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WASHINGTON BUREAU - Furious liberals on Monday threatened to derail the massive healthcare overhaul bill to protest a last-minute deal over insurance coverage of abortions that had secured passage of the legislation in the House.
At least 40 House members pledged not to vote for a final healthcare bill if the abortion provision survives--endangering the exceptionally fragile Democratic coalition that has kept the bill afloat.
At issue are the insurance policies offered in a new "exchange,'' or insurance marketplace, that the legislation would create to help consumers purchase health plans, many using newly created federal subsidies.
The House measure says the federal subsidies cannot be used to buy health policies that cover elective abortion. Abortion rights supporters say this would affect a broad set of consumers, because insurers would likely abandon abortion coverage in all policies offered in the exchange.
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 House Speaker Nancy Pelosi.
It was a tougher line than they had adopted less than 48 hours earlier, when they had, almost to a member, voted to pass the health legislation. The bill cleared the chamber late Saturday by a mere 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 revenues in its 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 language similar to that from the House.
"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."
Abortion rights opponents were also focusing on Sen. Robert 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.
"And 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. "Because one of the pledges I made in that same speech was to say that if you're happy and satisfied with the insurance that you have, that it's not going to change."
"I'm confident that we can actually arrive at this place where neither side feels that it's being betrayed," the president said. 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 women 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 percent 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 where women 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 for pregnancies resulting from rape or incest, or when the mother's life is at stake. Women living below the poverty level are more than four times more likely to have an abortion than women with income three times the poverty level.
Dr. Willie Parker, a board member at Physicians for Reproductive Choice and Health, said the amendment could have the greatest impact on women whose underlying health conditions require hospitalization in order for a safe abortion to be performed.
Parker cited an example of a woman with a pregnancy that involves abnormal attachment of the placenta. While a standard abortion may cost just $350, the cost in that situation would range between $3,000 and $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, referring to the House measure.
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 in a bid to see the House language adopted.
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 health care 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."
joliphant@tribune.com; kim.geiger@latimes.com
At least 40 House members pledged not to vote for a final healthcare bill if the abortion provision survives--endangering the exceptionally fragile Democratic coalition that has kept the bill afloat.
At issue are the insurance policies offered in a new "exchange,'' or insurance marketplace, that the legislation would create to help consumers purchase health plans, many using newly created federal subsidies.
The House measure says the federal subsidies cannot be used to buy health policies that cover elective abortion. Abortion rights supporters say this would affect a broad set of consumers, because insurers would likely abandon abortion coverage in all policies offered in the exchange.
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 House Speaker Nancy Pelosi.
It was a tougher line than they had adopted less than 48 hours earlier, when they had, almost to a member, voted to pass the health legislation. The bill cleared the chamber late Saturday by a mere 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 revenues in its 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 language similar to that from the House.
"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."
Abortion rights opponents were also focusing on Sen. Robert 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.
"And 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. "Because one of the pledges I made in that same speech was to say that if you're happy and satisfied with the insurance that you have, that it's not going to change."
"I'm confident that we can actually arrive at this place where neither side feels that it's being betrayed," the president said. 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 women 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 percent 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 where women 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 for pregnancies resulting from rape or incest, or when the mother's life is at stake. Women living below the poverty level are more than four times more likely to have an abortion than women with income three times the poverty level.
Dr. Willie Parker, a board member at Physicians for Reproductive Choice and Health, said the amendment could have the greatest impact on women whose underlying health conditions require hospitalization in order for a safe abortion to be performed.
Parker cited an example of a woman with a pregnancy that involves abnormal attachment of the placenta. While a standard abortion may cost just $350, the cost in that situation would range between $3,000 and $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, referring to the House measure.
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 in a bid to see the House language adopted.
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 health care 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."
joliphant@tribune.com; kim.geiger@latimes.com
