Abortion, immigration are factors in health-care reform vote

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Friday, November 6, 2009

House Democratic leaders were struggling Thursday to contain uprisings on the hot-button issues of abortion and immigration that have left them little margin for error as they attempt to push through a massive health-care reform bill this weekend.

Although confident of victory, House Speaker Nancy Pelosi (Calif.) and other Democratic leaders were working to limit defections to the roughly 25 Democrats viewed as "hard no" votes. There will be 258 Democrats in the House by the time the vote takes place, but to secure the 218 votes needed for passage -- and with prospects dim for Republican converts -- Pelosi can afford to lose no more than 40 members of her caucus. President Obama had been slated to head to the Hill on Friday to push wavering Democrats to get behind the measure, but he called off the trip after Thursday's shooting rampage at Fort Hood, Tex.

For party leaders, setting a weekend deadline for passage represented a calculated risk, one that could backfire if the vote -- now expected late Saturday or Sunday -- fails or must be delayed. But they feared that if members were given more time to consider the legislation, new issues could arise, particularly as lawmakers digest the results from Tuesday's elections. Most ominous for Democrats were their losses in gubernatorial contests in New Jersey and Virginia, although the party did prevail in House special elections in New York and California.

The legislation's prospects got a boost with key endorsements Thursday from AARP, the American Medical Association and the American Cancer Society. But Pelosi was still working Thursday night to chip away resistance from antiabortion Democrats, who worry the bill could lead to government funding of the procedure, and from Hispanic members trying to stave off efforts to add a Senate provision that would bar illegal workers from buying private insurance policies through new federally established marketplaces, even with their own money.

"We are right on the brink of passing historic legislation to provide quality, affordable, accessible health care for all Americans," Pelosi told reporters. Asked whether she had the votes to bring the bill to the House floor, the California Democrat pledged, "We will."

The legislation's next stop is the Rules Committee, which is scheduled to meet Friday afternoon to establish a framework for a historic debate on the biggest expansion of health coverage since Medicare and Medicaid were created in 1965. Committee Chairman Louise M. Slaughter (D-N.Y.) said that more than 50 amendments had been filed by members of both parties and that debate is expected to consume at least five hours of floor time on Saturday. Procedural maneuvering by Republicans could extend that period by several hours and possibly into Sunday.

The final House bill is expected to vary only slightly from the 1,990-page document Democratic leaders unveiled amid great fanfare last week. In addition to a 42-page "manager's amendment" released late Tuesday, Slaughter's committee will approve the guidelines governing the debate. That rule, she said, is likely to contain a provision aimed at quelling a long-simmering dispute over abortion that has slowed progress in the House for weeks.

As written, the House bill would allow plans offered through new insurance exchanges, set up for individuals without employer coverage, to cover abortion services. But the plans would be required to establish payment firewalls to prevent federal subsidies from covering the cost. Democrats opposed to abortion call that an accounting distinction and are seeking ironclad guarantees.

A compromise measure crafted by Rep. Brad Ellsworth, an antiabortion Democrat from Indiana, would require federal health officials operating the public insurance plan created in the House bill to hire a private contractor to pay abortion providers, thus avoiding direct federal payments. That language is acceptable to Democrats who support abortion rights, but not to many Democrats who oppose abortion, and House leaders were still working Thursday night to craft language that would win back a dozen or so of the 40 Democrats whose votes may be on the line.

As the hours ticked away, Democrats scrutinized the House bill for other potential landmines that could haunt them on the campaign trail next year. Immigration, and the prospect that Republicans will identify a loophole that could be construed as benefiting people who live in the United States illegally, is one area that is receiving a great deal of attention.

Rep. Gerald E. Connolly (Va.), president of the Democratic freshman class, said he wants to be able to assure his constituents that people "who are here illegally cannot avail themselves of the infrastructure that we're creating," although he said he is not necessarily opposed to letting undocumented workers buy insurance through the exchanges on their own. Connolly said he is leaning toward voting in favor of the measure, but he added: "I want to read the language. I can't afford to be voting for something sight unseen."

Party leaders are considering relenting on the more restrictive Senate language on illegal immigrants, in the hope of removing a contentious issue from the long list of concerns that must be worked out in a final House-Senate conference. That concerns wavering Hispanic members.

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