The Wedge Dividing Obama's Health Coalition

Many Democrats cheered when the health bill passed the House, but pro-choice groups denounced a last-minute amendment to ban coverage of abortions. Now the issue is tearing apart health-reform supporters in the Senate.

Alex Brandon / AP Photo

“Horrifying.” “Outrageous.” “Incredible.” “A nightmare.” “Strange.”

Those are the words pro-choice leaders are using to describe the outcome of the health-care vote in the House of Representatives, in which a sweeping reform plan passed—but one that would outlaw coverage of almost all abortions in the new insurance market known as the exchange.

As the Senate continues to debate the final details of its own health-care bill, including provisions on abortion, Planned Parenthood and the National Organization for Women said Monday they would oppose any final health package that includes the abortion ban, which would apply both to private and public insurance plans. And some pro-choice leaders said they expect other influential women’s groups to follow suit, potentially driving a wedge through the coalition that elected President Barack Obama and brought the Democratic Party to majorities in both the House and Senate.

“We want [the abortion ban] stripped. And I think everybody is extremely serious about this. It’s been a very strong and very quick reaction. It’s the feeling that you’ve been rolled.”

“I believe, frankly, that the women’s movement as a whole will go there,” said Eleanor Smeal, president of Feminist Majority. “We want [the abortion ban] stripped. And I think everybody is extremely serious about this. It’s been a very strong and very quick reaction. It’s the feeling that you’ve been rolled.”

Leaders from a number of reproductive rights groups told The Daily Beast they were shocked by the outcome of Saturday night’s vote, in which a group of 41 pro-life Democrats, led by Rep. Bart Stupak of Michigan, refused to support the overall health package unless their antiabortion amendment was included. More moderate pro-life Democrats had negotiated a compromise with the party’s leadership in which government funds would be banned from covering abortion in the exchange, but insurers could still pay for the procedure using funds collected through private co-pays. That agreement fell apart at the eleventh hour.

“We totally believed and thought it was going to be OK, with some assurances,” said Smeal, referring to conversations between pro-choice lobbyists and the House leadership. “And then all of a sudden this happened.”

Peter Beinart: Why Democrats Were Smart to Bail on AbortionBenjamin Sarlin: 6 Senators Stalling Health CareMatthew Yglesias: The Next Health Care MinefieldPaul Begala: Forget BipartisanshipThrough the Hyde Amendment and a number of other regulations, the law already prevents federal funding of elective abortions. “What Stupak does is go beyond current law, so in essence, it’s not about public funding at all, but a ban on coverage for women in the exchange,” said Rep. Rosa DeLauro (D-CT)—regardless of whether a woman receives a government affordability subsidy to purchase insurance. Stupak argues that his amendment retains “choice” by allowing women to buy a supplemental “rider” for abortion coverage. But in the five states where abortion riders are currently required, no insurance company offers them. An abortion typically costs between $300 and $400.

The Stupak language would allow customers of the exchange to access insurance-covered abortions without a rider only in cases of rape, incest, or when a pregnancy threatens a woman’s life. And because new individuals and businesses are expected to join the exchange each year, pro-choice advocates worry that Stupak could set the new standard for abortion coverage throughout the insurance industry, even in the private, employer-provided market. “It’s certainly possible that insurance companies could be dissuaded from covering abortion,” as 87 percent of plans currently do, said Adam Sonfield, senior public policy associate at the Guttmacher Institute, which researches reproductive health.

Nevertheless, in a meeting following Speaker Nancy Pelosi’s decision to allow the Stupak amendment to come to a floor vote, pro-choice legislators reportedly vented their frustration, but then decided not to let the issue deter them from supporting the health bill. Pelosi reassured them the Stupak ban would be moderated by the Senate, and, it was hoped, spiked entirely by the conference committee, in which the House and Senate will work together to come up with a final piece of legislation.

