Health care debate lurches toward climax

Bill's passage in Congress could hinge on abortion language that divides Democrats

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WASHINGTON -- As the White House and congressional aides continued Tuesday to adjust the final health care reform bill, their package of changes did not address an issue that could sink their end-stage efforts: abortion.

The House's passage of its health care reform bill in November wasn't assured until a group of anti-abortion Democrats led by Rep. Bart Stupak, D-Mich., won a concession that banned all abortion coverage in the new health insurance exchange.

Mr. Stupak and anti-abortion groups have said the Senate bill's approach to abortion is insufficient, forcing another potential standoff. And because abortion can't be included in the reconciliation package of Senate bill modifications that the House could vote on this week, there is no apparent wiggle room.

White House officials on Tuesday said the reconciliation bill, which can pass the Senate with 51 votes if it finds 216 votes for House passage, cannot change the Senate abortion-coverage wording because the reconciliation process can only deal with matters that affect the budget.

That leaves the White House and Democratic leaders arguing to wavering anti-abortion Democrats -- potentially a critical group in the razor-thin vote -- that the Senate bill does not indirectly use taxpayer funds for abortions.

A co-sponsor of the Stupak amendment, Pennsylvania's Rep. Kathy Dahlkemper, D-Erie, is among that group. She said Tuesday that she would like to see the abortion language changed from the provisions authored by Sen. Ben Nelson, D-Neb., with input from Sen. Bob Casey Jr., D-Pa. When told that it couldn't be done in the reconciliation process, she responded, "Anything's possible."

But Ms. Dahlkemper would not call the abortion provision a dealbreaker, and said that before she made her decision, she would await the final bill's details and the Congressional Budget Office accounting of its cost, which could be revealed as soon as today.

The Senate bill would allow the state-based health insurance exchanges to offer at least one plan that covers abortions and at least one that does not. Participants in the exchanges can buy a plan that includes abortion coverage but must pay a separate fee for that coverage, to be segregated from federal health insurance subsidies.

Many anti-abortion groups, including the powerful U.S. Conference of Catholic Bishops, say this amounts to back-door funding of abortions because insurers that get tax credits will be providing abortions. Mr. Stupak agrees, and has said a large enough bloc of anti-abortion Democrats will be able to kill this bill.

In a meeting with reporters Tuesday, White House officials insisted that because federal funds were segregated from those used to fund abortions, the Hyde amendment -- which prevents federal funding for abortions -- would remain intact. They trumpeted an endorsement from the Catholic Health Association, a group of Catholic hospitals, as further evidence.

"We believe that the status quo has not changed, a number of experts agree with us, and we are going to continue to engage in a conversation about that," White House Communications Director Dan Pfeiffer said.

Mr. Casey, who believes that the language is sufficient to keep taxpayer dollars from funding abortion, also made sure that the Senate bill included aid to pregnant women and a tax credit for women who decide to give up a child for adoption.

Besides the increased security provided by universal health coverage, those provisions should encourage more women to bring children to term, Mr. Casey said. "The cumulative effect of that is the number of abortions will go down. Ultimately, that's the real test," he said.

The vote-wrangling by the White House and House Speaker Nancy Pelosi, D-Calif., will be tested this week, as they try to allay members' concerns about abortion and other issues. To get the needed 216 votes, Ms. Pelosi can ill afford to see any of November's yes votes turn into no's, and a handful of those could hinge on the abortion provision.

Rep. Mike Doyle, D-Forest Hills, who voted for the Stupak amendment but now is supporting the final bill, said Tuesday that he has had informal talks with other members, trying to persuade them that the Senate bill is sufficient to prevent federal funds from being spent on abortions. But he added that he doesn't see the abortion issue as the biggest challenge to passage this time.

"It's how it's playing back home with folks," Mr. Doyle said. "Everybody's been back home. Everyone's talked to their folks. There's a lot of demagoguing going on, a lot of commercials being run. So I think it's just boiling down to everyone's going to make their own decision."


Daniel Malloy: dmalloy@post-gazette.com or 202-445-9980. Follow him on Twitter at PG_in_DC.


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