The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Rules
BILL: CS/SB 1580
INTRODUCER: Rules Committee and Senator Trumbull
SUBJECT: Protections of Medical Conscience
DATE: April 20, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Looke Brown HP Favorable
2. Looke Twogood RC Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 1580 establishes rights of conscience for health care providers and payors. The bill
provides legislative intent and provides that a health care provider or payor has the right to opt-
out of participation in or payment for a health care service on the basis of a conscience-based
objection (CBO). The bill establishes notification requirements for opting-out and prohibits a
payor from opting-out of paying for a service it is contractually obligated to cover during a plan
year. The bill also specifies that CBOs are limited to specific health care services, that the bill
may not be construed to waive or modify any duty a provider or payor may have for other health
care services that do not violate a provider’s or payor’s conscience, and that nothing in the bill
allows a health care provider or payor to opt-out of providing health care services to any patient
or potential patient because of that patient’s or potential patient’s race, color, religion, sex, or
national origin.
The bill prohibits health care providers from being discriminated against or suffering adverse
action for declining to participate in a health care service based on a CBO. The bill also provides
whistle-blower protections for providers or payors in specific situations and specifies that the bill
may not be construed to override any requirement to provide emergency medical treatment in
accordance with federal or state law.
The bill allows health care providers or payors to file complaints of violations to the Attorney
General (AG) and authorizes the AG to bring a civil action for appropriate relief. The bill also
provides civil immunity for health care providers and payors solely for declining to participate in
a health care service on the basis of a conscience-based objection, with some exceptions.
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Additionally, the bill prohibits a board,1 or the Department of Health (DOH) if there is no board,
from taking disciplinary action against a health care practitioner solely because he or she has
spoken or written publicly about a health care service or public policy, including on a social
media platform, as long as the speech or written communication does not provide advice or
treatment to a specific patient or patients and does not separately violate any other applicable law
or rule. The bill also authorizes a board within the DOH to revoke approval of any specialty
board for revoking the certification of an individual for the same reason.
The bill provides that its provisions are severable and provides an effective date of July 1, 2023.
II. Present Situation:
Medical Conscience
The Church Amendments
The conscience provisions contained in 42 U.S.C. 300a-7 (collectively known as the “Church
Amendments”) were enacted at various times during the 1970s in response to debates over
whether receipt of federal funds required the recipients of such funds to perform abortions or
sterilizations. The first conscience provision in the Church Amendments, 42 U.S.C. 300a-7(b),
provides that “[t]he receipt of any grant, contract, loan, or loan guarantee under [certain statutes
implemented by the Department of Health and Human Services] by any individual or entity, does
not authorize any court or any public official or other public authority to require:”
 The individual to perform or assist in a sterilization procedure or an abortion, if it would be
contrary to his or her religious beliefs or moral convictions;
 The entity to make its facilities available for sterilization procedures or abortions, if the
performance of sterilization procedures or abortions in the facilities is prohibited by the
entity on the basis of religious beliefs or moral convictions; or
 The entity to provide personnel for the performance or assistance in the performance of
sterilization procedures or abortions, if it would be contrary to the religious beliefs or moral
convictions of such personnel.
The second conscience provision in the Church Amendments, 42 U.S.C. 300a-7(c)(1), prohibits
any entity that receives a grant, contract, loan, or loan guarantee under certain statutes from
discriminating against any physician or other health care personnel in employment, promotion,
termination of employment, or the extension of staff or other privileges because the individual
“performed or assisted in the performance of a lawful sterilization procedure or abortion, because
he refused to perform or assist in the performance of such a procedure or abortion on the grounds
that his performance or assistance in the performance of the procedure or abortion would be
contrary to his religious beliefs or moral convictions, or because of his religious beliefs or moral
convictions respecting sterilization procedures or abortions.”
The third conscience provision, contained in 42 U.S.C. 300a-7(c)(2), prohibits any entity that
receives a grant or contract for biomedical or behavioral research under any program
1
Under s. 456.001(1), F.S., a “board” is any board or commission, or other statutorily created entity, to the extent such entity
is authorized to exercise regulatory or rulemaking functions within the Department of Health or the department’s Division of
Medical Quality Assurance. Most of Florida’s licensed health care professions have a board.
