Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

After a controversial amendment to restrict abortion was approved as part of the House healthcare bill over the weekend, senators are grappling with the abortion language in their legislation.

Senate Majority Leader Harry Reid (D-Nev.), who personally opposes abortion, said the issue was being negotiated.

“I expect the bill that will be brought to the floor will ensure no federal funding for abortion and that conscience rights of providers and healthcare facilities, like Catholic hospitals, are protected,” he told reporters on Tuesday.

The House on Saturday passed sweeping healthcare legislation by a vote of 220 to 215 after months of negotiations.

In the end, support from some moderate Democrats hinged on the inclusion of an anti-abortion amendment by Bart Stupak (D-Mich.) that was pushed by the United States Conference of Catholic Bishops.

The amendment would bar the government from offering abortion in its public plan, and make it illegal for private insurers who participate in the exchange from providing abortion coverage, except in the case of rape, incest or when the woman’s health is in danger.

Women in the public plan, or who have a plan through the exchange, could choose to buy a separate abortion-coverage plan using their own money.

Women wouldn’t be affected by the amendment’s provisions if they paid for their own private insurance outside of the exchange.

The amendment passed by a vote of 240 to 194, with support from 64 Democrats.

A 1977 law, known as the Hyde Amendment, already prevents use of federal money to fund abortions except in the case of rape, incest, or if the woman’s life is in danger.

However, many insurance plans provide more broad abortion coverage. According to a 2003 report from the Kaiser Family Foundation, nearly half of all employees who receive insurance from their employers have a plan that covers abortion.

Stupak said his amendment simply applied the Hyde amendment to H.R. 3962, but opponents said it would go much further.

Not only would it prevent a new public plan from paying for abortions, opponents charged, but none of the private insurance plans that participate in the exchange could provide abortions, either, because government money would pay for the creation of the exchange.

“Simply put, the Stupak/Pitts amendment would restrict women’s access to abortion coverage in the private health insurance market, undermining the ability of women to purchase private health plans that cover abortion, even if they pay for most of the premiums with their own money,” said Cecile Richards, president of Planned Parenthood, a group which is outraged over the inclusion of the amendment in the reform bill.

“This amendment is an unacceptable addition to the healthcare reform bill that, if enacted, would result in women losing health benefits they have today,” said Richards in a press release.

The Senate bill — though not released formally — uses the same language that was originally included in the House bill. That language says that at least one health plan in the exchange should provide abortion services, and at least one should not. It says no health plan would be discriminated against for its decision either way.

Moderate Republican Susan Collins of Maine said she thinks the Senate bill’s abortion language is sufficient.

“I think that the Senate Finance Committee did a good job of putting up a firewall that would prevent federal funds from being used to finance abortions,” she said. “That is in keeping with the Hyde Amendment that has been law for many years.”

But that language on abortion was added by the Finance Committee when it appeared that a public insurance plan would not be included in Senate legislation.

As Senate Leaders have worked to meld that bill with the one reported by the Health, Education, Labor and Pensions Committee, Reid has said a public plan will be a part of the final bill.

“If Congress makes the mistake of establishing a new government-owned insurance company, you would need to extend the prohibition to that [plan] because it is using federal funds,” Collins said.

Several anti-abortion Democrats said they support adding stronger language to the Senate bill to establish more restrictions on paying for abortions.

“It’s got to be clear that taxpayer funds are not being used to pay for abortion,” said Sen. Kent Conrad (D-N.D.)

Sen. Ben Nelson (D-Neb.) said he’d vote against a final bill on the floor if it doesn’t contain explicit language preventing federal money from paying for abortions. He said he’d like to see something similar to the Stupak amendment in the Senate bill.

Senate Minority Leader Mitch McConnell (R-Ky.) hedged on Tuesday when a reporter asked if the GOP was preparing a Stupak-like amendment to be considered during floor debate on the healthcare bill, which is expected next week at the earliest.

“I don’t come out here and talk Republican strategy,” he said, adding that floor debate would likely take weeks.

Meanwhile, abortions-rights senators spoke out against the inclusion of such an amendment in the Senate bill.

“To take away the rights women have had for decades — I find that very hard to believe we’d vote for that,” said Sen. Dianne Feinstein (D-Calif.)

Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee, said he doubts such an amendment could garner the 60 votes necessary to be approved in the Senate.

Sen. Ben Cardin (D-Md.), told reporters he’d like to see the Stupak amendment eliminated from the final bill.

Cardin also said that he would hate to see senators draw a line in the sand over the abortion issue.

“I think most senators agree that this bill is more important than any single issue,” Cardin said.

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