES, Mr. HORSFORD, Ms. HOULAHAN, Ms. HOYLEof Oregon, Mr.
H
UFFMAN, Mr. IVEY, Mr. JACKSONof North Carolina, Ms. JACKSON
L
EE, Ms. JACOBS, Ms. JAYAPAL, Mr. JEFFRIES, Ms. KAMLAGER-DOVE,
Ms. K
ELLYof Illinois, Mr. KHANNA, Mr. KILDEE, Mr. KILMER, Mr.
K
RISHNAMOORTHI, Ms. KUSTER, Mr. LARSENof Washington, Mr. LAR-
SONof Connecticut, Mrs. LEEof Nevada, Ms. LEEof California, Ms.
L
EEof Pennsylvania, Mr. LEVIN, Mr. LIEU, Ms. LOFGREN, Mr. LYNCH,
Mr. M
AGAZINER, Ms. MANNING, Ms. MATSUI, Mrs. MCBATH, Mrs.
M
CCLELLAN, Ms. MCCOLLUM, Mr. MCGOVERN, Mr. GALLEGO, Mr.
M
EEKS, Ms. MENG, Ms. MOOREof Wisconsin, Mr. MORELLE, Mr.
M
OSKOWITZ, Mr. MOULTON, Mr. MRVAN, Mr. MULLIN, Mr. NADLER,
Mrs. N
APOLITANO, Mr. NEAL, Mr. NICKEL, Mr. NORCROSS, Ms. NOR-
TON, Ms. OMAR, Mr. PALLONE, Mr. PANETTA, Mr. PASCRELL, Mr.
P
AYNE, Ms. PELOSI, Mr. PETERS, Ms. PETTERSEN, Ms. PINGREE, Mr.
P
OCAN, Ms. PORTER, Ms. PRESSLEY, Mr. QUIGLEY, Mr. RASKIN, Mr.
T
HANEDAR, Ms. ROSS, Mr. RUPPERSBERGER, Mr. RYAN, Ms. SALINAS,
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Ms. SA´NCHEZ, Mr. SARBANES, Ms. SCANLON, Ms. SCHAKOWSKY, Mr.
S
CHIFF, Mr. SCHNEIDER, Ms. SCHRIER, Mr. SCOTTof Virginia, Ms. SE-
WELL, Mr. SHERMAN, Ms. SHERRILL, Ms. SLOTKIN, Mr. SMITHof Wash-
ington, Mr. S
ORENSEN, Ms. STANSBURY, Mr. STANTON, Ms. STEVENS,
Ms. S
TRICKLAND, Mr. SWALWELL, Mrs. SYKES, Mr. TAKANO, Mr.
T
HOMPSONof California, Mr. THOMPSONof Mississippi, Ms. TITUS, Ms.
T
LAIB, Ms. TOKUDA, Mr. TONKO, Mrs. TORRESof California, Mr.
T
ORRESof New York, Mrs. TRAHAN, Mr. TRONE, Ms. UNDERWOOD, Ms.
V
ELA´ZQUEZ, Ms. WASSERMANSCHULTZ, Mrs. WATSONCOLEMAN, Ms.
W
EXTON, Ms. WILD, Ms. WILLIAMSof Georgia, Ms. WILSONof Florida,
Mrs. H
AYES, Mr. MFUME, Mr. JOHNSONof Georgia, Mr. KIMof New
Jersey, Mr. C
OSTA, Ms. LEGERFERNANDEZ, Ms. CLARKof Massachu-
setts, Ms. E
SHOO, Mr. VASQUEZ, Ms. SPANBERGER, Mr. LANDSMAN, Mr.
K
EATING, Mrs. FOUSHEE, Mr. MENENDEZ, Mr. HOYER, Mr. BOYLEof
Pennsylvania, Mr. S
OTO, Ms. OCASIO-CORTEZ, Mr. PHILLIPS, Ms.
P
LASKETT, Mr. GOLDENof Maine, Mr. MCGARVEY, Mr. RUIZ, Ms.
S
CHOLTEN, Mrs. PELTOLA, Ms. KAPTUR, Mr. CASE, Mr. NEGUSE, Mr.
