Democrats are close enough to taste victory in their quest to remake the nation's health care system, but differences between the House and Senate on abortion could still blow it all up.
The House health care bill would bar any health plan that receives federal money from covering abortions. Under the less restrictive Senate language, plans that get federal money could cover abortion as long as customers pay premiums for the procedure separately with their own money, and the premium payments are kept in a separate account.
"Something's going to have to give," said Rep. Bart Stupak, D-Mich., author of the abortion language in the House.
At this point it's not clear what that will be, although all involved in the intraparty dispute say they want to resolve the issue and sign on to a final health care bill for President Barack Obama to sign in January.
Abortion threatened to derail both the House and Senate legislation before last-minute compromises satisfied anti-abortion Democrats in both chambers. But those hard-won deals look very different.
Stupak's language bars federal funding from going to any insurance plan that includes abortion coverage. That's a significant limitation because Congress' redesigned health care system would give federal subsidies to millions of lower-income people to help them buy insurance at new marketplaces called exchanges. Since the bulk of purchasers in the exchanges would be receiving federal subsidies, most, if not all, insurance plans would be receiving federal money and therefore would be barred from covering abortion.
Stupak's language does allow insurers to offer separate rider policies covering only abortion, but abortion-rights activists contend such policies would be unlikely to materialize because there'd be little market for them. They note that most women don't plan for abortions ahead of time. Abortions in the first trimester typically cost between $350 and $900, according to Planned Parenthood.
The Senate's abortion compromise was designed to secure conservative Nebraska Democrat Ben Nelson's support as the critical 60th vote for the health care bill. It was reached after Nelson offered language nearly identical to Stupak's as an amendment on the Senate floor and it was defeated 54-45.
Democratic leaders scrambled for a compromise that would satisfy him. In the end, Nelson himself worked with Senate leaders, White House officials and Sen. Barbara Boxer, D-Calif. - representing abortion-rights supporters - to come up with a deal.
Their language would allow health plans that receive federal subsidies to sell insurance plans covering abortion. But those plans would have to collect separate premiums for the procedure from the customer and the money then segregated. And states would be allowed to decide whether or not abortion could be covered by health plans operating in the new exchanges.
Nelson said the language achieves his goal of ensuring that no federal money may go for abortion. Boxer said that although it wasn't her first choice, it still allows women to obtain abortion coverage. But the deal has been rejected by outside groups on both sides of the issue - something that Boxer and Nelson both cite as evidence that they achieved a fair outcome.
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More problematic for the final outcome of the health care bill, the Senate language has met a cool reception from Stupak, who said that he and 10 or so other House members could oppose the health overhaul if it's included. But Stupak is showing some flexibility. In an interview Tuesday, he termed the language "unacceptable" but also said he's not yet ready to say he would oppose a final bill over that issue alone.
"I do believe this is not an insurmountable issue. I think it can be worked out," Stupak said. He's talking with Nelson and others to see where common ground can be found.
Abortion-rights supporters in the House also are evaluating the Senate language. After being taken by surprise after talks in the House broke down and Stupak got his way, members of the House Pro-Choice Caucus are vowing not to let it happen again and say they won't support a final bill that goes beyond current law that generally bans federal funds for abortions.
"Our initial reaction is we don't like it," Rep. Diana DeGette, D-Colo., a leader of the Pro-Choice Caucus, said of the Senate compromise.
Currently an annually renewed law called the Hyde Amendment bars the federal government from covering abortions under Medicaid except in cases of rape, incest or where the life of the mother is threatened. Similar prohibitions cover other federal programs, although states may choose to pay for abortion coverage for people on Medicaid if they do it with state funds.
Boxer said the Senate language walls off private from public funds for abortion. She declined to say directly how she'd vote if the language became more restrictive.
"If the goal was to build a firewall we did it, and that's my last comment on it," Boxer said in an interview Tuesday.