Women’s Health Protection Act of 2019

II 116TH CONGRESS 1ST SESSION S. 1645 To protect a woman’s ability to determine whether and when to bear a child or end a pregnancy, and to protect a health care provider’s ability to provide reproductive health care services, including abortion services. IN THE SENATE OF THE UNITED STATES MAY 23 (legislative day, MAY 22), 2019 Mr. BLUMENTHAL (for himself, Ms. BALDWIN, Mr. MENENDEZ, Mr. BROWN, Ms. HARRIS, Mr. MERKLEY, Mr. WHITEHOUSE, Mr. BENNET, Mr. MAR- KEY, Ms. WARREN, Mr. CARDIN, Mr. HEINRICH, Ms. STABENOW, Ms. KLOBUCHAR, Mr. TESTER, Ms. ROSEN, Mr. COONS, Ms. CORTEZ MASTO, Mrs. SHAHEEN, Mr. SANDERS, Ms. HIRONO, Ms. HASSAN, Mr. SCHATZ, Mr. KING, Ms. SMITH, Mrs. MURRAY, Mr. PETERS, Mr. WYDEN, Mrs. FEINSTEIN, Mrs. GILLIBRAND, Mr. MURPHY, Mr. LEAHY, Ms. DUCKWORTH, Mr. VAN HOLLEN, Mr. CARPER, Ms. CANTWELL, Mr. BOOKER, Mr. WARNER, Mr. UDALL, Mr. SCHUMER, Mr. KAINE, Mr. DURBIN, and Ms. SINEMA) introduced the following bill; which was read twice and referred to the Committee on the Judiciary A BILL To protect a woman’s ability to determine whether and when to bear a child or end a pregnancy, and to protect a health care provider’s ability to provide reproductive health care services, including abortion services. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 17:46 Jun 03, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1645.IS S1645 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 1645 IS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Women’s Health Pro- 2 tection Act of 2019’’. 3 SEC. 2. FINDINGS AND PURPOSE. 4 (a) FINDINGS.—Congress finds the following: 5 (1) Access to safe, legal abortion services is es- 6 sential to women’s health and central to women’s 7 ability to participate equally in the economic and so- 8 cial life of the United States. 9 (2) Since 1973, the Supreme Court repeatedly 10 has recognized the constitutional right of a woman 11 to decide to terminate her pregnancy before fetal vi- 12 ability, and to terminate her pregnancy after fetal 13 viability where it is necessary, in the good-faith med- 14 ical judgment of the treating health care profes- 15 sional, for the preservation of her life or health. 16 (3) Nonetheless, access to safe, legal abortion 17 services has been hindered across the United States 18 in various ways, including blockades of health care 19 facilities and associated violence, prohibitions of and 20 restrictions on insurance coverage, restrictions which 21 shame and stigmatize women seeking abortion serv- 22 ices, and medically unnecessary regulations which 23 neither confer any health benefit nor further the 24 safety of abortion services, but which harm women 25 by delaying access to, and reducing the availability 26 VerDate Sep 11 2014 17:46 Jun 03, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1645.IS S1645 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 1645 IS of, services. Since 2010, States and local govern- 1 ments have passed more than 400 such restrictions 2 singling out health care providers who offer abortion 3 services and interfering with health care providers’ 4 ability to provide reproductive health care services 5 and the ability of patients to obtain those services. 6 (4) Many State and local governments have im- 7 posed restrictions on the provision of abortion that 8 are neither evidence-based nor generally applicable 9 to the medical profession or to other medically com- 10 parable outpatient gynecological procedures, such as 11 endometrial ablations, dilation and curettage for rea- 12 sons other than abortion, hysteroscopies, loop 13 electrosurgical excision procedures, or other analo- 14 gous non-gynecological procedures performed in 15 similar outpatient settings including vasectomy, 16 sigmoidoscopy, and colonoscopy. 17 (5) Legal abortion is one of the safest medical 18 procedures in the United States. An independent re- 19 view of research on the safety and quality of abor- 20 tion services in the United States, published by the 21 National Academies of Sciences, Engineering, and 22 Medicine in 2018, found that abortion in all forms 23 is safe and effective and that the biggest threats to 24 the quality of abortion services in the United States 25 VerDate Sep 11 2014 17:46 Jun 03, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1645.IS S1645 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 1645 IS are State regulations that create barriers to care. 1 These abortion-specific restrictions conflict with 2 medical standards and are not supported by the rec- 3 ommendations and guidelines issued by leading re- 4 productive health care professional organizations in- 5 cluding the American College of Obstetricians and 6 Gynecologists, the Society of Family Planning, the 7 National Abortion Federation, the World Health Or- 8 ganization, and others. 