B
ISHOPof Georgia, Mr. JACKSONof Illinois, Ms. WATERS, Mr. VARGAS,
Mrs. R
AMIREZ, Mr. CLYBURN, Mr. VEASEY, and Mr. CORREA) introduced
the following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on the Judiciary, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned
A BILL
To protect a person’s ability to determine whether to con-
tinue or end a pregnancy, and to protect a health care
provider’s ability to provide abortion services.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Women’s Health Pro-4
tection Act of 2023’’. 5
SEC. 2. FINDINGS. 6
Congress finds the following: 7
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(1) Abortion services are essential health care, 1
and access to those services is central to people’s 2
ability to participate equally in the economic and so-3
cial life of the United States. Abortion access allows 4
people who are pregnant to make their own decisions 5
about their pregnancies, their families, and their 6
lives. 7
(2) Reproductive justice requires every indi-8
vidual to have the right to make their own decisions 9
about having children regardless of their cir-10
cumstances and without interference and discrimina-11
tion. Reproductive justice is a human right that can 12
and will be achieved when all people, regardless of 13
actual or perceived race, color, national origin, immi-14
gration status, sex (including gender identity, sex 15
stereotyping, or sexual orientation), age, or disability 16
status have the economic, social, and political power 17
and resources to define and make decisions about 18
their bodies, health, sexuality, families, and commu-19
nities in all areas of their lives, with dignity and 20
self-determination. 21
(3) Abortion care, like all health care, is a 22
human right that should not depend on one’s ZIP 23
Code or region, age, actual or perceived race, na-24
tional origin, immigration status, sex, or disability 25
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status. Unfortunately, this is the current reality for 1
millions, creating a patchwork of abortion access 2
across the United States. Protecting the right to de-3
termine whether to continue or end a pregnancy, 4
and the right of health care providers to provide 5
abortion care, is necessary and essential to achieving 6
this human right, and ultimately reproductive jus-7
tice. 8
(4) On June 24, 2022, in its decision in Dobbs 9
v. Jackson Women’s Health Organization, the Su-10
preme Court overruled Roe v. Wade, reversing dec-11
ades of precedent recognizing a constitutional right 12
to terminate a pregnancy before fetal viability. 13
(5) The effects of the Dobbs decision were im-14
mediate and disastrous. In the aftermath of the 15
Dobbs decision, many States imposed near-total 16
bans on abortion. As of March 2023, abortion is un-17
available in 14 States, leaving 17.8 million women of 18
reproductive age (15–49) and transgender and gen-19
der nonconforming individuals with the capacity to 20
become pregnant without abortion access in their 21
home State. Within 100 days of the ruling, 66 clin-22
ics across 15 States were forced to stop offering 23
abortions. 24
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(6) Travel time to an abortion clinic, already a 1
burden for abortion seekers under Roe, has more 2
than tripled since Dobbs. As distance to an abortion 3
facility increases, so do the accompanying (and po-4
tentially prohibitive) burdens of time off work or 5
school, lost wages, transportation costs, lodging, 6
child care costs, and other ancillary costs. 7
(7) Even before the Dobbs decision, access to 8
abortion services had long been obstructed across 9
the United States in various ways, including: prohi-10
bitions of, and restrictions on, insurance coverage; 11
mandatory parental involvement laws; restrictions 12
that shame and stigmatize people seeking abortion 13
services; and medically unnecessary regulations that 14
fail to further the safety of abortion services, but in-15
stead cause harm people by delaying, complicating 16
access to, and reducing the availability of, abortion 17
services. 18
(8) Being denied an abortion can have serious 19
consequences for people’s physical, mental, and eco-20
nomic health and well-being, and that of their fami-21
lies. According to the Turnaway Study, a longitu-22
dinal study published by Advancing New Standards 23
In Reproductive Health (ANSIRH) in 2019, individ-24
uals who are denied a wanted abortion are more 25
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likely to experience economic insecurity than individ-1
uals who receive a wanted abortion. After following 2
participants for five years, the study found that peo-3
ple who were denied abortion care were more likely 4
to live in poverty, experience debt, and have lower 5
credit scores for several years after the denial. These 6
findings demonstrate that when people have control 7
over when to have children and how many children 8
to have, their children benefit through increased eco-9
nomic security and better maternal bonding. 10
(9) Abortion bans and restrictions have reper-11
cussions for a broad range of health care beyond 12
pregnancy termination, including exacerbating the 13
existing maternal health crisis facing the United 14
States. The United States has the highest maternal 15
mortality rate of any industrialized nations, and 16
Black women and birthing people face three times 17
the risk of dying from pregnancy related causes as 18
their white counterparts. Even prior to Dobbs, re-19
search found that States that enacted abortion re-20
strictions based on gestation increased their mater-21
nal mortality rate by 38 percent. Research has 22
