Health Reform Hinges on Votes From Abortion Foes

(March 9) -- The arcane rules that govern debate as Congress finishes health care reform soon will meet the simple rule of majority math.

House Democratic leaders, resigned to the fact that no Republicans are likely to vote for a major overhaul of the nation's health insurance system, will be focused on getting to the number 216, which is the total votes that make up a majority.

To get there, they will need the support of Democrats who vehemently oppose abortion. Rep. Bart Stupak, D-Mich., is pushing for greater restrictions on abortion funding and claims to represent a bloc of 12 Democrats who won't vote for health reform without stronger language on that front.

The House passed health reform -- with anti-abortion funding language by Stupak -- last year by 220-215. But changes in the composition of the House mean three of those supporters (and only one opponent) are gone and won't be voting this time. So even if Stupak's band of opponents is smaller than a dozen, it will be an influential force in whether Democrats' top policy effort passes.

So far, Democratic leaders have not reached a deal with Stupak, according to a top Democratic leadership aide and Stupak's his press secretary, Michelle Begnoche.

"Last Thursday, the congressman had meaningful discussions with [Energy and Commerce Committee] Chairman [Henry] Waxman and Majority Leader [Steny] Hoyer," Begnoche said. "Congressman Stupak expects further meetings this week and remains optimistic that language can be worked out."

The controversy surrounds a plan to offer subsidies to Americans who need help buying health insurance. A clearinghouse, called an exchange, would offer insurance policies that Americans could choose from if they don't have affordable insurance coverage through their employers.

Many people who buy the insurance through the exchange would get federal subsidies to help pay for it. And that's what worries Stupak and other abortion opponents, like Sen. Ben Nelson, D-Neb.

"While people are very divided on abortion, [Nelson] thinks a majority of Americans would not want to have taxpayer money used for abortion insurance,'' Nelson spokesman Jake Thompson said.

The House, under Stupak's amendment, barred exchanges from offering insurance policies that cover abortion. Nelson tried a similar amendment in the Senate but lost. Instead, the bill that passed the Senate in December requires that anyone who wants abortion coverage through the exchanges pay a separate premium that would be pooled to cover the procedures.

"This is not an abortion bill," said Brendan Daly, spokesman for House Speaker Nancy Pelosi, D-Calif. "It's historic health reform. And there's no federal funding for abortion."

But the U.S. Conference of Catholic Bishops and the National Right to Life Committee disagree. They view the separate optional premiums for abortion as an accounting fiction and say the bill runs afoul of the longstanding Hyde Amendment, which bars federal funding for abortions.

Douglas Johnson, legislative director for the National Right to Life Committee, made clear he will press lawmakers hard to oppose health reform if it doesn't include Stupak's anti-abortion provisions. The Senate bill, he said, allows federal tax dollars to pay for abortions through community health clinics as well as through the exchanges.

"Any House member who votes for the Senate health bill is casting a career-defining pro-abortion vote. A House member who votes for the Senate bill would forfeit a plausible claim to pro-life credentials," Johnson said.

That Senate measure is what the House is now faced with. Democratic leaders plan to bring the Senate bill to a vote in the House and then work out differences between the two chambers in a separate measure called a reconciliation bill. Reconciliation rules require that anything in the bill be related to the budget. And abortion rights advocates are hoping that means abortion can't be dealt with.

Abortion rights advocates don't actually like the Senate language -- they say it will discourage insurance companies from offering abortion coverage, even for people without federal subsidies. But they dislike the Senate language less than the House language. So they are pressing for health care reform and hoping the reconciliation rules will block further abortion law changes.

But Begnoche said abortion has come up before under reconciliation rules. A children's health insurance bill passed in 1997 had anti-abortion language, she said. A parliamentary point of order was raised about the fact that abortion is not directly a budget issue, but no one pressed for a vote because they wanted the bill to pass.

"Where there is a will, there is a way," Begnoche said. "This can be done."