9 (6) Many abortion-specific restrictions do not 10 confer any health or safety benefits on the patient. 11 Instead, these restrictions have the purpose and ef- 12 fect of unduly burdening women’s personal and pri- 13 vate medical decisions to end their pregnancies by 14 making access to abortion services more difficult, 15 invasive, and costly, forcing women to travel signifi- 16 cant distances and make multiple unnecessary visits 17 to the provider, and in some cases, foreclosing the 18 option altogether. For example, a 2018 report from 19 the University of California San Francisco’s Advanc- 20 ing New Standards in Reproductive Health research 21 group found that in 27 cities across the United 22 States, people have to travel more than 100 miles in 23 any direction to reach an abortion provider. 24 VerDate Sep 11 2014 17:46 Jun 03, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1645.IS S1645 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 1645 IS (7) These restrictions additionally harm wom- 1 en’s health by reducing access not only to abortion 2 services but also to the other essential health care 3 services offered by the providers targeted by the re- 4 strictions, including— 5 (A) contraceptive services, which advance 6 women’s health and provide a range of benefits, 7 including preventing unintended pregnancies 8 and reducing the need for abortion; and 9 (B) screenings for cervical cancer and sex- 10 ually transmitted infections. 11 (8) The cumulative effect of these numerous re- 12 strictions has been to severely limit the availability 13 of abortion services in some areas, creating a patch- 14 work system where access to abortion services is 15 more available in some States than in others. A 16 2019 report from the Government Accountability Of- 17 fice examining State Medicaid compliance with abor- 18 tion coverage requirements analyzed 7 key chal- 19 lenges (identified both by health care providers and 20 research literature) and their effect on abortion ac- 21 cess, and found that access to abortion services var- 22 ied across the States and even within a State. 23 (9) The harms of these abortion-specific restric- 24 tions fall especially heavily on low-income women, 25 VerDate Sep 11 2014 17:46 Jun 03, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1645.IS S1645 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 1645 IS women of color, immigrants, young people, and 1 women living in rural and other medically under- 2 served areas. 3 (10) Abortion-specific restrictions single out 4 health services used by women, and rely on and rein- 5 force stereotypes about women’s roles, women’s deci- 6 sionmaking, and women’s need for protection. These 7 restrictions harm the basic autonomy, dignity, equal- 8 ity, and ability of women to participate in the social 9 and economic life of the Nation. 10 (11) Not all people who become pregnant or 11 need abortion services identify as women. Access to 12 abortion services is critical to the health of every 13 person regardless of actual or perceived race, color, 14 national origin, immigration status, sex (including 15 gender identity, sex stereotyping, or sexual orienta- 16 tion), age, or disability status. This Act’s protection 17 is inclusive of all pregnant people. 18 (12) These restrictions affect the cost and 19 availability of abortion services, and the settings in 20 which abortion services are delivered. Women travel 21 across State lines and otherwise engage in interstate 22 commerce to access this important medical care, and 23 more would be forced to do so absent this Act. Like- 24 wise, health care providers travel across State lines 25 VerDate Sep 11 2014 17:46 Jun 03, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1645.IS S1645 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 1645 IS and otherwise engage in interstate commerce in 1 order to provide reproductive health services to pa- 2 tients, and more would be forced to do so absent this 3 Act. 4 (13) Health care providers, including those who 5 provide abortion services, engage in a form of eco- 6 nomic and commercial activity when they provide 7 abortion services, and there is an interstate market 8 for abortion services. 