By Alec MacGillis
Washington Post Staff Writer
Monday, November 9, 2009

President Obama and Senate Democrats sought on Sunday to generate momentum from the House's passage of health-care legislation, even as a new hurdle emerged: profound dismay among abortion-rights supporters over antiabortion provisions inserted into the House bill.

The House passed its version of health-care legislation Saturday night by a vote of 220 to 215 after the approval of an amendment that would sharply restrict the availability of coverage for abortions, which many insurance plans now offer. The amendment goes beyond long-standing prohibitions against public funding for abortions, limiting abortion coverage even for women paying for it without government subsidies.

The abortion issue had been rumbling within the House Democratic caucus for weeks, but Saturday's votes revealed the depths of the fault lines. The amendment passed with the support of 64 Democrats, roughly a quarter of the party caucus.

But abortion-rights supporters are vowing to strip the amendment out, as the focus turns to the Senate and the conference committee that would resolve differences between the two bills.

Although House liberals voted for the bill with the amendment to keep the process moving forward, Rep. Diana DeGette (Colo.) said she has collected more than 40 signatures from House Democrats vowing to oppose any final bill that includes the amendment -- enough to block passage.

"There's going to be a firestorm here," DeGette said. "Women are going to realize that a Democratic-controlled House has passed legislation that would prohibit women paying for abortions with their own funds. . . . We're not going to let this into law."

Senate Majority Leader Harry M. Reid (D-Nev.) is waiting for cost estimates of provisions of the bill he is cobbling together, and he hopes to bring it to the Senate floor before Thanksgiving. The battle over abortion has been more muted in the Senate, but Jim Manley, Reid's spokesman, predicted that would change.

"The debate in the House highlighted some of these issues that we're going to have to face here in the Senate, and on this issue in particular, it's something [Reid] is going to have to talk with his caucus about," Manley said.

Obama left the abortion issue unmentioned Sunday when he appeared in the White House Rose Garden to give brief remarks congratulating the House on its "courageous" passage of the bill. "Now it falls on the United States Senate to take the baton and bring this effort to the finish line on behalf of the American people," he said. "And I'm absolutely confident that they will."

Other issues remain unresolved. The House bill's primary new revenue source to pay for the bill is an income tax surcharge on families earning more than $1 million; the Senate bill will probably rely on a proposed new excise tax on costly insurance plans. The House and Senate also differ on a government-run insurance plan to be offered on the new marketplace where small businesses and people without employer-provided coverage -- about 30 million in all -- would buy coverage.

The Senate version would limit this "public option" by allowing states to opt out of it, but even in that form, the bill's prospects are unclear. Sen. Joseph I. Lieberman (I-Conn.), whose vote Democrats will probably need to break a filibuster, warned again Sunday that he will withhold his support if the bill includes a public option.

The bills also differ in their requirements for employers to provide coverage -- the House's language is tougher -- and in the subsidies for those who cannot afford coverage, which are larger in the House version. Both bills deny subsidies to illegal immigrants, but the Senate version goes further by also barring them from buying coverage on the new marketplace with their own money.

On CBS's "Face the Nation," Sen. Lindsey O. Graham (R-S.C.) said the fact that more than 30 conservative House Democrats voted against the bill bodes poorly for it in the Senate, where conservative Democrats have more power. "The House bill is dead on arrival in the Senate," he said. "It was a bill written by liberals for liberals."

The abortion debate in the House has centered on how to put the bill in compliance with the ban on taxpayer funding for abortions. Rep. Lois Capps (D-Calif.) proposed that a government-run plan and private plans offered in the new marketplace for people without employer-based coverage could offer abortion coverage but that payments for abortions would come out of premiums, not the government subsidies for those who need help buying coverage.

Antiabortion groups argued that such a segregation of funds would be a mere accounting gimmick. After a compromise foundered, the amendment by Rep. Bart Stupak (D-Mich.) and Joe Pitts (R-Pa.) emerged as the leading alternative, with the strong backing of the U.S. Conference of Catholic Bishops. The amendment would prohibit abortion coverage in the government-run plan and any private plan on the new marketplace that accepts people who are using government subsidies to buy coverage.

Under that language, abortion coverage would be unavailable not only to working-class women buying coverage with government subsidies, but probably also to women buying coverage on the new marketplace without federal assistance. The amendment suggests that women could buy separate "riders" covering abortions, but abortion-rights supporters say it is offensive to require a separate purchase for coverage of a medical procedure that for most women is unexpected.

Charmaine Yoest, president of Americans United for Life Action, hailed the wide margin for the amendment. "I said all along that the inclusion of abortion as health care was going to be a political conflagration," she said.

But Nancy Keenan, president of NARAL-Pro Choice America, said that although the vote was "extremely disappointing and outrageous," the "fight isn't over." DeGette said she remains hopeful that the amendment will be dropped as more Democrats who voted for it -- and their constituents -- realize it goes beyond the status quo of limiting federal funding for abortions. Some of those House Democrats are not against abortion rights, just against federal funding, and she surmised that they may have misunderstood the amendment.

She said her House allies have requested a meeting with Obama, saying they "need him to back us up" after lying low on the issue.

"This would be the greatest restriction on a woman's right to get an abortion with her own money in our lifetime," she said. "The stakes could not be higher."