House Democratic leaders agreed Friday night to settle an impasse over abortion by letting the entire House vote on a proposed solution, a risky decision that could determine the fate of their trillion-dollar overhaul of the nation's health care system.
Under the agreement, anti-abortion Democrats will be permitted to offer an amendment on the House floor to the health-care overhaul bill. The amendment would prohibit a new government-run insurance plan created by the health-care bill from offering to cover abortion services, congressional sources said. It would also block people who received federal subsidies for the purchase of health insurance from buying policies that offered coverage for abortions.
The deal clears the way for the dozens of Democratic lawmakers who oppose abortion to lend their support to the health care package, the most dramatic expansion of health coverage in more than 40 years. It also satisfies the demands of the U.S. Conference of Catholic Bishops, which had threatened to oppose the House bill.
If the amendment from Rep. Bart Stupak (D-Mich.) passes, said Richard Doerflinger, associate director of the bishops conference, "we become enthusiastic advocates for moving forward with health care reform."
The amendment is expected to pass with the combined support of more than 40 anti-abortion Democrats and virtually every House Republican. That likelihood meant that leaders of the much larger group of Democrats who support abortion rights were not happy to learn of the deal.
"There will be no abortion, not just with public funds, but with private funds under the public option, and that's not acceptable," said Rep. Diana DeGette (D-Colo.).
House leaders met with that bloc of Democrats late Friday to try to quell their frustration., but the agreement makes clear that they believe abortion-rights Democrats will find it difficult to vote against the health-care bill even with such a restriction attached to it.
"This is a small facet of the bill that's very important to a lot of people," said House Majority Leader Steny Hoyer (D-Md.), adding that the greater goal is to pass legislation that makes health care "affordable and accessible to all Americans."
Abortion-rights Democrats said Friday that they were willing to accept only limited revisions to the health-care package.
Upon learning of Friday night's deal, the Planned Parenthood Federation of American quickly fired off a statement from president Cecile Richards opposing the amendment. Such a measure, Richards said, would effectively force private insurers to drop coverage of abortion in order to offer their policies through the new insurance exchanges.
"The fact is, the majority of private health insurance plans currently offer abortion coverage," Richards said, adding that the Stupak amendment "upends the carefully crafted compromise in the House bill and unambiguously restricts women's access to care."
Stiffening the backbone of those who oppose abortion was the bishops' conference, which circulated a letter late Friday arguing that without such an explicit prohibition in the bill, the legislation could otherwise force individuals who oppose abortion to indirectly subsidize the procedure with their tax dollars.
The disagreement, and Saturday's proposed resolution, sets the stage for a messy fight in the middle of the day's debate over President Obama's top domestic initiative. And House leaders must still address a separate dispute within the House Democratic caucus over immigration policy.
Hispanic lawmakers said they had received assurances from House leaders that the health bill would not be changed to bar undocumented workers from purchasing insurance through newly created insurance marketplaces. Language promoted by the White House and adopted by the Senate Finance Committee would establish such a barrier.
Hispanic lawmakers said they remained concerned, however, that Republicans would attempt a parliamentary maneuver to add the provision to the bill -- and that the maneuver would attract enough votes from conservative Democrats to win approval. Republican aides declined Friday to say whether they were planning such a move.
House leaders were working late Friday to secure assurances from about 20 Hispanic Democrats that they would vote for the health-care package regardless. Hispanic lawmakers, for their part, were seeking Pelosi's commitment to try to prevent Democratic defections.
The health-care bill would spend more than $1 trillion over the next decade to expand coverage to 36 million additional Americans by expanding Medicaid and creating a new insurance marketplace where people could shop for a variety of policies, including a government-run insurance option. Low- and moderate-income people would be eligible for federal subsidies to help them cover the cost of premiums, and to reduce their co-payments and other out-of-pocket expenses.
As written, the bill would permit those insurance plans to provide abortion services so long as the procedure was paid for with private premium dollars, rather than any government subsidies, a position supported by Democrats who support abortion rights.
Anti-abortion lawmakers, led by Stupak, demanded more ironclad commitments that public funding would not be used for abortion except in cases of rape, incest or to save the life of the mother. That standard has been applied to federal programs, such as Medicaid and Medicare, for more than 30 years.
To try to bridge the divide, Rep. Brad Ellsworth (D-Ind.) proposed that private insurance plans be required to clearly segregate public and private funds. The Ellsworth proposal also would require the hiring of a private contractor to handle funds for abortion services.
Stupak and other abortion opponents were not satisfied. Doerflinger of the bishops conference called the Ellsworth plan well-intentioned but "an accounting gimmick."
"The Catholic bishops are a very important group, to especially a lot of the Catholic members and people from districts with large Catholic populations," House Energy and Commerce Chairman Henry A. Waxman (D-Calif.) noted Friday. "The problem is that we have a very fragile situation. You give somebody a vote one way and we lose people on the other side."
Negotiations between the two camps consumed much of the day Friday, as representatives from the warring factions shuttled into and out of House Speaker Nancy Pelosi's office just off the Capitol Rotunda. A deal was finally struck shortly before 9:30 p.m., sending Stupak to the House Rules Committee to request official permission to offer his amendment -- permission that was finally granted shortly after 1 a.m. Saturday.
After the deal was struck, annoyed pro-choice leaders filed out of Pelosi's office to confer with their supporters.