WASHINGTON — As health-care legislation moves to the U.S. Senate for a vote, pro-life advocates are working to keep their grassroots members engaged.

Pro-life lobbyists are crediting the efforts of individuals from across the nation with the successful effort to bar public funding for abortions from health-care reform legislation. The House of Representatives passed its version of the legislation Nov. 7, and the Senate is expected to take up the bill Nov. 16.

The unexpected victory for pro-life forces followed months of outreach to members of Congress by a coalition of organizations with a strong presence on Capitol Hill. But the key to success in the abortion-funding fight came from individuals — including Catholics urged to act — who contacted their members of Congress on the issue.

“When you get into an issue like this, what really makes a difference is what the congressmen are hearing from home,” said Douglas Johnson, legislative director at the National Right to Life Committee.

Johnson credited the grassroots effort of National Right to Life and allied organizations like the Southern Baptist Convention and the U.S. Conference of Catholic Bishops. The bishops sent bulletin inserts to almost 19,000 parishes across the country that urged Catholics to help prevent health-care reform from funding abortion.

The ensuing wave of calls, letters and e-mails is credited with helping to bolster a group of pro-life Democrats who refused to support health-care reform unless an abortion-defunding amendment was considered. The amendment vote was allowed by Democratic leaders at the last minute because the support of the pro-life Democrats — led by Rep. Bart Stupak, D-Mich. — was needed to pass the bill.

“I’ve never seen a tidal wave of letters go to members of Congress like they did on this issue,” said Marjorie Dannenfelser, president of the Susan B. Anthony List and former congressional staffer. “And I can tell you it’s not lost on members of Congress.”

She estimated that about 400,000 e-mails were sent from her members to their congressional representatives specifically regarding the abortion issue.

In the end, 64 Democrats joined all but one Republican in adopting an amendment to the health-care reform bill (H.R. 3962) that would bar taxpayer funding for elective abortions. The change was needed, said pro-life activists, to prevent public funding of elective abortions through both a public insurance option and through private insurance plans offered through an insurance exchange, or marketplace.

Rep. Chris Smith, R-N.J., co-chairman of the Congressional Pro-Life Caucus, noted that the Stupak language would be an extension of the Hyde Amendment, which prohibits federal funding of abortion through the annual appropriations bill for the Health and Human Services Department. It must be renewed by congressional vote each year.

“Today the House has an opportunity to significantly limit public funding of abortion in a manner that replicates the Hyde Amendment and applies it to the two, new, massive government health programs created in the pending bill — the public option and the affordability credit program,” Smith said in a floor speech Nov. 7.

Earlier in the week, Smith blasted a deal worked out by Democratic leaders as “another phony amendment designed to subsidize and expand the abortion industry.” He said it “does nothing to change the fact that the public option will be authorized to pay for abortion.”

Continuing Threats

It was not expected that House Speaker Nancy Pelosi, D-Calif., a longtime supporter of abortion rights, would allow a vote on such an amendment because a majority in the House was expected to support it. But when the pro-life Democrats refused to accept weaker tweaks to the abortion-funding language, Pelosi relented and allowed a late vote.

“It came as quite a shock to a lot of people,” said Kristen Day, executive director of Democrats for Life of America, about the decision to allow the vote.

Not all pro-life activists were happy about the Stupak amendment. Judie Brown, president of the American Life League, pointed out that it maintains current law allowing taxpayer funding of abortion in cases of rape, incest and the life of the mother.

In addition, she noted in a Nov. 10 column that the House bill expands access to and funding of abortifacient contraception as well as funds for “permissive sex education programs.”

After the amendment was adopted, pro-abortion Democrats voted to support passage of the underlying health-care overhaul but immediately denounced the abortion-defunding amendment as a way to bar abortions for all women.

A group of 40 Democrats, including Rep. Diana DeGette, D-Colo., wrote to Pelosi that they would oppose the underlying health-care bill when it came back from the Senate if it still included the Stupak amendment’s ban on abortion funding.

Pro-life advocates counter that the bill would not bar all abortions and that women could still purchase riders to their insurance plans bought through the exchange to cover elective abortions.

“We’re going to be working to educate [members of Congress] about it because there are a lot of misconceptions being pushed out there,” Day said.

Senate Fight Looms

The adoption of the abortion-defunding provision also took senators by surprise and may improve the outlook for inclusion of a similar provision in that chamber’s health-care bill. Pro-life advocates had expected a Senate bill to include broad government funding for abortion. But the House vote showed how unpopular taxpayer funding for elective abortions is, even for many Democrats.

