Leading up to Thursday's health care summit, there has been plenty of chatter about everything from consideration of an excise tax on so-called Cadillac insurance plans to whether President Obama will sit at the table with congressional leaders or speak from a podium. But Democrats and Republicans alike have uttered hardly a word about an issue that could sink the health reform effort unless it is resolved: abortion.
The silence is surprising given that disagreements about abortion coverage almost scuttled health reform in the House last fall. House Speaker Nancy Pelosi wasn't able to gather sufficient votes to pass the health reform bill until after she struck a deal with pro-life Democrat Bart Stupak to allow a vote on his amendment that would prohibit plans that cover abortion in an insurance exchange from receiving federal subsidies. The House voted to approve the amendment's tough language, which became part of the final bill. Even so, heading into the health summit, no one from the White House on down knows whether abortion will still be an obstacle to passing a reform bill.
The proposal Obama released on Monday does not address the question of abortion coverage. Both pro-life and pro-choice politicians are interpreting that absence to mean that the White House supports using the abortion provision authored by Nebraska Senator Ben Nelson, which became part of the Senate version of health reform. The Nelson language, less restrictive than Stupak's, would allow a woman receiving federal subsidies to purchase insurance from a plan that covers abortions, but those subsidies must be segregated and not used to pay for abortion procedures.
The U.S. Conference on Catholic Bishops has made clear that it considers the Nelson language "deficient," and Stupak released a statement on Tuesday declaring that anything short of his abortion restriction would be "unacceptable." Shortly after the House bill passed in November, Stupak vowed that 40 Democrats would stand with him to vote against final passage of health reform if his strict language was not included.
It's far from certain that Stupak can rally that number, so the White House's decision to use the Nelson language in a reconciliation bill may be a smart political move. According to leadership aides, however, there have been no conversations between the White House and congressional leaders about the abortion issue, which a staffer said had been put on the "back burner." Nor did the White House consult with pro-life Democrats before deciding to go with the Nelson language.
As of this week, no one in the House leadership can answer the question of whether the Nelson language would cause some pro-life Democrats who supported health reform in November to vote against a reconciliation bill. There simply is no way of knowing whether the President's approach would garner enough votes to pass.
But on the basis of conversations with a half-dozen key congressional offices, we can identify four categories of House members who will be crucial to Democratic attempts to pass a bill. The first group includes Democrats who voted for the Stupak amendment and yet opposed final passage of the House bill. There were 23 of these Democrats, mostly Representatives from Southern congressional districts, like Heath Shuler of North Carolina and Gene Taylor of Mississippi. It's safe to say that Democratic leaders shouldn't worry about which abortion language is preferred by these members because that wasn't the issue that prevented them from supporting health reform.
The second group will also probably avoid lobbying attention, but for a different reason. Roughly 17 Democrats with mixed voting records on abortion issues voted for the Stupak amendment and the House bill. These Democrats are not members of the congressional pro-life caucus but were concerned about what appeared to be federal funding of abortion in the original version of health reform. However, they would have settled for something far short of the strict prohibition in the Stupak amendment, and they are likely to be comfortable with the Nelson language.
Another 24 members who supported Stupak and the House bill are solidly pro-life. The key question for them is whether they are willing to accept an abortion prohibition that falls short of the Stupak language. No one in the House leadership has polled members on this point to get a head count, but the best guess is that many in this category would be satisfied with the Nelson language. A number of them signed onto a compromise offered last fall by Brad Ellsworth of Indiana himself a member of this group that would have strengthened the segregation of subsidies and ensured that no federal dollars could be used to fund elective abortions in an exchange.
The final group of 16 Democrats voted against both the Stupak amendment and the House bill. While abortion did not drive their votes in November, these members could be in play if the House votes on a reconciliation bill. Half of the members of this group are freshmen Democrats who opposed the House bill because of concerns about cost or because they opposed the public option, which is not in the Senate version. The biggest mystery is figuring out which way these Democrats are leaning. But Democratic leaders might find that a slightly more modest reconciliation bill could swing enough of this group to offset any pro-life Democrats who jump ship over the Nelson language.
The question of abortion coverage is not on the agenda for the White House summit. Whether he wants to or not, however, Obama may be forced to talk about the one issue his proposal has avoided if he has any hopes of succeeding on health reform.