Abortion snags health bills

WASHINGTON — House Democratic leaders, while insisting they have the finish line in sight on their $1 trillion plan to overhaul the nation's health-care system, have hit a last-minute snag on perhaps the most divisive issue in domestic politics: abortion.

And Senate Democratic leaders' continued problem winning over party moderates is raising the possibility that the votes on health care might be pushed into next year.

In a blow to the White House, Senate Majority Leader Harry Reid, D-Nev., for the first time publicly raised the possibility that lawmakers would not be able to meet their — and President Obama's — self-imposed deadline of completing work on health care by year's end.

House leaders, on a somewhat faster track, pointed toward a vote this weekend on a bill to extend coverage to tens of millions who lack it, ban insurance-industry practices such as denying coverage because of pre-existing medical conditions and generally slow the rate of growth of medical spending nationwide. The 10-year, $1.2 trillion legislation is estimated to expand coverage to about 96 percent of eligible Americans.

Even though Democrats theoretically hold solid majorities, the delay reflects the significant divisions below the surface — making consensus-building a delicate task at best.

The challenge is particularly great where abortion is concerned. House and Senate leaders already have adopted language they say would prevent federal funds from being used to pay for abortions. But some anti-abortion members say the language needs to be stronger.

And some of the demands, abortion-rights critics say, would go beyond maintaining the status quo to make abortions harder to obtain than they are now.

The fight is focused on the health-insurance exchanges that would be set up to help uninsured consumers buy policies. Some consumers would qualify for government-subsidies help if their incomes are close to the federal poverty line.

House Democrats opposed to abortion are demanding tougher restrictions to keep those funds from being used to cover abortion services.

"I will oppose bringing the bill to the floor until an amendment can be offered or language agreed to that will prevent public funding for abortion," Rep. Bart Stupak, D-Mich., said Tuesday, adding that negotiations with House leaders were ongoing.

Stupak wants an up-or-down floor vote on language that would adopt wording from the Hyde Amendment, the far-reaching form of a ban on using federal money to pay for abortions that was adopted by Congress 33 years ago.

Stupak also wants to prevent a government-run health insurer from offering abortion services to women.

Under the House's public-option provision, the government-run insurer now would be required to offer the same minimum-benefits package private insurers would have to offer those qualified to buy insurance through the exchange — and thus potentially receive government aid in paying their premiums.

A benefits "advisory council" would determine which benefits to recommend, but the bill bars the council from requiring that abortion services be provided.

Stupak has warned that he could keep as many as 40 House Democrats from supporting the bill if his terms aren't met — a serious threat when leaders are worried about securing a bare majority.

Abortion-rights activists say Stupak's amendment would effectively prevent private insurance companies from offering abortion services through the exchanges, reducing the availability of those services to women nationwide.

"Stupak is basically saying you cannot even participate in the exchange unless your plan does not cover abortion," said Nancy Keenan, president of NARAL Pro-Choice America. "He's taking away coverage from women who already have it."

In the meantime, another member of the House's Pro-Life Caucus, Sen. Brad Ellsworth, D-Ind., is negotiating with the leadership to toughen the funding restrictions and require at least one insurer in the exchange to offer a plan that doesn't cover abortion.

House leaders said they expected a compromise to be reached with Ellsworth that would satisfy enough of the anti-abortion Democrats.

"I am pretty confident that we can get there," House Majority Leader Steny Hoyer, D-Md., said Tuesday, "essentially making very clear that any money spent on the issue of termination of pregnancy will be spent, not by the government, but by the individuals."

House leaders had hoped to begin debate — and even vote — on the final bill this weekend. But House Speaker Nancy Pelosi, D-Calif., has promised to make public the final version of the bill three days before debate begins to ensure members have time to examine it.

That pledge and the lagging negotiations threaten to push debate and a vote into next week, although it remains possible that a deal could be struck in time to avoid that.

In the meantime, Democratic Senate leaders are awaiting cost estimate from the Congressional Budget Office and struggling with centrists over including a version of the public option.

Senate debate may not begin until close to Thanksgiving, with a vote sometime in December.

Then weeks would likely be needed to reconcile the Senate and House versions.