9 (14) To provide abortion services, health care 10 providers engage in interstate commerce to purchase 11 medicine, medical equipment, and other necessary 12 goods and services. To provide and assist others in 13 providing abortion services, health care providers en- 14 gage in interstate commerce to obtain and provide 15 training. To provide abortion services, health care 16 providers employ and obtain commercial services 17 from doctors, nurses, and other personnel who en- 18 gage in interstate commerce and travel across State 19 lines. Abortion restrictions substantially affect inter- 20 state commerce in numerous ways. 21 (15) It is difficult and time consuming for clin- 22 ics to challenge State laws that burden or impede 23 abortion services. Litigation that blocks one abortion 24 restriction may not prevent a State from adopting 25 VerDate Sep 11 2014 17:46 Jun 03, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1645.IS S1645 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 1645 IS other abortion restrictions or using different meth- 1 ods to burden or impede abortion services. There is 2 a history and pattern of States passing successive 3 and different laws that impede and unduly burden 4 abortion services. 5 (16) When a health care provider ceases pro- 6 viding abortion services as a result of burdensome 7 and medically unnecessary regulations, it is often 8 difficult or impossible for that health care provider 9 to recommence providing those abortion services, 10 and difficult or impossible for other health care pro- 11 viders to provide abortion services that restore or re- 12 place the ceased abortion services. 13 (17) An overwhelming majority of abortions in 14 the United States are provided in clinics, not hos- 15 pitals. The large majority of United States counties 16 have no clinics that provide abortion. 17 (18) Congress has the authority to enact this 18 Act to protect abortion services pursuant to— 19 (A) its powers under the commerce clause 20 of section 8 of article I of the Constitution of 21 the United States; 22 (B) its powers under section 5 of the Four- 23 teenth Amendment to the Constitution of the 24 VerDate Sep 11 2014 17:46 Jun 03, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1645.IS S1645 pamtmann on DSKBFK8HB2PROD with BILLS 9 •S 1645 IS 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 (19) Congress has used its authority in the past 6 to protect women’s ability to access abortion services 7 and health care providers’ ability to provide abortion 8 services. In the early 1990s, protests and blockades 9 at health care facilities where abortion services were 10 provided, and associated violence, increased dramati- 11 cally and reached crisis level, requiring congressional 12 action. Congress passed the Freedom of Access to 13 Clinic Entrances Act (Public Law 103–259; 108 14 Stat. 694) to address that situation and protect 15 physical access to abortion services. 16 (20) Congressional action is necessary to put an 17 end to harmful restrictions, to federally protect ac- 18 cess to abortion services for all women regardless of 19 where they live, and to protect the ability of repro- 20 ductive health care providers to provide these serv- 21 ices in a safe and accessible manner. 22 (b) PURPOSE.—It is the purpose of this Act— 23 (1) to permit health care providers to provide 24 abortion services without limitations or requirements 25 VerDate Sep 11 2014 17:46 Jun 03, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1645.IS S1645 pamtmann on DSKBFK8HB2PROD with BILLS 10 •S 1645 IS that single out the provision of abortion services for 1 restrictions that are more burdensome than those re- 2 strictions imposed on medically comparable proce- 3 dures, do not significantly advance women’s health 4 or the safety of abortion services, and make abortion 5 services more difficult to access; 6 (2) to promote women’s health and women’s 7 ability to participate equally in the economic and so- 8 cial life of the United States; and 9 (3) to invoke congressional authority, including 10 the powers of Congress under the commerce clause 11 of section 8 of article I of the Constitution of the 12 United States, its powers under section 5 of the 13 Fourteenth Amendment to the Constitution of the 14 United States to enforce the provisions of section 1 15 of the Fourteenth Amendment, and its powers under 16 the necessary and proper clause of section 8 of arti- 17 cle I of the Constitution of the United States. 18 SEC. 3. DEFINITIONS. 19 In this Act: 20 (1) ABORTION SERVICES.—The term ‘‘abortion 21 services’’ means an abortion and any medical or 22 non-medical services related to and provided in con- 23 junction with an abortion (whether or not provided 24 VerDate Sep 11 2014 17:46 Jun 03, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1645.IS S1645 pamtmann on DSKBFK8HB2PROD with BILLS 11 •S 1645 IS at the same time or on the same day as the abor- 1 tion). 2 (2) HEALTH CARE PROVIDER.—The term 3 ‘‘health care provider’’ means any entity or indi- 4 vidual (including any physician, certified nurse-mid- 5 wife, nurse practitioner, and physician assistant) 6 that is— 7 (A) engaged in the delivery of health care 8 services, including abortion services; and 9 (B) if required by law or regulation to be 10 licensed or certified to engage in the delivery of 11 such services, is so licensed or c [Text truncated for display. Full text available on Congress.gov.]