Abortion amendment threatens to derail health reform

Washington -- The eleventh-hour addition of health system reform language favored by anti-abortion Democrats has added a complex new element to the Senate debate and threatens the razor-thin margin of House support for reform.

House Democratic leaders were unable to move the Affordable Health Care for America Act forward until they agreed on Nov. 7 to allow consideration of an amendment offered by Rep. Bart Stupak (D, Mich.). The provision stipulates that the public health insurance option would not cover elective abortions and that recipients of federal subsidies could not use them to buy abortion coverage. The amendment passed by a vote of 240-194, allowing the House to move to final consideration later that night and approve the final bill by a vote of 220-215.

The debate moved to the upper chamber, where Senate Majority Leader Harry Reid (D, Nev.) was working to craft final health reform legislation that could gain the 60 votes needed to limit debate. But health policy experts said the new abortion debate presented trouble for Reid.

"Harry Reid is in a very difficult situation right now," said Brian Darling, director of Senate relations for the Heritage Foundation, a conservative think tank based in Washington, D.C. "All of a sudden, the health care bill is in danger of becoming a referendum on abortion."

Abortion rights advocates were upset with the addition of the Stupak amendment because they said it reaches further than the so-called Hyde amendment, which Congress has kept renewing since 1977 to prohibit public funding of most types of abortions. They said it would undermine a woman's ability to purchase plans that cover abortion, even if she pays the premiums on her own.

Some Senate Democrats suggested they are willing to include federal health system reform language matching the Hyde amendment but would go no further than that. Sen. Barbara Boxer (D, Calif.) attended a Nov. 10 meeting with fellow Democratic women senators to discuss how the Senate should move forward in light of the Stupak amendment.

"Sen. Boxer said she would be working to ensure that the decades-long compromise of no federal funds for abortion is what is in the Senate bill but that she would fight against any amendment that prevents women from using their own private funds for their reproductive health care," said Natalie Ravitz, Boxer's senior adviser and deputy chief of staff.

"Unprecedented and unacceptable"

Anti-abortion organizations cheered the development in the House.

"This is a huge pro-life victory for women, their unborn children and families," said Tony Perkins, president of the Family Research Council. "I congratulate the bipartisan coalition that for months has worked to ensure that abortion is not covered in the bill."

But soon after the House passage of the reform legislation, lawmakers favoring abortion rights insisted that the Stupak language be stripped out when the bill goes to conference with whatever measure the Senate might pass.

"Members of the pro-choice caucus are going to stand very strongly against the Stupak amendment," said Laurie Rubiner, vice president of public policy for Planned Parenthood Federation of America, based in Washington, D.C. "There is no such amendment in either of the Senate committee-passed bills, so we don't expect anything like the Stupak amendment to be in the final bill."

Language could be added once the Senate bill goes to the floor, but Rubiner said she doesn't believe an amendment like the Stupak one would garner the votes needed to be included.

House Democrats object

After passage of the House bill, Reps. Diana DeGette (D, Colo.) and Louise Slaughter (D, N.Y.) sent a letter to House Speaker Nancy Pelosi (D, Calif.) stating that the Stupak amendment "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 lawmakers said they had 40 signatures on the letter from House members vowing that they would not vote for a conference report "that restricts women's right to choose any further than current law."

Under the Stupak amendment, insurance companies that offer a plan under the proposed health insurance exchange that includes abortion coverage -- only available to those who pay out of pocket for the plan -- also must offer an identical plan without abortion coverage.

But some insurance policy experts said it is unrealistic to expect insurance companies to meet that demand.

"The bottom line is that the market is so small and the hurdles are so great that it seems unlikely that insurance companies are going to bother offering coverage that includes abortion in the exchange," said Adam Sonfield. He's a public policy analyst at the Guttmacher Institute, a nonprofit organization based in New York that supports worldwide advances in reproductive health and tracks related policy.

Stupak's amendment would allow federal subsidy recipients to buy supplemental abortion coverage, or riders, using their own money. Such coverage so far has been offered in five states, according to Planned Parenthood: Kentucky, Idaho, Missouri, North Dakota and Oklahoma.

But Sonfield said the supplemental coverage is not a workable solution, either.

"This is not how people buy insurance," he said. "You don't pick and choose which health problems you expect to have in the future. No one plans on an unintended pregnancy, and they certainly don't plan on medically complicated pregnancies."