Liberals furious over a last-minute deal that secured passage of healthcare legislation in the House by restricting abortion coverage threatened Monday to derail the massive overhaul bill.
At least 40 House members pledged to reject the final bill if the abortion provision survives in the Senate and the conference that joins the Senate and House versions into a single piece of legislation.
At issue are the insurance policies offered in a new “exchange,” or marketplace, where many people would use federal subsidies to buy coverage.
The House measure bars any insurance policy from covering abortions if it was purchased with a federal subsidy.
That would probably force insurance companies to drop abortion coverage in the exchange to keep their policies open to the potentially large pool of subsidized customers.
As a result, abortion rights supporters say, even a customer who received no subsidies would be unable to purchase a comprehensive policy covering abortion.
The provision “represents an unprecedented and unacceptable restriction on women’s ability to access the full range of reproductive health services to which they are lawfully entitled,” the House members wrote to Speaker Nancy Pelosi (D-San Francisco).
It was a tougher line than they had adopted less than 48 hours earlier, when the 40 legislators had, almost to a member, voted to pass the health legislation.
The bill cleared the chamber late Saturday by five votes.
The tumult over abortion now travels to the Senate, where it promises to cause headaches for Democrats still wrestling with fundamental issues of cost, coverage and revenue in their version of the health bill.
The Senate legislation contains looser restrictions on abortion coverage than were approved by the House. But already at least one Democrat, Sen. Ben Nelson of Nebraska, has signaled that he may be willing to work with abortion rights opponents on developing language similar to the House’s.
“He wants to make sure the intent is the same” as the House amendment, said Jake Thompson, a spokesman for Nelson. “The final bill has to satisfy him that it doesn’t support federal funding of abortions.”
Activists were also focusing on Sen. Bob Casey (D-Pa.), who opposes abortion rights. Because Democrats will likely need the vote of every member of their caucus to pass the health bill, Nelson and Casey might have significant leverage in demanding tough language on abortion coverage.
President Obama suggested Monday that the House measure might be altered as the legislation moves through Congress, though he did not say that he would push for changes himself.
Obama told ABC News that the bill should uphold the principle that federal money may not be used to subsidize abortions.
“I want to make sure that the provision that emerges meets that test -- that we are not in some way sneaking in funding for abortions, but on the other hand that we’re not restricting women’s insurance choices,” he said.
“I’m confident that we can actually arrive at this place where neither side feels that it’s being betrayed.”
The House amendment, which was sponsored by Reps. Bart Stupak (D-Mich.) and Joe Pitts (R-Pa.), would allow people buying insurance in the exchange to purchase separate “riders” that would cover abortions.
Abortion rights advocates say few would do so because few anticipate an unplanned pregnancy and few insurers are likely to offer such a separate service.
“No one counts on getting an abortion,” said Rachel Laser, a lawyer with Third Way, a Washington think tank that advocates centrist policies.
If the House language ends up in the final version of the bill -- which would come after it is merged with a Senate version -- it remains unclear how much of an effect it would have.
In 2001, 13% of abortions were billed directly to insurance companies, according to the Guttmacher Institute, which studies reproductive health.
That figure, however, may understate insurance payments for abortion, because it does not include cases in which patients paid for the procedure out of pocket and later asked for reimbursement from their insurers.
Women who obtain health coverage through Medicaid, the federal-state program for low-income people, currently are covered for abortion only in the case of rape or incest, or when the mother’s life is at stake.
Dr. Willie Parker, a board member at Physicians for Reproductive Choice and Health, said the amendment could have the greatest effect on women whose underlying health conditions require hospitalization for a safe abortion.
As an example, Parker cited a pregnancy involving abnormal attachment of the placenta. Although a standard abortion may cost as little as $350, the cost in that situation would range from $3,000 to $4,000.
“Many women don’t have that kind of disposable income. If we allow the Stupak amendment to stand, we have just set women back 30 years in guaranteed access to safe abortion services,” Parker said.
Charmaine Yoest, president of Americans United for Life, which opposes abortion rights, said she was confident that the Senate ultimately would take a similar route as the House.
“There is a division on abortion in the country,” Yoest said. “There’s not a division on federal funding.”
The United States Conference of Catholic Bishops, which played an instrumental role in the House legislation, has already asked its 19,000 member parishes to contact the Senate.
But Cecile Richards, president of Planned Parenthood, said prior bids to tighten the abortion language in the Senate had failed, and that the Senate would not follow the House’s lead.
“The most important part of healthcare reform to us has been the guarantee that the president made that no one would lose their benefits as a result, and the Stupak amendment undercuts that promise,” Richards said. “I think cooler heads will prevail in the Senate.”