WASHINGTON — An unusual Saturday night vote launched Senate debate on a health-care overhaul bill that pro-life advocates oppose as a massive new funding source for elective abortions.

The Senate voted along party lines, 60-39, on Nov. 21 to begin debate on the Patient Protection and Affordable Care Act (H.R. 3590), which would reorganize the health-care system in the United States. Republican Sen. George Voinovich of Ohio did not vote.
The debate on the bill is likely to last for several weeks, with a vote on final passage expected before Christmas.

Supporters of the bill praised it for requiring most Americans to purchase health insurance and provide subsidies to those who cannot afford it. It also drew praise for new insurance industry regulations, which would ban the practice of denying coverage on the basis of pre-existing medical conditions.

The House of Representatives passed its own health-care overhaul bill two weeks earlier. 
Among the most significant differences in the two bills was their approach to abortion funding. The House amended its bill to bar the use of federal taxpayer funds for elective abortions through either a so-called public option insurance plan or through private insurance plans offered through a new national insurance marketplace. Individuals could buy riders that would cover abortions under private plans.

However, the Senate bill lacked any provisions barring the use of taxpayer funds for elective abortions in either the public option or through the exchange.

The omission of provisions barring such funding would allow the secretary of Health and Human Services to mandate both insurance programs to require coverage of elective abortions.

The Senate bill drew opposition from many abortion opponents.

“The bill provides federal funding for plans that cover abortion, and creates an unprecedented mandatory ‘abortion surcharge’ in such plans that will require pro-life purchasers to pay directly and explicitly for other people’s abortions,” wrote three Catholic bishops on behalf of the U.S. Conference of Catholic Bishops in a Nov. 20 letter to senators.

The bishops wrote that if the language is not modified to bar public funding of abortion then the conference would oppose the entire health-care overhaul.

Supporters of abortion access hailed the Senate vote as a victory.

“This is a bill about health-insurance reform, not about expanding or contracting access to abortion services,” said Rep. Lois Capps, D-Calif.

She said the bill’s abortion language echoed an amendment that she had sought to include in the final House bill and would provide a “reasonable compromise” on the issue by trying to segregate taxpayer funds to only the non-abortion-related portions of insurance policies.

Need Democratic Support

The ability of the Capps amendment to keep taxpayer money from funding abortion was dismissed by pro-life Democrats and Republicans in the House who voted instead for an amendment offered by Rep. Bart Stupak, D-Mich.

“President Obama and [Senate Majority Leader Harry] Reid know that the substance of these abortion-promoting policies is deeply unpopular, so they seek to conceal the reality with layers of contorted definitions and money-laundering schemes,” said Douglas Johnson, legislative director of the National Right to Life Committee, about the Senate and Capps approaches.

The Senate bill is expected to draw numerous amendments to try to strip out federal taxpayer funding for elective abortions that pro-life activists worry could result in more than a million additional pregnancy terminations annually.

Any such amendment will need the support of 51 senators, and it is unclear whether all 40 Republicans and at least 11 Democrats would support such an amendment. All pro-life amendments are expected to draw significant opposition from pro-abortion forces who were caught off guard by the abortion-defunding vote in the House version of health-care reform.

Several Democratic senators have expressed a desire for such language defunding abortion in the Senate bill, including Sen. Robert Casey Jr., D-Pa.

“He continues to work with his colleagues in the Senate and with the White House to ensure that the Senate health-care reform bill protects existing federal and state conscience protections, existing state abortion laws and contains strong language to prohibit federal funds from being used to fund abortions,” said Larry Smar, communications director for Casey.

It remains unclear whether Casey or any other Democratic senator with a pro-life voting record would vote to oppose the overall health-care bill if the abortion-defunding language is not added. Such a threat by a group of 41 pro-life Democrats in the House was behind the last-minute vote on abortion funding in that chamber.

“A vote to close debate without the addition of strong pro-life language will be a vote for government-funded abortion,” said Marjorie Dannenfelser, president of the Susan B. Anthony List, which seeks to elect pro-life women to Congress. “That would be the ultimate betrayal of pro-life constituents and even self-described pro-choice Americans who oppose government-funded abortion.”

Her group and other pro-life organizations have launched national campaigns to have members contact their senators specifically to urge that the bill explicitly bar taxpayer funds for abortions.

Other Measures

The Reid health-care bill includes numerous other controversial provisions for Catholic and family groups, including the creation of a national home-visitation program that would target, among others, families with tobacco users and members of the military or veterans. That provision is opposed by groups such as the Home School Legal Defense Association, which is concerned it would spawn invasive government programs that would dictate educational and religious decisions to families under threat of removal of their children.

The Senate debate will likely include renewed controversy around the role of proposed expert panels to determine the relative merits of different medical treatments and tests. Newly released guidelines on breast-cancer screening from one such existing panel caused a furor among cancer patient advocates and members of Congress. Democrats maintained the new panels would be purely advisory, but Republicans countered that the panels are intended to control costs and would eventually dictate which treatments would be covered by public and private insurers. Similar panels in European health-care systems are routinely used to determine health-care coverage.

Any bill that passes the Senate must be reconciled with the version that the House passed. After identical bills are passed by both chambers, the legislation will go to the president for his signature.

Rich Daly writes