Abortion
Both sides in the longstanding abortion debate generally, if in some cases reluctantly, agree on two principles when it comes to health reform: federal funds should not be used to pay for abortions, and women should not lose their access to abortion services. The tricky questions have been how to segregate public and private funds for abortion, and how far restrictions on abortion coverage can go before they effectively limit access.
In each respect, the House and Senate bills go much further than abortion rights supporters prefer. Each provides protections for medical providers — including hospitals — that refuse to perform, cover or refer patients for abortions. And each also singles out abortion coverage as something patients must separately pay for — either by purchasing a rider, in the House version, or by writing a separate check for premiums to cover abortion, in the Senate.
Ultimately, however, the House version places stricter limits on abortion, prohibiting any insurance plans that cover abortion — with the exception of supplemental abortion riders — from participating in the public exchange and receiving subsidies. The Senate bill, which was amended late in the game to win the vote of Nebraska Senator Ben Nelson, would give states the option of excluding such plans from the public exchange, but would not require them to do so.
Reconciliation of the two versions will come down to a numbers game for the Democratic leadership. Pro-choice politicians in both chambers are reluctantly willing to accept the abortion language in the Senate bill, but they have vowed to oppose health reform if the more restrictive House version wins out. At the same time, pro-life Demcratic Congressman Bart Stupak, who authored the abortion restrictions in the House bill, is warning that he'll bolt if the Senate version emerges from conference committee.
But Stupak may not hold the same power he did just a few months ago when he won a last-minute concession from House speaker Nancy Pelosi in exchange for delivering the necessary pro-life Democratic votes to pass health reform. The Senate version is strong enough for many of those pro-life Democrats, who are not insisting that Stupak's language go untouched. And other changes in the Senate bill — including cost-saving measures, the elimination of the public option and certain family-planning measures such as increased adoption tax credits that pro-life Senator Bob Casey got put in — could pick up some additional Democratic votes even without Stupak's support.