found that a nationwide ban would increase the 23
United States maternal mortality rate by an addi-24
tional 24 percent. Furthermore, States that have 25
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banned, are planning to ban, or have severely re-1
stricted abortion care have fewer maternal health 2
providers, more maternity care deserts, higher rates 3
of both maternal and infant mortality, and greater 4
racial inequity in health care. 5
(10) Abortion bans and restrictions additionally 6
harm people’s health by reducing access to other es-7
sential health care services offered by many of the 8
providers targeted by the restrictions, including— 9
(A) screenings and preventive services, in-10
cluding contraceptive services; 11
(B) testing and treatment for sexually 12
transmitted infections; 13
(C) LGBTQ health services; and 14
(D) referrals for primary care, intimate 15
partner violence prevention, prenatal care, and 16
adoption services. 17
(11) This ripple effect has only worsened since 18
the Dobbs decision. Clinicians and pharmacists have 19
denied access to essential medication for conditions 20
including gastric ulcers and autoimmune diseases be-21
cause those drugs are also used for medication abor-22
tion care. Patients are reporting being denied or de-23
layed in their receipt of necessary and potentially 24
lifesaving treatment for ectopic pregnancies and mis-25
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carriage management because of the newfound legal 1
risks facing providers. 2
(12) Reproductive justice seeks to address re-3
strictions on reproductive health, including abortion, 4
that perpetuate systems of oppression, lack of bodily 5
autonomy, white supremacy, and anti-Black racism. 6
This violent legacy has manifested in policies includ-7
ing enslavement, rape, and experimentation on Black 8
women; forced sterilizations, medical experimen-9
tation on low-income women’s reproductive systems; 10
and the forcible removal of Indigenous children. Ac-11
cess to equitable reproductive health care, including 12
abortion services, has always been deficient in the 13
United States for Black, Indigenous, Latina/x, Asian 14
American and Pacific Islander, and People of Color 15
(BIPOC) and their families. 16
(13) The legacy of restrictions on reproductive 17
health, rights, and justice is not a dated vestige of 18
a dark history. Data show the harms of abortion- 19
specific restrictions fall especially heavily on people 20
with low incomes, people of color, immigrants, young 21
people, people with disabilities, and those living in 22
rural and other medically underserved areas. Abor-23
tion bans and restrictions are compounded further 24
by the ongoing criminalization of people who are 25
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pregnant, including those who are incarcerated, liv-1
ing with HIV, or with substance-use disorders. 2
These populations already experience health dispari-3
ties due to social, political, and environmental in-4
equities, and restrictions on abortion services exacer-5
bate these harms. Removing bans and restrictions on 6
abortion services would constitute one important 7
step on the path toward realizing reproductive jus-8
tice by ensuring that the full range of reproductive 9
health care is accessible to all who need it. 10
(14) Abortion bans and restrictions are tools of 11
gender oppression, as they target health care serv-12
ices that are used primarily by women. These pater-13
nalistic bans and restrictions rely on and reinforce 14
harmful stereotypes about gender roles and women’s 15
decisionmaking, undermining their ability to control 16
their own lives and well-being. These restrictions 17
harm the basic autonomy, dignity, and equality of 18
women. 19
(15) The terms ‘‘woman’’ and ‘‘women’’ are 20
used in this bill to reflect the identity of the majority 21
of people targeted and most directly affected by bans 22
and restrictions on abortion services, which are root-23
ed in misogyny. However, access to abortion services 24
is critical to the health of every person capable of 25
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becoming pregnant. This Act is intended to protect 1
all people with the capacity for pregnancy— 2
cisgender women, transgender men, nonbinary indi-3
viduals, those who identify with a different gender, 4
and others—who are unjustly harmed by restrictions 5
on abortion services. 6
(16) Pregnant individuals will continue to expe-7
rience a range of pregnancy outcomes, including 8
abortion, miscarriage, stillbirths, and infant losses 9
regardless of how the State attempts to exert power 10
over their reproductive decisionmaking, and will con-11
tinue to need support for their health and well-being 12
through their reproductive lifespans. 13
(17) Evidence from the United States and 14
around the globe bears out that criminalizing abor-15
tion invariably leads to arrests, investigations, and 16
imprisonment of people who end their pregnancies or 17
experience pregnancy loss, leading to violations of 18
fundamental rights to liberty, dignity, bodily auton-19
omy, equality, due process, privacy, health, and free-20
dom from cruel and inhumane treatment. 21
(18) All major experts in public health and 22
medicine such as the American Medical Association, 23
American Public Health Association, American 24
Academy of Pediatrics, American Society of Addic-25
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tion Medicine, and the American College of Obstetri-1
cians and Gynecologists, oppose the criminalization 2
of pregnancy outcomes because the threat of being 3
subject to investigation or punishment through the 4
criminal legal system when seeking health care 5