“One absolutely necessary element in passing anything is momentum and intensity, and we have that now,” Dannenfelser said about pro-life advocates.

In the face of united Republican opposition, Sen. Harry Reid, D-Nev., the Senate majority leader, will need every Democrat to support health-care reform. Several Democratic senators have repeatedly stated public objections to the use of taxpayer funding for elective abortions, and at least one of them will vote against the bill if it includes such funding.

“I support provisions like those included in the Stupak amendment to the House bill and will seek to have them included in the Senate bill,” said Sen. Ben Nelson, D-Neb., in a written statement.

Nelson’s position was based on the fact that an “overwhelming majority” of people in his state oppose federal funding of abortion, regardless of their views on the procedure.

Nebraskans’ opposition to public abortion funding is reflected nationally, according to recent polls. A September Rasmussen Reports national telephone survey found 48% of Americans support a prohibition on abortion coverage in any government-subsidized health-care plan. By comparison, 13% supported abortion funding, while 32% favored an approach with no requirements in either direction. The remaining respondents were undecided.

The looming Senate fight also may put President Obama in an awkward position. Obama has repeatedly called for a health-care reform bill that does not fund abortion. However, he said in a Nov. 9 interview with ABC News that he does not support inclusion of the Stupak amendment in the final version of the bill.

“I want to make sure that the provision that emerges meets that test — that we are not in some way sneaking in funding for abortions, but on the other hand that we’re not restricting women’s insurance choices,” Obama said.

The president’s opposition to the abortion funding ban did not surprise some abortion opponents, who cite his long-stated goal of including “reproductive services” among basic health care in any health-care reform.

“The Obama administration and the Democratic leadership were trying to smuggle in two new major abortion programs,” Johnson said. “We expect more attempts.”

Rich Daly writes

from Washington.

Highlights of the House Bill

Among other things, the Affordable Health Care for America Act (H.R. 3962):

• Requires nearly all individuals to obtain health-care coverage beginning in 2013.

• Permits individuals to keep their current health plan as a “grandfathered” plan.

• Subjects those who do not obtain coverage to a penalty tax of 2.5% of adjusted gross income above a threshold.

• Requires employers to offer their employees health-care insurance, or make an insurance contribution on their behalf, starting in 2013.

• Subjects businesses that fail to provide coverage to penalties of up to 8% of their payroll.

• Creates a federal exchange, to begin operation in 2013, that would allow individuals and small businesses to purchase health insurance from insurers participating in the exchange.

• Allows states to apply to operate their own state-based health-insurance exchanges.

• Requires the establishment of a public health-insurance option within the insurance exchange by 2013.

• Directs the Health and Human Services Department to run the public option and negotiate with providers to determine rates.

• Requires those rates to be no lower than those under Medicare and no higher than the average for private plans.

• Provides affordability credits to individuals and families with incomes of up to 400% of the federal poverty level.

• Bars insurance companies from denying or reducing coverage based on pre-existing medical conditions, beginning in 2013.

• Prohibits annual or lifetime coverage limits.

• Limits annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family.

• Requires all qualified health-benefits plans to provide coverage that meets or exceeds the standards of an “essential benefits package.”

• Requires an essential benefits package to, at a minimum, cover hospitalization, outpatient hospital and clinic services, professional services of physicians and other health professionals, prescription drugs, rehabilitative services, mental health and substance-use disorder services, preventive services, maternity care, well-baby and well-child care, and medical equipment.

• Requires Medicaid to cover newborns during the first 60 days of life.

• Transfers children eligible for coverage under the Children’s Health Insurance Program to either Medicaid or the health-insurance exchange in 2014.

• Imposes a tax surcharge of 5.4% on adjusted gross income exceeding $500,000 for an individual or $1 million for a joint return.

• Limits contributions to health flexible savings accounts to $2,500 per year, indexed to inflation.

• Prohibits the use of federal funds to provide abortions, except in cases of rape, incest or danger to the mother’s life.

• Prohibits individuals who receive affordability credits from purchasing a plan that provides elective abortions. Individuals could purchase with their own funds plans that cover elective abortions.

• Bars illegal immigrants from receiving federal subsidies to purchase health insurance.

• Does not explicitly bar illegal immigrants from participating in exchanges to purchase health insurance with their own money.

— Congressional Quarterly