WASHINGTON — The passage last spring of the Patient Protection and Affordable Care Act left a nation still divided over the best way to ensure that all Americans can receive high-quality, affordable health care.

It also left a question mark about whether the bill, seen by conservatives as a massive government intrusion into the private sector, will have taxpayers paying for abortions and medical care being rationed at the end of life.

“It’s a major setback in a two-year period of setbacks,” said Douglas Johnson, the legislative director for the National Right to Life Committee. “But the hard work of pro-life activists fighting Obamacare was not in vain. Some of the extreme components were blunted. And many Americans were educated about the true content of the bill with regard to abortion. That will make it easier to repair the damage. The ultimate result could be a very good one.”

The health-insurance bill came within a hair’s breadth of defeat, as a handful of pro-life Democrats unnoticed by the mainstream media until the last minute refused to support the bill until safeguards against public funding of abortion were inserted.

Then, after President Obama promised to issue an executive order purporting to guarantee that prohibition, the pro-life Democrats, led by Rep. Bart Stupak of Michigan, pledged to vote for the bill.

At year’s end, most of the complex, many-faceted, 900-plus-page law has yet to come into force; much of it will take years to do so. But already, say its pro-life critics, there is firm evidence it will indeed deliver abortion on demand at axpayers’ expense, despite the executive order.

And already Americans, who by a strong majority have long told pollsters they don’t want their taxes to pay for abortions, are retaliating against the law and the legislators who gave it to them. Newly elected pro-life state and federal legislators are taking their own actions to reverse the law’s abortion funding or reduce its impact.

Johnson charges that the administration ultimately squeezed its legislation past a hostile public and a narrowly pro-life House by burying the abortion-funding provisions in a mountain of paper, claiming all the time that the president opposed public funding and that the legislation did not give it.

The U.S. Conference of Catholic Bishops and the Catholic Medical Association (representing Catholic doctors) aligned with the National Right to Life Committee in opposition. The Catholic Health Association, which represents the nation’s Catholic hospitals, supported the legislation, as did several other groups, such as Catholics United and Democrats for Life of America: All insisted that it would not fund abortions.

In July the first element of the new law was implemented, and both sides insisted that implementation proved their point.

Voters Have Their Say

This was the Pre-Existing Condition Insurance Plan, intended to cover immediate medical issues. The federal government invited states to propose their own plans, and in July, the details from a few of the responses fell into the National Right to Life’s hands.

The states “proposed to insure abortions, and the administration approved them so willy-nilly the first chance they got; they were ready to do what we’d been told they wouldn’t do,” Johnson said.

When National Right to Life went public with the responses, the Obama administration withdrew its approval.

“But the administration also said that this decision [to withdraw approval of abortion funding] would set no precedent for other components of the law. What could that mean but that the law doesn’t forbid abortion funding and neither does the presidential order?” Johnson asked.

But Chris Korzen, executive director of Catholics United, said that the administration’s response to state proposals under the Pre-Existing Condition Insurance Plan “proves that the administration meant what it said: that no taxpayers’ money would go to fund abortions. It proves the mechanisms are in place to carry out the presidential order and those mechanisms are working.”

In the November midterm elections it became clear that most pro-life voters did not believe the Obama administration. They sent between 40 and 55 additional pro-life lawmakers to the House and three to six to the Senate.

Even more telling, only one of a dozen House Democrats who changed their vote in favor of the health-care bill when Obama signed the executive order was re-elected. The rest were defeated by pro-life Republican candidates. And pro-life voters, according to National Right to Life’s polling, cast their votes based on this issue far more than did pro-abortion voters.

Legislative Hopes

With a pro-life majority in the new House, Johnson hopes for repeal of the entire health-care law, or, failing that, passage of Republican-backed legislation: New Jersey Rep. Chris Smith’s No Taxpayer Funding for Abortion Act or Rep. Joe Pitts’ more modest bill to ban abortion funding from the health-care law. Pitts, from Pennsylvania, will serve as chairman of the Health Subcommittee of the House Energy and Commerce Committee in the 112th Congress.