threatens pregnant people’s lives and undermines 6
public health by deterring people from seeking care 7
for obstetrical emergencies. 8
(19) Antiabortion stigma that is compounded 9
by abortion bans and restrictions also contributes to 10
violence and harassment that put both people seek-11
ing and people providing abortion care at risk. From 12
1977 to 2021, there were 11 murders, 42 bombings, 13
196 acts of arson, 491 assaults, and thousands of 14
other incidents of criminal activity directed at abor-15
tion seekers, providers, volunteers, and clinic staff. 16
This violence existed under Roe and has been stead-17
ily escalating for years. The presence of dangerous 18
protestors and organized extremists acts as yet an-19
other barrier to abortion care, and this threat has 20
become even more urgent as abortion bans pro-21
liferate and stigma around abortion care increases. 22
(20) Abortion is one of the safest medical pro-23
cedures in the United States. An independent, com-24
prehensive review of the state of science on the safe-25
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ty and quality of abortion services, published by the 1
National Academies of Sciences, Engineering, and 2
Medicine in 2018, found that abortion in the United 3
States is safe and effective and that the biggest 4
threats to the quality of abortion services in the 5
United States are State regulations that create bar-6
riers to care. Such abortion-specific restrictions, as 7
well as broader State bans, conflict with medical 8
standards and are not supported by the rec-9
ommendations and guidelines issued by leading re-10
productive health care professional organizations in-11
cluding the American College of Obstetricians and 12
Gynecologists, the Society of Family Planning, the 13
National Abortion Federation, the World Health Or-14
ganization, and others. 15
(21) For over 20 years, medication abortion 16
care has been available in the United States as a 17
safe, effective, Food and Drug Administration 18
(FDA)-approved treatment to end an early preg-19
nancy. Today, medication abortion care accounts for 20
more than half of all pregnancy terminations in the 21
United States; however, significant barriers to access 22
remain in place, particularly in States that have im-23
posed onerous restrictions that conflict with FDA’s 24
regulation of medication abortion. Additionally, op-25
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ponents of abortion are now deploying new tactics to 1
limit access to this FDA-approved medication that 2
would set a dangerous precedent for the Federal 3
regulation of medication products and have national 4
repercussions. 5
(22) Health care providers are subject to licens-6
ing laws in various jurisdictions, which are not af-7
fected by this Act except as expressly provided in 8
this Act. 9
(23) International human rights law recognizes 10
that access to abortion is intrinsically linked to the 11
rights to life, health, equality and nondiscrimination, 12
privacy, and freedom from ill treatment. United Na-13
tions (UN) human rights treaty monitoring bodies 14
have found that legal abortion services, like other re-15
productive health care services, must be available, 16
accessible, affordable, acceptable, and of good qual-17
ity. UN human rights treaty bodies have condemned 18
criminalization of abortion and medically unneces-19
sary barriers to abortion services, including manda-20
tory waiting periods, biased counseling requirements, 21
and third-party authorization requirements. 22
(24) Core human rights treaties ratified by the 23
United States protect access to abortion. For exam-24
ple, in 2018, the UN Human Rights Committee, 25
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which oversees implementation of the International 1
Covenant on Civil and Political Rights (ICCPR), 2
made clear that the right to life, enshrined in Article 3
6 of the ICCPR, at a minimum requires govern-4
ments to provide safe, legal, and effective access to 5
abortion where a person’s life and health are at risk, 6
or when carrying a pregnancy to term would other-7
wise cause substantial pain or suffering. The Com-8
mittee stated that governments must not impose re-9
strictions on abortion which subject women and girls 10
to physical or mental pain or suffering, discriminate 11
against them, arbitrarily interfere with their privacy, 12
or place them at risk of undertaking unsafe abor-13
tions. The Committee stated that governments 14
should not apply criminal sanctions to women and 15
girls who undergo abortion or to medical service pro-16
viders who assist them in doing so. Furthermore, the 17
Committee stated that governments should remove 18
existing barriers that deny effective access to safe 19
and legal abortion, refrain from introducing new 20
barriers to abortion, and prevent the stigmatization 21
of those seeking abortion. 22
(25) International human rights experts have 23
condemned the Dobbs decision and regression on 24
abortion rights in the United States more generally 25
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as a violation of human rights. Immediately upon re-1
lease of the decision, then-UN High Commissioner 2
for Human Rights Michelle Bachelet reiterated 3
human rights protections for abortion and the im-4
pact that the decision will have on the fundamental 5
rights of millions within the United States, particu-6
larly people with low incomes and people belonging 7
to racial and ethnic minorities. UN independent 8
human rights experts, including the UN Working 9
Group on discrimination against women and girls, 10
the UN Special Rapporteur on the right to health, 11
