The Health Reform Abortion Wars, Part Deux

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What is it about those Nebraska governors-turned-senators? Did they not get enough attention as children? Do they chafe at being told they hail from a “flyover” state? Does that unicameral legislature leave too few adoring supporters? Bob Kerrey was infamous for waiting until the verrrrrry last moment to make up his mind on important pieces of legislation, waiting until he’d been courted and wheedled and begged. And now it appears Ben Nelson is looking to make himself similarly indispensable to the Democratic effort to pass health reform legislation.

On Monday, Nelson introduced an amendment that would prohibit the public option from covering abortion and would prevent private insurance plans that covered abortion procedures from receiving federal subsidies (bill text after the jump). It is virtually identical to the Stupak amendment that passed as part of a deal to get health reform through the House last month. But there is one important difference between the two.

Unlike the Stupak amendment, which garnered the support of 64 House Democrats, the Nelson provision will certainly not pass when the Senate considers it (probably Tuesday). The amendment would need 60 votes to pass, and pro-choice organizations count at least 41 senators who are solidly on their side. Each side is still playing their part, of course, with choice groups circulating frantic emails to their members about the “outrageous” Nelson amendment and a trio of key Catholic leaders sending a letter to senators to urge a “yes” vote on “an essential amendment.”

So what happens when the Nelson amendment fails? Last week, Nelson was threatening to filibuster health reform if his abortion language was not included, but he’s since walked that back. Even a Nebraska attention-seeker can only go so far, after all. Democratic leaders have said they’re working on other compromises to win Nelson’s support for the final bill, but it’s unclear that he was ever willing to vote for health reform, even if his amendment were to pass. And other pro-life Democrats–like Bob Casey, who is a co-sponsor of Nelson’s amendment–have not said the issue will determine their vote.

Casey has talked about introducing parts of his Pregnant Women Support Act in order to insure that the bill contains measures to reduce abortion rates. But such a move would be almost entirely for his own comfort, and not to bring more pro-life senators aboard or placate the Catholic hierarchy. Richard Doerflinger, associate director of the U.S. Conference of Catholic Bishops’ secretariat of pro-life activities, told the Wall Street Journal over the weekend that compromise in the wake of a defeat of the Nelson amendment was “not a negotiation we’re prepared to have,” adding, “I really don’t know how you compromise further.”

Another factor arguing against additional abortion amendments is the fact that if Reid cannot count on Nelson to get to 60 votes, he will have to pin his hopes on Olympia Snowe, a strong supporter of abortion rights. Snowe’s main stated concern about health reform is the public option. But stronger abortion restrictions would only make her less likely to sign on to be that crucial last vote to pass reform. Which is why as of Monday night, Democratic leaders were much busier crafting a public option compromise than worrying about abortion negotiations.

The buzz early this week may be about the Nelson amendment and whether it will be the key or the stumbling block to passing health reform, but the real focus of players in the abortion world is what happens in conference committee once (if) there are Senate and House versions to reconcile. Intense brainstorming and negotiations are taking place, especially among House Democrats who voted both for the Stupak amendment and health reform. They aren’t willing to see health reform go down in flames and they don’t need language as strong as the Stupak amendment to support final legislation.

TEXT OF THE NELSON-HATCH AMENDMENT

Purpose: To prohibit the use of Federal funds for abortions.

H. R. 3590

To amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes.

Referred to the Committee on __________ and ordered to be printed

Ordered to lie on the table and to be printed

Amendment intended to be proposed by Mr. Nelson of Nebraska (for himself, Mr. Hatch, Mr. Casey, Mr. Brownback, Mr. Thune, Mr. Enzi, Mr. Coburn, Mr. Johanns, Mr. Vitter and Mr. Barrasso) to the amendment (No. 2786) proposed by Mr. Reid

Viz:

Beginning on page 116, strike line 15 and all that follows through line 15 on page 123, and insert the following:

(a) Special Rules Relating to Coverage of Abortion Services.–

(1) In general.–Subject to paragraph (2), nothing in this Act (or any amendment made by this Act) shall be construed to require any health plan to provide coverage of abortion services or to allow the Secretary or any other person or entity implementing this Act (or amendment) to require coverage of such services.

(2) Community health insurance option.–The Secretary may not provide coverage of abortion services in the community health insurance option established under section 1323, except in the case where use of funds authorized or appropriated by this Act is permitted for such services under subsection (b)(1).

(3) No discrimination on the basis of provision of abortion.–No Exchange participating health benefits plan may discriminate against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions.

(b) Limitation on Abortion Funding.–

(1) In general.–No funds authorized or appropriated by this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the result of an act of rape or incest.

(2) Option to purchase separate supplemental coverage or plan.–Nothing in this subsection shall be construed as prohibiting any non-Federal entity (including an individual or a State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this subsection, or a plan that includes such abortions, so long as–

(A) such coverage or plan is paid for entirely using only funds not authorized or appropriated by this Act; and

(B) such coverage or plan is not purchased using–

(i) individual premium payments required for a qualified health plan offered through the Exchange towards which a credit is applied under section 36B of the Internal Revenue Code of 1986; or

(ii) other non-Federal funds required to receive a Federal payment, including a State’s or locality’s contribution of Medicaid matching funds.

(3) Option to offer supplemental coverage or plan.–Nothing in this subsection shall restrict any non-Federal health insurance issuer offering a qualified health plan from offering separate supplemental coverage for abortions for which funding is prohibited under this subsection, or a plan that includes such abortions, so long as–

(A) premiums for such separate supplemental coverage or plan are paid for entirely with funds not authorized or appropriated by this Act;

(B) administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan; and

(C) any such non-Federal health insurance issuer that offers a qualified health plan through the Exchange that includes coverage for abortions for which funding is prohibited under this subsection also offers a qualified health plan through the Exchange that is identical in every respect except that it does not cover abortions for which funding is prohibited under this subsection.