Abortion emerges as obstacle in health care debate

WASHINGTON – The divisive issue of abortion emerged Monday as an obstacle to Senate passage of President Barack Obama's health care overhaul as a moderate Democrat proposed tough restrictions that liberals said they could not possibly accept.

The amendment by Sen. Ben Nelson, D-Neb., would bar any private insurance company from offering plans to cover abortion if they receive federal subsidies. In practice, the restriction would apply to most plans within a proposed new insurance marketplace, or exchange, since most people shopping in the exchange would be using federal subsidies to purchase coverage.

The amendment also would block a proposed new government insurance plan from covering abortions except in cases of rape, incest or danger to the mother's life.

Joining Nelson in sponsoring the amendment was another anti-abortion Democrat, Bob Casey of Pennsylvania, along with eight Republicans. The measure is unlikely to get the necessary 60 votes to pass, but Nelson has threatened to oppose the underlying health care legislation if it doesn't.

"As written, the Senate health care bill allows taxpayer dollars, directly and indirectly, to pay for insurance plans that cover abortion," Nelson said in a statement. "Most Nebraskans, and Americans, do not favor using public funds to cover abortion and as a result this bill shouldn't open the door to do so."

Other Democrats said the amendment, expected to come to a vote Tuesday, goes too far by making it difficult for patients to use their own money to purchase coverage for a legal medical procedure, since there could be few if any plans offering the coverage.

The amendment does let insurance companies set up separate plans with abortion coverage if they're supported solely by private money, but abortion-rights supporters say companies would be unlikely to do so since there would be little market for them, as most potential customers would be shopping with federal dollars.

The bill under consideration in the Senate attempts to solve the issue by allowing private companies that get federal subsidies to offer abortion coverage as long as they strictly segregate private from public funds and use only the private money for abortion coverage.

Nelson and other abortion opponents dismiss that as an accounting gimmick. But Democrats and abortion-rights groups contend that the underlying bill attempts to replicate existing federal laws barring public funds from covering abortion.

"It crosses a line," said Sen. Debbie Stabenow, D-Mich. "The Nelson amendment takes us back, it takes away options on health care coverage. And the biggest concern for me is that it goes beyond what we agreed to in terms of keeping in place a 30-year policy of the federal government to have no federal funding for abortion services."

Nelson's strict abortion language mimics language adopted by the House last month, at the insistence of anti-abortion Democrats over objections from liberals. The U.S. Conference of Catholic Bishops played a large role in forcing the language in the House and released a letter to senators Monday urging passage of Nelson's amendment, contending that without it, the bill "violates this moral principle" against federal funding of elective abortions.

Senate Majority Leader Harry Reid, D-Nev., cannot easily afford to lose Nelson's vote because Reid needs 60 votes in the 100-member Senate to overcome Republican stalling tactics and move forward on debate.

Nelson's defection could force Reid to instead look for support from one or two Republicans, such as moderate Maine senators Olympia Snowe and Susan Collins. Snowe may be lured if a compromise is reached on allowing the government to sell insurance in competition with private businesses, and negotiations were under way Monday toward that goal.

The developments came as the Senate started its eighth day of health care debate and Reid said lawmakers are approaching the end game and expect to prevail.

"We've tried to get to this point with health care legislation for almost 70 years, and we're there," said Reid, after a weekend of work capped by a presidential pep talk Sunday.

The latest compromise under discussion on the government insurance plan — nonprofit private plans overseen by the Office of Personnel Management, the same agency that oversees health insurance for federal employees — doesn't approach the muscular government-run program that liberals wanted — and the insurance industry feared.

Nonetheless, some liberals were sounding open to it. Supporters note it could be explained simply to voters as offering them much the same coverage members of Congress get.

By a vote of 43-56, the Senate rejected a Republican amendment that would have prevented the government from implementing the bill by using savings from Medicare. The measure needed 60 votes to pass.

The Senate bill would cover more than 30 million additional Americans over the next decade with a new requirement for nearly everyone to buy insurance. The federal-state Medicaid program for the poor would be expanded, and there would be a ban on unpopular insurance company practices such as denying coverage based on medical history.

It would create marketplaces where people could shop for and compare insurance plans. Lower-income people would get subsidies to help them buy coverage.

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Associated Press writers Ricardo Alonso-Zaldivar and Charles Babington contributed to this report.