Abortion opponents in the Senate are seeking tough restrictions in the health care overhaul bill, a move that could roil a shaky Democratic effort to pass President Barack Obama's signature issue by year's end.
Sen. Ben Nelson, D-Neb., said Monday it's unlikely he could support a bill that doesn't clearly prohibit federal dollars from going to pay for abortions. His spokesman said Nelson is weighing options, including offering an amendment similar to the one passed by the House this weekend.
The House-passed restrictions were the price Speaker Nancy Pelosi, D-Calif., had to pay to get a health care bill passed, on a narrow 220-215 vote. But it's prompted an angry backlash from liberals at the core of her party, and some are now threatening to vote against a final bill if the curbs stay in.
Obama said the legislation needs to find a balance.
"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," Obama said in an interview with ABC News.
Pressure will intensify
Senate Democrats will need Nelson's vote — and those of at least a half-dozen other abortion opponents in their caucus. They face a grueling debate against Republicans who are unified in their opposition to a sweeping remake of the health care system. It's unclear how the abortion opponents would line up; the pressure on them will intensify once the legislation is on the floor.
"This is a very important issue to Sen. Nelson, and it is highly unlikely he would support a bill that doesn't clearly prohibit federal dollars from going to abortion," said his spokesman, Jake Thompson.
An intraparty fight over abortion is the last thing that Majority Leader Harry Reid, D-Nev., needs. Reid is already facing a revolt among Democratic moderates over the government-sponsored health plan that liberals want to incorporate in the legislation as a competitor to private insurance companies.
Reid, who is himself opposed to abortion, will have to confront the issue directly as he puts together a Democratic bill for floor consideration. The committee-passed Senate versions differ on abortion, but none would go as far as the restrictive amendment passed by the House.
The House bill would bar the new government insurance plan from covering abortions, except in cases or rape, incest or the life of the mother being in danger. That's the basic rule currently in federal law.
It would also prohibit health plans that receive federal subsidies in a new insurance marketplace from offering abortion coverage. Insurers, however, could sell separate coverage for abortion, which individuals would have to purchase entirely with their own money.
At issue is a profound disagreement over how current federal restrictions on abortion funding should apply to what would be a new stream of federal funding to help the uninsured gain coverage.
Abortion opponents have sought to impose the same restrictions that now apply to the federal employee health plan, military health care and Medicaid, the federal-state health program for the poor. Abortion rights supporters say such an approach would threaten women's right to a legal medical procedure already widely covered by private insurance.
The Senate health committee bill is largely silent on abortion, a stance that abortion opponents interpret as permitting coverage by private insurance plans that would receive federal subsidies.
The Senate Finance Committee bill attempts to craft a compromise, as the House unsuccessfully tried to do before this weekend's vote tightened restrictions.
The Finance plan would require insurance carriers to separate federal subsidy moneys from any funds used to provide abortions, and it would prohibit abortion coverage from being included in a minimum benefits package. It would require that state and regional insurance markets offer one plan that covers abortion, and one plan that does not.
An accounting gimmick?
Abortion opponents — including U.S. Catholic bishops — rejected a somewhat similar approach in the House, saying that the approach of keeping federal funds separate amounted to little more than an accounting gimmick.
For now, the liberals are saying they will fight. Abortion rights supporters in the House were circulating a letter to Pelosi, threatening to vote against a final bill that restricts access to abortion coverage. At least 40 lawmakers had signed by early Monday.
"I, along with the other pro-choice members in the House, intend to push very hard to ensure that language is not included in the final conference product," said Rep. Debbie Wasserman Schultz, D-Fla.
They're likely to have help in the Senate from two Republican women who support abortion rights, Sens. Olympia Snowe and Susan Collins of Maine. Collins indicated Monday that she thinks the House went too far.
"I think the Senate Finance Committee did a good job of putting up a firewall that would prevent federal funds from being used for abortion," she said. "Generally, I prefer the Senate approach."