and the UN Special Rapporteur on violence against 12
women and girls, similarly denounced the decision. 13
At the conclusion of a human rights review of the 14
United States in August 2022, the UN Committee 15
on the Elimination of Racial Discrimination noted 16
deep concerns with the Dobbs decision and rec-17
ommended that the United States address the dis-18
parate impact that it will have on racial and ethnic 19
minorities, Indigenous women, and those with low 20
incomes. 21
(26) Abortion bans and restrictions affect the 22
cost and availability of abortion services, and the 23
settings in which abortion services are delivered. 24
People travel across State lines and otherwise en-25
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gage in interstate commerce to access this essential 1
medical care. Likewise, health care providers travel 2
across State lines and otherwise engage in interstate 3
commerce in order to provide abortion services to 4
patients, and more would be forced to do so absent 5
this Act. 6
(27) Legal limitations and requirements im-7
posed upon health care providers or their patients 8
invariably affect commerce over which the United 9
States has jurisdiction. Health care providers engage 10
in a form of economic and commercial activity when 11
they provide abortion services, and there is an inter-12
state market for abortion services. 13
(28) Abortion bans and restrictions substan-14
tially affect interstate commerce in numerous ways. 15
For example, to provide abortion services, health 16
care providers engage in interstate commerce to pur-17
chase medicine, medical equipment, and other nec-18
essary goods and services. To provide and assist oth-19
ers in providing abortion services, health care pro-20
viders engage in interstate commerce to obtain and 21
provide training. To provide abortion services, health 22
care providers employ and obtain commercial serv-23
ices from doctors, nurses, and other personnel who 24
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engage in interstate commerce, including by and 1
traveling across State lines. 2
(29) Congress has the authority to enact this 3
Act to protect access to abortion services pursuant 4
to— 5
(A) its powers under the commerce clause 6
of section 8 of article I of the Constitution of 7
the United States; 8
(B) its powers under section 5 of the Four-9
teenth Amendment to the Constitution of the 10
United States to enforce the provisions of sec-11
tion 1 of the Fourteenth Amendment; and 12
(C) its powers under the necessary and 13
proper clause of section 8 of article I of the 14
Constitution of the United States. 15
(30) Congress has used its authority in the past 16
to protect access to abortion services and health care 17
providers’ ability to provide abortion services. In the 18
early 1990s, protests and blockades at health care 19
facilities where abortion services were provided, and 20
associated violence, increased dramatically and 21
reached crisis level, requiring congressional action. 22
Congress passed the Freedom of Access to Clinic 23
Entrances Act (Public Law 103–259; 108 Stat. 694) 24
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to address that situation and protect physical access 1
to abortion services. 2
(31) Congressional action is necessary to put an 3
end to harmful restrictions, to protect access to 4
abortion services for everyone regardless of where 5
they live, to protect the ability of health care pro-6
viders to provide these services in a safe and acces-7
sible manner, and to eliminate unwarranted burdens 8
on commerce and the right to travel. 9
SEC. 3. PURPOSE. 10
The purposes of this Act are as follows: 11
(1) To permit people to seek and obtain abor-12
tion services, and to permit health care providers to 13
provide abortion services, without harmful or unwar-14
ranted limitations or requirements that single out 15
the provision of abortion services for restrictions 16
that are more burdensome than those restrictions 17
imposed on medically comparable procedures, do not 18
significantly advance reproductive health or the safe-19
ty of abortion services, or make abortion services 20
more difficult to access. 21
(2) To promote access to abortion services and 22
thereby protect women’s ability to participate equally 23
in the economic and social life of the United States. 24
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(3) To protect people’s ability to make decisions 1
about their bodies, medical care, family, and life’s 2
course. 3
(4) To eliminate unwarranted burdens on com-4
merce and the right to travel. Abortion bans and re-5
strictions invariably affect commerce over which the 6
United States has jurisdiction. Health care providers 7
engage in economic and commercial activity when 8
they provide abortion services. Moreover, there is an 9
interstate market for abortion services and, in order 10
to provide such services, health care providers en-11
gage in interstate commerce to purchase medicine, 12
medical equipment, and other necessary goods and 13
services; to obtain and provide training; and to em-14
ploy and obtain commercial services from health care 15
personnel, many of whom themselves engage in 16
interstate commerce, including by traveling across 17
State lines. Congress has the authority to enact this 18
Act to protect access to abortion services pursuant 19
to— 20
(A) its powers under the commerce clause 21
of section 8 of article I of the Constitution of 22
the United States; 23
(B) its powers under section 5 of the Four-24
teenth Amendment to the Constitution of the 25
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United States to enforce the provisions of sec-1