BILL: CS/SB 1580 Page 3
administered by the U.S. Department of Health and Human Services (HHS) from discriminating
against any physician or other health care personnel in employment, promotion, termination of
employment, or extension of staff or other privileges “because he performed or assisted in the
performance of any lawful health service or research activity, because he refused to perform or
assist in the performance of any such service or activity on the grounds that his performance or
assistance in the performance of such service or activity would be contrary to his religious
beliefs or moral convictions, or because of his religious beliefs or moral convictions respecting
any such service or activity.”
The fourth conscience provision, 42 U.S.C. 300a-7(d), provides that “[n]o individual shall be
required to perform or assist in the performance of any part of a health service program or
research activity funded in whole or in part under a program administered by [the HHS] if his
performance or assistance in the performance of such part of such program or activity would be
contrary to his religious beliefs or moral convictions.”
The final conscience provision contained in the Church Amendments, 42 U.S.C. 300a-7(e),
prohibits any entity that receives a grant, contract, loan, loan guarantee, or interest subsidy under
certain Departmentally-implemented statutes from denying admission to, or otherwise
discriminating against, “any applicant (including applicants for internships and residencies) for
training or study because of the applicant's reluctance, or willingness, to counsel, suggest,
recommend, assist, or in any way participate in the performance of abortions or sterilizations
contrary to or consistent with the applicant's religious beliefs or moral convictions.”2
Public Health Service Act Section 245
Enacted in 1996, section 245 of the Public Health Service Act (PHS Act) prohibits the federal
government and any state or local government receiving federal financial assistance from
discriminating against any health care entity on the basis that the entity:
 “Refuses to undergo training in the performance of induced abortions, to require or provide
such training, to perform such abortions, or to provide referrals for such training or such
abortions;”
 Refuses to make arrangements for such activities; or
 “Attends (or attended) a post-graduate physician training program, or any other program of
training in the health professions, that does not (or did not) perform induced abortions or
require, provide, or refer for training in the performance of induced abortions, or make
arrangements for the provision of such training.”
For the purposes of this protection, the statute defines “financial assistance” as including, “with
respect to a government program,” “governmental payments provided as reimbursement for
carrying out health-related activities.” In addition, PHS Act Sec. 245 requires that, in
determining whether to grant legal status to a health care entity (including a state's determination
of whether to issue a license or certificate), the federal government and any state or local
government receiving federal financial assistance must deem accredited any post-graduate
physician training program that would be accredited, but for the reliance on an accrediting
2
Safeguarding the Rights of Conscience as Protected by Federal Statutes: A Proposed Rule by the HHS, 1/5/23, available at
https://www.federalregister.gov/documents/2023/01/05/2022-28505/safeguarding-the-rights-of-conscience-as-protected-by-
federal-statutes, (last visited April 1, 23).
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standard that, regardless of whether such standard provides exceptions or exemptions, requires
an entity:
 To perform induced abortions; or
 To require, provide, or refer for training in the performance of induced abortions, or make
arrangements for such training.3
Medicare and Medicaid
Federal Medicare and Medicaid law includes certain conscience provisions as well. In particular,
the Balanced Budget Act of 1997, Public Law 105-33, 111 Stat. 251 (1997), prohibits Medicaid
managed care organizations and Medicare Advantage plans from prohibiting or restricting a
physician from informing a patient about his or her health and full range of treatment options.
However, it also provides that Medicaid managed care organizations and Medicare Advantage
plans are not required to provide, reimburse for, or cover a counseling or referral service if the
organization or plan objects to the service on moral or religious grounds. Such organization or
plan must, however, provide sufficient notice of its moral or religious objections to prospective
enrollees.4
Weldon Amendment
The Weldon Amendment, originally adopted as section 508(d) of the Labor-HHS Division
(Division F) of the 2005 Consolidated Appropriations Act,5 has been readopted (or incorporated
by reference) in each subsequent legislative measure appropriating funds to HHS.