Smith’s bill would permanently prevent federal funding from paying for abortion. Currently, said Johnson, the House attaches amendments each year to desirable legislation that bans such funding from health appropriations, but these “take up a lot of energy,” and none of them applies to the new law.

Johnson is not optimistic that either measure will pass. Even if they won the support of both the Senate and the House, Obama could veto them. To pass them, he said, would require a pro-life president plus pro-life majorities in both chambers.

Meanwhile, the so-called “lame duck” Congress which adjourns Jan. 4 still has the power to enact more pro-abortion measures, but Johnson reports that these have been successfully obstructed by pro-life members of Congress. Most notably, a bill that would see the Armed Forces providing abortions to its members has died in committee.

The backlash against the health-care reform law has also been seen at the state level, said Mary Spaulding Balch, the National Right to Life Committee’s state legislation coordinator. “The idea of abortions being paid for by federal funds does not play well with the American people,” she said. Polling by National Right to Life indicates the public reaction to this “certainly had some impact on state election results” in November.

Not only were many additional pro-life state legislators elected, but 15 pro-abortion governors were replaced by pro-lifers (while two pro-life governors were defeated by pro-abortion-rights candidates).

Balch said the combination of pro-life legislatures and governors make for good prospects of passing pro-life legislation modeled on Nebraska’s Pain Capable Unborn Child Act, which has already been introduced in 25 states. The legislation outlaws abortion after 20 weeks.

Already, five states have passed laws specifically responding to the new health-care law, said Balch, prohibiting insurance exchanges set up by the law from paying for elective abortions.

Other states, such as Virginia, have asked courts to declare the healthcare reform law unconstitutional.

Ruling on Virginia’s case, brought by the state’s Attorney General Kenneth Cuccinelli, federal Judge Henry Hudson declared the law’s requirement that people purchase health insurance to be unconstitutional and “severed” that clause in the act. Allowing this requirement to take force, declared the judge, would constitute “an unbridled exercise of federal police powers.”

Moon Over Hudson

But the administration won in two other rulings. Another federal judge in Virginia, Norman Moon, threw out Liberty University’s claim that the health-reform act would violate its religious freedom by forcing it to pay for abortions through its health-insurance plan. “The act explicitly states that no plan is required to cover any form of abortion services,” Moon ruled. Contradicting Hudson, he found the requirement that Americans buy insurance to be justified under the federal constitutional power to regulate interstate commerce.

In Detroit, federal Judge George Steeh used the same grounds to uphold the law. The New York Times counted 23 challenges in all to the health-care law and reported a general expectation that the challenges will end up in the Supreme Court.

Catholics United’s Korzen believes that the law “is great as far as pro-life objectives go.” The plan will make the economic burden both of having babies and rearing them much less, he said. The law Massachusetts passed in 2006 has already demonstrated this by reducing the abortion rate there. While it costs from $6,000 to $12,000 to bring a baby to term, said Korzen, it costs just $400 to $500 to have an abortion. Therefore, Korzen argued, the denial of federal funding for abortion will have little impact on abortion rates.

Korzen doubts that the Republicans will follow through with any undertakings to replace or repeal the health-care law: “Polling indicates that Americans like the individual provisions in the act, but for some reason don’t like the law as a whole.” Republicans won’t get wrapped up in the health-reform law “because they know it will hurt them in the next election.”

But Michael New, a political science professor at the University of Alabama, says the Republicans have done quite well by the abortion issue: “The pro-lifers drew a line in the sand quite successfully over public funding. Real Americans feel uncomfortable about their taxes paying for abortions. A funding ban could get passed in the House. Whether it could pass in the Senate is less definite.”  

Steve Weatherbe writes from Victoria, British Columbia.