HR-3589-119
Referred to the House Committee on Energy and Commerce.
Sponsored by Diana Harshbarger (R-TN)
What it does
This bill would prohibit the federal government and federally funded entities from penalizing health care providers who decline to participate in assisted reproductive technology (ART), such as in vitro fertilization (IVF), on the basis of religious beliefs or moral convictions. It would direct HHS to update medical billing codes to reflect restorative reproductive medicine — an approach that monitors and treats underlying health conditions (such as endometriosis) to restore natural fertility rather than using ART. The bill would also expand federal grant eligibility and training programs to include providers and educators focused on restorative reproductive medicine, and would require HHS to produce research reports and develop education on male infertility and reproductive health conditions.
Who benefits
Health care providers (physicians, nurses, clinics) who object to performing ART on religious or moral grounds and currently face professional or financial penalties. Patients who prefer or are better served by treating the root causes of infertility rather than using ART. Organizations and clinics that practice or teach restorative reproductive medicine, which would gain access to federal grant funding. Researchers in reproductive health conditions such as endometriosis and polycystic ovary syndrome (PCOS). Patients with male-factor infertility, who would benefit from expanded HHS education and research. Faith-based health systems that have declined to offer ART services.
Who is hurt
Patients seeking ART services who may face reduced provider availability if more providers opt out without penalty. Fertility clinics and ART specialists who could face increased competition for federal grant dollars now shared with restorative medicine providers. Entities currently receiving family planning grants that may see funding diluted as new providers become eligible. Patients in rural or underserved areas where provider choice is already limited, who may have fewer ART options if opt-outs increase. Advocacy organizations that support broad access to ART, who may view the conscience protections as reducing practical access to fertility treatments.
Supporters argue
Supporters argue that no health care provider should be compelled to perform procedures that violate their sincerely held religious beliefs or moral convictions, a principle already recognized in federal law for abortion and sterilization under the Church Amendments. They contend that restorative reproductive medicine is an evidence-based approach that addresses the root causes of infertility — conditions like endometriosis affect roughly 1 in 10 women of reproductive age — yet receives little federal research or training support compared to ART. Expanding funding and training for this approach, they argue, gives patients more treatment options and promotes genuine reproductive health rather than bypassing underlying conditions.
Opponents argue
Opponents argue that broadening conscience opt-outs for ART could meaningfully reduce patient access to fertility treatments, particularly in areas with few providers, where a single clinic's refusal could leave patients without viable options. They contend that restorative reproductive medicine, while appropriate for some patients, has a more limited evidence base for treating infertility than ART, and that redirecting federal grant eligibility and training resources toward it may disadvantage patients for whom ART is the medically indicated path. Critics also argue the bill's framing could allow providers to decline services based on broad "moral convictions" — a standard that may be difficult to define or limit in practice.
Constitutional context
The bill's conscience protections for providers who decline ART on religious grounds implicate the Free Exercise Clause (First Amendment) and the Religious Freedom Restoration Act (RFRA), the same framework the Supreme Court applied in Burwell v. Hobby Lobby (2014) to allow religious exemptions from ACA healthcare mandates. Federal spending conditions attached to grant eligibility must also comply with the Spending Clause (Art. I, §8, cl. 1); conditions that effectively coerce grantees could raise concerns under the coercion doctrine recognized in NFIB v. Sebelius (2012).
Checks and balances
The Executive Branch (HHS) gains new administrative duties — updating billing codes, issuing reports, and expanding grant eligibility — while Congress sets the conscience protection standards; courts retain authority to review whether grant conditions are coercive or whether conscience protections are applied consistently with RFRA and the First Amendment.
Historical precedent
The Church Amendments (1973) established the first federal conscience protections for health care providers declining to perform abortions or sterilizations on moral or religious grounds, and have been upheld as a valid exercise of Congress's Spending Clause authority.