Abortion language complicates Democratic health efforts

House Democratic leaders, while insisting that the finish line is in sight on their overhaul of the nation’s healthcare system, have hit a last-minute snag over the abortion issue. Senate Democratic leaders, meanwhile, are continuing to have problems winning over moderates in their own party -- raising the possibility that the climactic votes on healthcare might be pushed into next year.

The delays in both houses reflect the fact that even though Democrats hold solid majorities, significant divisions exist below the surface, making consensus-building a delicate task at best.

The challenge is particularly great where abortion is concerned. House and Senate leaders already have adopted language that they say would prevent federal funds from being used to cover abortions. But some antiabortion lawmakers say that the language needs to be stronger.

And critics who favor abortion rights say that some of the demands would go beyond maintaining the status quo to make abortions harder to obtain.

The fight is focused on the health insurance exchanges that would be set up to help uninsured consumers buy policies. Some consumers whose incomes are close to the federal poverty line would qualify for government subsidies.

House Democrats who are opposed to funding abortion are demanding tougher restrictions to keep those assistance funds from being used for abortion services.

“I will oppose bringing the bill to the floor until an amendment can be offered or language agreed to that will prevent public funding for abortion,” Rep. Bart Stupak (D-Mich.) said Tuesday, adding that negotiations with House leaders were ongoing.

Stupak wants an up-or-down floor vote on language adopted from the Hyde Amendment, the far-reaching ban on using federal funds to pay for abortions that was adopted by Congress 33 years ago.

Stupak also wants to prevent a “public option” plan from offering abortion services.

Under the current version of the House bill, the government and private companies could market their plans through an insurance exchange that would require a minimum benefits package. Some of the customers purchasing coverage through the exchange would do so with the help of government subsidies.

An advisory council would determine which benefits to recommend, but the bill now specifically bars the council from requiring that abortion services be covered.

Stupak has warned that he could keep as many as 40 House Democrats from supporting the bill if his terms aren’t met -- a serious threat when leaders are worried about securing a bare majority.

Abortion-rights activists maintain that Stupak’s amendment would effectively prevent private insurance companies from offering abortion services through the exchanges, reducing the availability of those services to women nationwide.

“Stupak is basically saying you cannot even participate in the exchange unless your plan does not cover abortion,” said Nancy Keenan, president of NARAL Pro-Choice America. “He’s taking away coverage from women who already have it.”

Meantime, another member of the House’s Pro-Life Caucus, Rep. Brad Ellsworth (D-Ind.), is negotiating with the leadership to toughen the funding restrictions and require at least one insurer in the exchange to offer a plan that doesn’t cover abortion.

House leaders said that they expected a compromise to be reached with Ellsworth that would satisfy enough of the antiabortion Democrats.

“I am pretty confident that we can get there,” House Majority Leader Steny H. Hoyer (D-Md.) said Tuesday, “essentially making very clear that any money spent on the issue of termination of pregnancy will be spent not by the government, but by the individuals.”

House leaders had hoped to begin debate, and even vote, on the final bill this weekend. But Pelosi has promised to make public the final version of the bill three days before debate begins to ensure that members have time to examine it.

That pledge, plus the lagging negotiations, threatens to push debate and a vote into next week, though it remains possible that a deal could be struck in time to avoid that.

In the Senate, meanwhile, Democratic leaders are awaiting cost estimates from the Congressional Budget Office and struggling with centrists over including a version of the public option.

Senate debate may not begin until close to Thanksgiving, with a vote sometime in December.

After that, it is expected to take weeks to reconcile the Senate and House versions.

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joliphant@latimes.com