Now the focus is on the upper chamber, where pro-life Democrats Bob Casey of Pennsylvania and Kent Conrad of North Dakota are preparing legislative language modeled on the Stupak ban. Pro-choice lobbyists say they are optimistic about a better outcome there, since the blueprint Senate Finance Committee health-care reform draft, spearheaded by Max Baucus—who is known to have the ear of White House Chief of Staff Rahm Emanuel—is “abortion-neutral.” In the Finance draft, abortion cannot be federally funded but remains available to customers participating in the exchange, paid for by individual insurance co-pays.

“Historically, the Senate has been known as the cooling-off place,” said Cecile Richards, president of Planned Parenthood. “I believe these issues will really be thought through in a calmer fashion there than what happened at the 24th hour in the House.”

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But there are alarming signs for pro-choice groups. Just 13 Democratic senators are female, but one of them, Claire McCaskill of Missouri, signaled on MSNBC on Monday that she would consider voting for a bill that included a ban on abortion coverage in the exchanges. “Frankly, once again, this is another example of having to govern with moderates,” McCaskill said. “We can’t just turn our back on the fact that the reason we are in majority is because states like Indiana, and Arkansas, and Louisiana, and Missouri, and North Carolina, and Virginia sent Democrats to the Senate.” (She later noted on Twitter that she opposes the Stupak amendment.)

On Monday morning, Rep. Diana DeGette (D-CO), co-chairwoman of the Congressional Pro-Choice Caucus, announced she had collected 40 signatures of Democrats who have vowed to vote against any final reform bill that retains the Stupak amendment. The list of the letter’s signatories remains closely guarded, though, and even some outspoken champions of abortion rights are refusing to say whether they’ve signed—perhaps reflecting a last-ditch willingness to accept the Stupak amendment, as a means to pushing through the president’s top domestic policy priority.

“I’m not going to prejudge an outcome,” said DeLauro, who would not say whether she signed the DeGette letter. “I just want to work very hard in terms of affecting an outcome. Health reform is critical to our economy, for families, for women. Forty-five thousand people die every year because they don’t have health coverage. This is an outstanding piece of legislation, it really is.”

Speaking to ABC’s Jake Tapper on Monday, President Obama said he hoped the Stupak abortion ban would be scrubbed from the final health bill. “I want to make sure…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,” the president said.

But some liberal activists are saying the Democratic Party and its pro-choice organizational allies did too little, too late to beat back the attack on abortion rights. Throughout the months-long health-care negotiations, the White House signaled that abortion access was on the table for discussion. In a July interview with Katie Couric and on the floor of Congress in September, President Obama promised there would be no public financing of abortion in health reform, meaning the procedure would not be available to women who opt in to any potential new public insurance plan. That pushed the goalposts closer to the pro-life position.

Others are pointing at the pro-choice groups themselves. Jane Hamsher, who runs the Netroots blog Firedoglake, says the organizations have gotten too cozy with the Democratic Party establishment, which often seeks to avoid public discussion of abortion. In the health-reform fight, NARAL and Planned Parenthood were less effective in advocating for their agenda than were proponents of the public insurance option, Hamsher said. “We went out and got commitments from members of the House to vote against any bill that doesn’t have a public option,” Hamsher told The Daily Beast. “They weren’t doing the same thing.”

Richards, of Planned Parenthood, said she wasn’t aware of any efforts, before Saturday’s vote, to extract promises from legislators to vote against a health bill that restricts abortion access. “Frankly, this issue came out Friday night,” she said. Yet Stupak has been on the warpath since July, when he released a letter signed by 19 Democrats demanding a ban on abortion coverage in the exchanges.

“Maybe we should have” created a more threatening pro-choice coalition earlier on, said Smeal. She continued, “Here we are playing nice guy again, we didn’t want to make a fuss, we agreed to a compromise that was already over-generous. And then, bango! These guys go in there like gangbusters. Pelosi was held up, like by bandits. Now the women are saying, ‘That’s it, it’s enough.’”

Dana Goldstein is an associate editor and writer at The Daily Beast. Her work on politics, women’s issues, and education has appeared in The American Prospect, Slate, BusinessWeek, The New Republic, and The Nation.