With House leaders struggling to reach agreement on healthcare legislation, aiming toward a possible vote this week, a new hurdle has emerged: abortion.
Some conservative Democrats are threatening to pull their support from the massive healthcare bill unless their concerns over potential federal funding of abortion procedures are met. They fear that the Obama administration will take advantage of an expanded government role in healthcare to increase the availability of abortions nationwide.
Republicans, meanwhile, are trying to use the divisive issue to build opposition to the bill.
The abortion issue has taken a back seat to a protracted dispute between Rep. Henry A. Waxman (D-Beverly Hills), chairman of the Energy and Commerce Committee, and moderate "Blue Dog" Democrats who worry about the bill's price tag and lack of cost controls. That conflict has delayed House Democrats from arriving at a final version of the bill and made it increasingly unlikely that the chamber will vote on the package this week.
On Monday, House Speaker Nancy Pelosi (D-San Francisco) signaled an openness to postponing the voting.
"I have said that I wanted a bill to pass before we left for the August recess," she said. "But I've also said that our members need the time . . . not only to get the bill written but to have plenty of time to review it. . . . So, we're on schedule either to do it now or to do it whenever."
The Senate last week pushed off floor action on a healthcare measure until September to give the finance committee more time to draft its version of the bill.
If the House leadership's dispute with the Blue Dogs is resolved, abortion looms as the next sticking point. Rep. Bart Stupak of Michigan and other Democrats opposed to abortion rights want to ensure that the bill includes language restricting taxpayer funds for the procedure.
The Hyde Amendment, passed in 1976, explicitly prevents the federal government from using tax dollars to fund abortion through Medicaid. But the reach of that law grows murkier if the government establishes its own competitive health insurance plan, or if it assists in creating a new market in which the public could sort through various private insurance plans. Both ideas could be included in the healthcare bill under consideration in Congress.
The Obama administration has tried to stay neutral on the matter.
"I think that it's appropriate for us to figure out how to just deliver on the cost savings and not get distracted by the abortion debate," President Obama said in an interview with CBS News last week.
When asked about abortion prohibitions in the bill, White House spokesman Robert Gibbs said last week that "a benefit package is better left to experts in the medical field to determine how best and what procedures to cover."
That is precisely what worries antiabortion advocates.
"By being silent on this issue, [Obama is] actually making an affirmative statement in favor of taxpayer abortions," Rep. John Fleming (R-La.) said.
As it stands, the House bill would create a Health Benefits Advisory Committee to prescribe which "essential benefits" should be offered in any government-supported insurance plan.
Opponents of abortion rights believe that unless there is specific wording to the contrary, abortion services will be included. "Unless you can specifically exclude abortion, it will be part of any federalized healthcare system," said Charmaine Yoest, executive director of Americans United for Life.
Efforts in other House committees to insert such prohibitions have failed. Stupak has vowed to push Waxman to include them in the version being written by the Energy and Commerce Committee.
Stupak was one of 19 Democrats to write to Pelosi last month to say that they "cannot support any healthcare proposal unless it excludes abortion from the scope of any government-defined or subsidized health insurance plan."
Abortion rights advocates say the bill simply would maintain the status quo, in which companies that offer health insurance are free to choose whether to cover abortion services. And they argue that any government restriction would mean that women who seek abortion coverage could be forced to choose a more expensive private health plan instead of a lower-cost, government-supported one. They also fear that insurers who wished to take advantage of government incentives would be forced to discontinue covering abortion procedures.
Stupak's proposal has drawn strong opposition from abortion rights advocates such as Rep. Louise M. Slaughter (D-N.Y.), who leads the rules committee.
"The starting point for Rep. Slaughter on the healthcare debate was protecting abortion rights," said Slaughter's spokesman, Vincent Morris.
"Opponents of women's health and healthcare reform are exploiting healthcare reform as a way to push for unprecedented prohibitions on abortion coverage in the private marketplace," Planned Parenthood said in a recent statement.
Noam N. Levey in the Washington Bureau contributed to this report.