tion 1 of the Fourteenth Amendment; and 2
(C) its powers under the necessary and 3
proper clause of section 8 of article I of the 4
Constitution of the United States. 5
SEC. 4. DEFINITIONS. 6
In this Act: 7
(1) A
BORTION SERVICES.—The term ‘‘abortion 8
services’’ means an abortion and any medical or 9
non-medical services related to and provided in con-10
junction with an abortion (whether or not provided 11
at the same time or on the same day as the abor-12
tion). 13
(2) G
OVERNMENT.—The term ‘‘government’’ 14
includes each branch, department, agency, instru-15
mentality, and official of the United States or a 16
State. 17
(3) H
EALTH CARE PROVIDER .—The term 18
‘‘health care provider’’ means any entity (including 19
any hospital, clinic, or pharmacy) or individual (in-20
cluding any physician, certified nurse-midwife, nurse 21
practitioner, pharmacist, or physician assistant) 22
that— 23
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(A) is engaged or seeks to engage in the 1
delivery of health care services, including abor-2
tion services; and 3
(B) if required by law or regulation to be 4
licensed or certified to engage in the delivery of 5
such services— 6
(i) is so licensed or certified; or 7
(ii) would be so licensed or certified 8
but for their past, present, or potential 9
provision of abortion services protected by 10
section 4. 11
(4) M
EDICALLY COMPARABLE PROCEDURES .— 12
The term ‘‘medically comparable procedures’’ means 13
medical procedures that are similar in terms of 14
health and safety risks to the patient, complexity, or 15
the clinical setting that is indicated. 16
(5) P
REGNANCY.—The term ‘‘pregnancy’’ refers 17
to the period of the human reproductive process be-18
ginning with the implantation of a fertilized egg. 19
(6) S
TATE.—The term ‘‘State’’ includes the 20
District of Columbia, the Commonwealth of Puerto 21
Rico, and each territory and possession of the 22
United States, and any subdivision of any of the 23
foregoing, including any unit of local government, 24
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such as a county, city, town, village, or other general 1
purpose political subdivision of a State. 2
(7) V
IABILITY.—The term ‘‘viability’’ means 3
the point in a pregnancy at which, in the good-faith 4
medical judgment of the treating health care pro-5
vider, and based on the particular facts of the case 6
before the health care provider, there is a reasonable 7
likelihood of sustained fetal survival outside the 8
uterus with or without artificial support. 9
SEC. 5. PROTECTED ACTIVITIES AND SERVICES. 10
(a) G
ENERALRULES.— 11
(1) P
RE-VIABILITY.—A health care provider has 12
a right under this Act to provide abortion services, 13
and a patient has a corresponding right under this 14
Act to terminate a pregnancy prior to viability with-15
out being subject to any of the following limitations 16
or requirements: 17
(A) A prohibition on abortion prior to via-18
bility, including a prohibition or restriction on 19
a particular abortion procedure or method, or a 20
prohibition on providing or obtaining such abor-21
tions. 22
(B) A limitation on a health care pro-23
vider’s ability to prescribe or dispense drugs 24
that could be used for reproductive health pur-25
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poses based on current evidence-based regimens 1
or the provider’s good-faith medical judgment, 2
or a limitation on a patient’s ability to receive 3
or use such drugs, other than a limitation gen-4
erally applicable to the prescription, dispensing, 5
or distribution of drugs. 6
(C) A limitation on a health care provider’s 7
ability to provide, or a patient’s ability to re-8
ceive, abortion services via telemedicine, other 9
than a limitation generally applicable to the 10
provision of medically comparable services via 11
telemedicine. 12
(D) A limitation or prohibition on a pa-13
tient’s ability to receive, or a provider’s ability 14
to provide, abortion services in a State based on 15
the State of residency of the patient, or a prohi-16
bition or limitation on the ability of any indi-17
vidual to assist or support a patient seeking 18
abortion. 19
(E) A requirement that a health care pro-20
vider perform specific tests or medical proce-21
dures in connection with the provision of abor-22
tion services (including prior to or subsequent 23
to the abortion), unless generally required for 24
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the provision of medically comparable proce-1
dures. 2
(F) A requirement that a health care pro-3
vider offer or provide a patient seeking abortion 4
services medically inaccurate information. 5
(G) A limitation or requirement concerning 6
the physical plant, equipment, staffing, or hos-7
pital transfer arrangements of facilities where 8
abortion services are provided, or the creden-9
tials or hospital privileges or status of personnel 10
at such facilities, that is not imposed on facili-11
ties or the personnel of facilities where medi-12
cally comparable procedures are performed. 13
(H) A requirement that, prior to obtaining 14
an abortion, a patient make one or more medi-15
cally unnecessary in-person visits to the pro-16
vider of abortion services or to any individual or 17
entity that does not provide abortion services. 18
(I) A limitation on a health care provider’s 19
ability to provide immediate abortion services 20
when that health care provider believes, based 21
on the good-faith medical judgment of the pro-22
vider, that delay would pose a risk to the pa-23
tient’s life or health. 24
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(J) A requirement that a patient seeking 1
abortion services at any point or points in time 2
