WASHINGTON — President Barack Obama's health care bill would change federal policy on abortion, but not open the spigot of taxpayer dollars that some abortion opponents fear.
Abortion rights groups such as Planned Parenthood and NARAL Pro-Choice America say the House and Senate versions of the bill represent the biggest expansion of abortion restrictions in years, yet they're not trying to defeat the measures. Instead, a bitter dispute among abortion opponents over which version is stricter could derail Obama's quest to remake the health insurance system.
Major anti-abortion groups such as the U.S. Conference of Catholic Bishops and the National Right to Life Committee say the Senate provisions expected to come before the House shortly are a backdoor taxpayer subsidy for abortion. Other abortion opponents disagree.
"I actually think the Senate bill will more effectively prohibit federal funds from going to abortion," said Stephen Schneck, director of the Institute for Policy Research & Catholic Studies at Catholic University of America in Washington. "That legislation will actually reduce the demand for abortion in the United States."
Here's a look in question and answer form at a simmering conflict that is vexing House Speaker Nancy Pelosi, D-Calif., as she and other Democratic leaders try to find enough votes to pass health care:
Q: Obama said he wouldn't tamper with the status quo on abortion, so what's the problem?
A: That's what he said, but it's not exactly what happened.
Current law — known as the Hyde amendment — prohibits federal funding for abortion except in cases of rape, incest or to save the life of the mother.
The first drafts of the Democratic health care bills, written by abortion rights supporters in Congress, would have allowed health insurance plans receiving federal subsidies to cover abortion as a legal medical procedure. They couldn't get the votes to advance, so eventually Democratic abortion foes took over writing the language. But any trust abortion opponents might have had in the administration was gone.
The House and Senate ended up passing different provisions.
Q: OK, what are some of the differences?
A: Both bills would set up a new health insurance marketplace for small businesses and people buying coverage on their own, with government subsidies to help keep premiums affordable. That's the similarity.
Here's the key difference: The House provision, written by Rep. Bart Stupak, D-Mich., would prohibit health plans receiving subsidies from covering abortions, except as allowed by the Hyde amendment. Women who want coverage for abortion would have to buy a separate policy.
The Senate language, written by Sen. Ben Nelson, D-Neb., would allow the plans to cover abortion with private funds collected directly from policyholders. People who want the coverage would have to write two checks to their health insurance plan, and the plans would keep the money in a separate account from taxpayer funds.
With the Senate bill going back to the House, Obama is asking Democrats to unite behind it.
Q: Would the Senate bill change the status quo?
A: Yes. The federal employee health benefits program is seen as the model for the new insurance marketplace, and none of the plans available to government workers may cover abortion, except as allowed by Hyde.
"It would be a pretty significant change," said Kristen Day, executive director of Democrats for Life of America. Stupak and Nelson, both longtime abortion foes, serve on the group's advisory board. Day said Stupak's approach is preferable, because it closely follows existing law. But the Senate rejected it, forcing Nelson to develop his plan as a fallback.
Q: Does that mean the Senate bill allows taxpayer money for abortions?
A: Douglas Johnson, legislative director for the National Right to Life Committee, says money is fungible, and the separation between taxpayer funds and private premiums is only a fig leaf.
"The Senate bill departs from long-standing federal policy by authorizing tax subsidies to help tens of millions of Americans buy private health plans that could cover abortion on demand," said Johnson. "Anyone enrolling in such plan would be required to make separate payments into an abortion fund."
But Timothy Jost, a law professor at Washington and Lee University, analyzed the two bills and concluded the only difference is an administrative technicality.
"What Stupak says is you have to buy a separate policy, and what Nelson says is you have to write two checks," said Jost. "There's no public funding of abortion."
And people who don't want to pay for other people's abortions wouldn't be forced to do so, Jost added. They could simply pick a plan that doesn't cover it.
Q: What are the odds that health plans which don't cover abortion would be available?
A: There would definitely be a demand for them, and not just from people with moral objections. Single men and older women would have no reason to pay an extra premium for abortion coverage.
"Because this is such a hot political issue, my expectation is that insurance companies would definitely offer it both ways," said Robert Laszewski, a former health insurance executive turned consultant.
Abortion coverage is now widely available through workplace health plans, but many women who have abortions pay out of pocket instead of using their insurance.
Q: Don't abortion opponents have other concerns about the bill?
A: A major one has to do with $11 billion that Obama wants to pump into community health centers serving low-income people and the uninsured. As the bill is currently written, those funds are not explicitly covered by the Hyde amendment.
White House health overhaul spokeswoman Linda Douglass says Obama is willing to clarify the language.
Q: What are the odds that these disputes can be worked out?
A: Stupak sounded optimistic Monday. "The president says he doesn't want to expand or restrict current law (on abortion). Neither do I," Stupak said. "I think we can get there."
Abortion opponent Rev. Derrick Harkins, pastor of the Nineteenth St. Baptist Church in Washington, said he believes it ultimately could hurt the anti-abortion cause if the health care bill collapses because of the divisive issue.
"You can't be blanket pro-life and not address those things that encourage women to make the choice of having an abortion," said Harkins, a board member of World Relief, the humanitarian arm of the National Association of Evangelicals. "If you are really looking to reduce the number of abortions in America, one of the things that will make that happen is to have comprehensive health care coverage."