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The Abortion Deal That Saved Health Care (for Now)

4 years ago
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If the traditional definition of a compromise is a deal that pleases no one, then the newly minted provision on abortion funding in the health care deal that won over Ben Nelson is already a classic.

Terry O'Neill, president of the National Organization for Women, said she was outraged that Senate Democrats "would cave in to Senator Ben Nelson" -- while Deal Hudson, a conservative Catholic activist with ties to the GOP, said Nelson "caved in to Democratic Party."

"[I]t is a sad day when women's health is traded away for one vote," Cecile Richards, president of Planned Parenthood Federation of America, said as she announced that her organization would oppose the bill. Ditto for Nancy Keenan of NARAL Pro-Choice America, who called the Nelson compromise "outrageous" and "inexplicable" and called on supporters to defeat health care reform if the language is not changed.

On the other side, Deacon Keith Fournier, a conservative Catholic activist, called this Nelson's "Judas moment" because of the generous Medicaid exemption Nelson's holdout also won for Nebraska -- "a bag of silver," Fournier labeled it. (The Catholic bishops also announced their opposition, though somewhat more diplomatically.) Liberal Catholic activists from Catholics for Choice, on the other hand, declared that the latest language on abortion "makes a mockery of the entire health care reform package."

Of course, the only one who counted in the 60-votes-or-filibuster world of Senate politics was Nelson, and he declared himself satisfied.

So, done deal? Hardly. If the Senate passes the bill by Christmas Eve, as expected, then it goes to a conference committee that will attempt to reconcile the Senate and House versions, which have any number of important (though not insurmountable) differences -- except on abortion, where the House's more stringent Stupak-Pitts amendment on abortion funding (the brainchild of Democrat Bart Stupak of Michigan) is in the view of many pro-lifers the only acceptable version.

Stupak is one of those pro-lifers, and like Nelson, he's the one whose vote counts -- since the House bill passed only by 220-215 last month, with Stupak bringing in a bloc of 40-plus fellow Dems with his anti-abortion amendment. Stupak has made it clear that the Nelson-Casey Senate amendment (Pennsylvania's pro-life Dem, Sen. Bob Casey, proffered the amendment that Nelson tweaked) is a non-starter.

"Unacceptable" was in fact the word he used in an interview with Politico's Ben Smith. Stupak said the Senate version represented "a dramatic shift in federal policy" -- though he said he remained hopeful that the differences could be overcome in conference.

Under the Stupak amendment, insurers in an exchange could not "pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion." Women could still buy abortion coverage with their own funds, but many believe such coverage would not be offered because insurers would not find it feasible financially. The Senate version would allow each state to bar abortion coverage in health plans in the exchanges. But exchange plans would be subsidized by federal funds, hence the concern among pro-lifers that taxpayer dollars would subsidize abortions. The Nelson-Casey amendment provides for a system to segregate federal dollars from private premiums to ensure that only private money pays for abortion coverage. Pro-lifers say it would be impossible to keep the funds separate, and pro-choicers say such a system would prove so onerous that most women could not buy abortion coverage.

But Smith also revealed the startling news that an aide to Stupak was working closely with the Republican Senate leadership and anti-abortion groups to rally opposition to the Senate bill. As Smith noted, that kind of Democratic collaboration with Republicans -- who have been staunchly opposed to Democratic-led health care reform -- is not likely to help Stupak's cause. (Stupak did disavow the behind-the-scenes maneuverings of his aide, Erika Smith.)

The reality, however, is that the House is not likely to pass a bill that Stupak does not support. Which means the only changes on abortion funding language are likely to be in the direction of more rather than less restrictive. Earlier this month Nelson had offered an amendment that was modeled on Stupak's and it was defeated, leading to his holdout for something he would accept -- and the Medicaid exemption.

Such changes could potentially appease some of today's angry pro-lifers, and even turn them into allies. But it would further alienate pro-choice organizations, which would have to make the agonizing decision of whether to hold their noses -- and hold their fire -- or work to sink the entire health care reform project.

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