The Weldon Amendment provides that “[n]one of the funds made available in this Act [making
appropriations for the Departments of Labor, Health and Human Services, and Education] may
be made available to a Federal agency or program, or to a State or local government, if such
agency, program, or government subjects any institutional or individual health care entity to
discrimination on the basis that the health care entity does not provide, pay for, provide coverage
of, or refer for abortions.” It also defines “health care entity” to include “an individual physician
or other health care professional, a hospital, a provider-sponsored organization, a health
maintenance organization, a health insurance plan, or any other kind of health care facility,
organization, or plan.”6
The Patient Protection and Affordable Care Act (ACA)
Section 1553 of the federal ACA provides that the federal government, any state or local
government, and any health care provider that receives federal funding under the ACA, or any
health plan created under the ACA, may not subject an individual or health care entity to
discrimination on the grounds that the individual or entity does not provide services for the
purpose of causing or assisting in the death of any individual, including through assisted suicide,
euthanasia, and mercy killing.
3
Id.
4
Supra note 2.
5
Public Law 108-447, 118 Stat. 2809, 3163 (Dec. 8, 2004)
6
Supra note 2.
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Section 1303 provides that a state may choose to prohibit abortion coverage in its qualified
health plans and that such a plan is not required to provide abortion coverage as part of its
“essential health benefits.” However, a qualified health plan that declines to provide abortion
coverage must provide notice of this exclusion to potential enrollees, and no qualified health plan
may discriminate against any health care provider or facility because it refuses to provide, pay
for, cover, or refer for abortions. Section 1303 also states that nothing in the ACA shall be
construed to preempt state laws on abortion or federal laws on conscience protection, willingness
or refusal to provide abortion, and discrimination based on that willingness or refusal to provide,
pay for, cover, or refer for abortion or to provide or participate in training to provide abortion, or
to relieve health care providers of their obligations to provide emergency services under federal
or state laws, including the Emergency Medical Treatment and Labor Act.7
State Medical Conscience Laws
According to the Guttmacher Institute:
 Forty-six states allow some health care providers to refuse to provide abortion services.
o All of these states permit individual health care providers to refuse to provide abortion
services.
o Forty-four states allow health care institutions to refuse to provide abortion services;
o Thirteen limit the exemption to private health care institutions; and
o One state allows only religious health care entities to refuse to provide such services.
 Twelve states allow some health care providers to refuse to provide services related to
contraception.
o Nine states allow individual health care providers to refuse to provide services related to
contraception.
o Six states explicitly permit pharmacists to refuse to dispense contraceptives. (Six
additional states have broad refusal clauses that do not specifically include pharmacists,
but may apply to them.)
o Eight states allow health care institutions to refuse to provide services related to
contraception; and
o Five states limit the exemption to private entities.
 Eighteen states allow some health care providers to refuse to provide sterilization services.
o Seventeen states allow individual health care providers to refuse to provide sterilization
services.
o Sixteen states allow health care institutions to refuse to provide sterilization services;
o Four limit the exemption to private entities.8
Freedom of Speech
“Congress shall make no law … abridging the freedom of speech.”9
The First Amendment of the U.S. Constitution protects the right to freedom of expression from
government interference. The First Amendment is applicable to the states through the Due
7
Supra note 2.
8
For details, please see: Refusing to Provide Health Services, Guttmacher Institute, Updated March 1, 2023, available at
https://www.guttmacher.org/state-policy/explore/refusing-provide-health-services, (last visited April 1, 2023).
9
U.S. CONST. amend. I.
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Process Clause of the Fourteenth Amendment.10 “[T]he First Amendment assures the broadest
tolerable exercise of free speech, free press, and free assembly, not merely for religious purposes,
but for political, economic, scientific, news, or informational ends as well.”11
It is well established that a government regulation based on the content of speech is
presumptively invalid and will be upheld only if it is necessary to advance a compelling
governmental interest, precisely tailored to serve that interest, and is the least restrictive means
available for establishing that interest.12 The government bears the burden of demonstrating the
constitutional