prior to viability disclose the patient’s reason or 3
reasons for seeking abortion services, or a limi-4
tation on providing or obtaining abortion serv-5
ices at any point or points in time prior to via-6
bility based on any actual, perceived, or poten-7
tial reason or reasons of the patient for obtain-8
ing abortion services, regardless of whether the 9
limitation is based on a health care provider’s 10
actual or constructive knowledge of such reason 11
or reasons. 12
(2) P
OST-VIABILITY.— 13
(A) I
N GENERAL.—A health care provider 14
has a right under this Act to provide abortion 15
services and a patient has a corresponding right 16
under this Act to terminate a pregnancy after 17
viability when, in the good-faith medical judge-18
ment of the treating health care provider, it is 19
necessary to protect the life or health of the pa-20
tient. This subparagraph shall not otherwise 21
apply after viability. 22
(B) A
DDITIONAL CIRCUMSTANCES .—A 23
State may provide additional circumstances 24
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under which post viability abortions are per-1
mitted under this paragraph. 2
(C) L
IMITATION.—In the case where a ter-3
mination of a pregnancy after viability, in the 4
good-faith medical judgement of the treating 5
health care provider, is necessary to protect the 6
life or health of the patient, a State shall not 7
impose any of the limitations or requirements 8
described in paragraph (1). 9
(b) O
THERLIMITATIONS ORREQUIREMENTS.—The 10
rights described in subsection (a) shall not be limited or 11
otherwise infringed through any other limitation or re-12
quirement that— 13
(1) expressly, effectively, implicitly, or as imple-14
mented, singles out abortion, the provision of abor-15
tion services, individuals who seek abortion services 16
or who provide assistance and support to those seek-17
ing abortion services, health care providers who pro-18
vide abortion services, or facilities in which abortion 19
services are provided; and 20
(2) impedes access to abortion services. 21
(c) F
ACTORS FORCONSIDERATION.—A court may 22
consider the following factors, among others, in deter-23
mining whether a limitation or requirement impedes ac-24
cess to abortion services for purposes of subsection (b)(2): 25
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(1) Whether the limitation or requirement, in a 1
provider’s good-faith medical judgment, interferes 2
with a health care provider’s ability to provide care 3
and render services, or poses a risk to the patient’s 4
health or safety. 5
(2) Whether the limitation or requirement is 6
reasonably likely to delay or deter a patient in ac-7
cessing abortion services. 8
(3) Whether the limitation or requirement is 9
reasonably likely to directly or indirectly increase the 10
cost of providing abortion services or the cost for ob-11
taining abortion services such as costs associated 12
with travel, childcare, or time off work. 13
(4) Whether the limitation or requirement is 14
reasonably likely to have the effect of necessitating 15
patient travel that would not otherwise have been re-16
quired, including by making it necessary for a pa-17
tient to travel out of State to obtain services. 18
(5) Whether the limitation or requirement is 19
reasonably likely to result in a decrease in the avail-20
ability of abortion services in a given State or geo-21
graphic region. 22
(6) Whether the limitation or requirement im-23
poses penalties that are not imposed on other health 24
care providers for comparable conduct or failure to 25
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act, or that are more severe than penalties imposed 1
on other health care providers for comparable con-2
duct or failure to act. 3
(7) The cumulative impact of the limitation or 4
requirement combined with other limitations or re-5
quirements. 6
(d) E
XCEPTION.—To defend against a claim that a 7
limitation or requirement violates a health care provider’s 8
or patient’s rights under subsection (b) a party must es-9
tablish, by clear and convincing evidence, that the limita-10
tion or requirement is essential to significantly advance 11
the safety of abortion services or the health of patients 12
and that the safety or health objective cannot be accom-13
plished by a different means that does not interfere with 14
the right protected under subsection (b). 15
SEC. 6. PROTECTION OF THE RIGHT TO TRAVEL. 16
A person has a fundamental right under the Con-17
stitution of the United States and this Act to travel to 18
a State other than the person’s State of residence, includ-19
ing to obtain reproductive health services such as prenatal, 20
childbirth, fertility, and abortion services, and a person 21
has a right under this Act to assist another person to ob-22
tain such services or otherwise exercise the right described 23
in this section. 24
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SEC. 7. APPLICABILITY AND PREEMPTION. 1
(a) I
NGENERAL.— 2
(1) S
UPERSEDING INCONSISTENT LAWS .—Ex-3
cept as provided under subsection (b), this Act shall 4
supersede any inconsistent Federal or State law, and 5
the implementation of such law, whether statutory, 6
common law, or otherwise, and whether adopted 7
prior to or after the date of enactment of this Act. 8
A Federal or State government official shall not ad-9
minister, implement, or enforce any law, rule, regu-10
lation, standard, or other provision having the force 11
and effect of law that conflicts with any provision of 12
this Act, notwithstanding any other provision of 13
Federal law, including the Religious Freedom Res-14
toration Act of 1993 (42 U.S.C. 2000bb et seq.). 15
(2) L
AWS AFTER DATE OF ENACTMENT .—Fed-16
eral law enacted after the date of the enactment of 17
this Act shall be subject to this Act unless such law 18
explicitly excludes such application by reference to 19
this Act. 20
(b) L
IMITATIONS.—The provisions of this Act shall 21
not supersede or apply to— 22
(1) laws regulating physical access to clinic en-23
trances; 24
(2) laws regulating insurance or medical assist-25
ance coverage of abortion services; 26
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(3) the procedure described in section 1
1531(b)(1) of title 18, United States Code; or 2
(4) generally applicable State contract law. 3
(c) P
REEMPTIONDEFENSE.—In any legal or admin-4
istrative action against a person or entity who has exer-5
cised or attempted to exercise a right protected by section 6
4 or section 5 or against any person or entity who has 7
taken any step to assist any such person or entity in exer-8
cising such right, this Act shall also apply to, and may 9
be raised as a defense by, such person or entity, in addi-10
tion to the remedies specified in section 8. 11
SEC. 8. RULES OF CONSTRUCTION. 12
(a) L
IBERALCONSTRUCTION BY COURTS.—In any 13
action before a court under this Act, the court shall lib-14
erally construe the provisions of this Act to effectuate the 15
purposes of the Act. 16
(b) P
ROTECTION OFLIFE ANDHEALTH.—Nothing 17
in this Act shall be construed to authorize any government 18
official to interfere with, diminish, or negatively affect a 19
person’s ability to obtain or provide abortion services prior 20
to viability, or after viability when, in the good-faith med-21
ical judgment of the treating health care provider, continu-22
ation of the pregnancy would pose a risk to the pregnant 23
patient’s life or health. 24
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(c) GOVERNMENTOFFICIALS.—Any person who, by 1
operation of a provision of Federal or State law, is per-2
mitted to implement or enforce a limitation or requirement 3
that violates section 4 or 5 shall be considered a govern-4
ment official for purposes of this Act. 5
SEC. 9. ENFORCEMENT. 6
(a) A
TTORNEYGENERAL.—The Attorney General 7
may commence a civil action on behalf of the United 8
States in any district court of the United States against 9
any State that violates, or against any government official 10
(including a person described in section 7(c)) who imple-11
ments or enforces a limitation or requirement that vio-12
lates, section 4 or 5. The court shall declare unlawful the 13
limitation or requirement if it is determined to be in viola-14
tion of this Act. 15
(b) P
RIVATERIGHT OFACTION.— 16
(1) I
N GENERAL.—Any individual or entity ad-17
versely affected by an alleged violation of this Act, 18
including any person or health care provider, may 19
commence a civil action against any government offi-20
cial (including a person described in section 7(c)) 21
that implements or enforces a limitation or require-22
ment that violates, section 4 or 5. The court shall 23
declare unlawful the limitation or requirement if it 24
is determined to be in violation of this Act. 25
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(2) HEALTH CARE PROVIDER .—A health care 1
provider may commence an action for relief on its 2
own behalf, on behalf of the provider’s staff, and on 3
behalf of the provider’s patients who are or may be 4
adversely affected by an alleged violation of this Act. 5
(c) P
RE-ENFORCEMENT CHALLENGES.—A suit 6
under subsection (a) or (b) may be brought to prevent en-7
forcement or implementation by any government of a 8
State limitation or requirement that is inconsistent with 9
section 4 or 5. 10
(d) D
ECLARATORY AND EQUITABLERELIEF.—In 11
any action under this section, the court may award appro-12
priate declaratory and equitable relief, including tem-13
porary, preliminary, or permanent injunctive relief. 14
(e) C
OSTS.—In any action under this section, the 15
court shall award costs of litigation, as well as reasonable 16
attorney’s fees, to any prevailing plaintiff. A plaintiff shall 17
not be liable to a defendant for costs or attorney’s fees 18
in any non-frivolous action under this section. 19
(f) J
URISDICTION.—The district courts of the United 20
States shall have jurisdiction over proceedings under this 21
Act and shall exercise the same without regard to whether 22
the party aggrieved shall have exhausted any administra-23
tive or other remedies that may be provided for by law. 24
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(g) ABROGATION OF STATEIMMUNITY.—Neither a 1
State that enforces or maintains, nor a government official 2
(including a person described in section 7(c)) who is per-3
mitted to implement or enforce any limitation or require-4
ment that violates section 4 or 5 shall be immune under 5
the Tenth Amendment to the Constitution of the United 6
States, the Eleventh Amendment to the Constitution of 7
the United States, or any other source of law, from an 8
action in a Federal or State court of competent jurisdic-9
tion challenging that limitation or requirement, unless 10
such immunity is required by clearly established Federal 11
law, as determined by the Supreme Court of the United 12
States. 13
SEC. 10. EFFECTIVE DATE. 14
This Act shall take effect upon the date of enactment 15
of this Act. 16
SEC. 11. SEVERABILITY. 17
If any provision of this Act, or the application of such 18
provision to any person, entity, government, or cir-19
cumstance, is held to be unconstitutional, the remainder 20
of this Act, or the application of such provision to all other 21
persons, entities, governments, or circumstances, shall not 22
be affected thereby. 23
Æ
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