By Alec MacGillis
Washington Post Staff Writer
Friday, March 5, 2010; A01
As President Obama makes his final plea for a health-care overhaul, Democratic leaders in Congress are embarking on a delicate strategy to win over abortion opponents, a gambit that could determine whether the legislation becomes law.
The effort depends on convincing as many as a dozen antiabortion Democrats in the House that abortion language in the Senate bill is more stringent than initially portrayed. But Democratic leaders must be careful that they don't drive away abortion rights supporters who are increasingly concerned that the measure would prove severely restrictive.
"It's going to be a heavy lift, because people on both sides don't like" the language, said Kristen Day, director of Democrats for Life of America, an antiabortion group that otherwise supports health-care reform. "It's a difficult situation right now."
Rep. Bart Stupak (D-Mich.), the head of the antiabortion contingent, has repeatedly reaffirmed his opposition to the Senate terms, saying that House leaders have all but given up on his vote. "Some people are saying we have to vote for the Senate bill. That ain't going to happen," he said in an interview this week.
But congressional leaders are still working behind the scenes to try to persuade some in the Stupak group. If the leadership loses antiabortion members, most of them Midwestern Roman Catholics who otherwise support the legislation, the only way to compensate would be to add votes from conservative Democrats who previously opposed the measure.
House Speaker Nancy Pelosi (D-Calif.) expressed confidence Thursday that resistance from antiabortion members could be overcome. "When people think there isn't going to be a bill, they can take whatever position they want," she said. "But now they know there is going to be a bill, and these members are saying, 'Let's talk.' "
The leadership has two choices: It can try to revise the Senate language, which would be all but impossible under the process Democrats are using to pass a final bill, or it can try to convince some abortion opponents that the provisions are acceptable.
Underlying the controversy is the question of whether the Senate language -- agreed to in a last-minute deal with Sen. Ben Nelson (D-Neb.) -- maintains the 33-year-old ban on federal funding for abortion. The bill would allow the procedure to be covered in plans offered on new "exchanges" in which people without employer-based coverage would buy insurance with the help of federal subsidies.
But it would require buyers to make two premium payments -- one for most of their coverage and a second, far smaller one for abortion coverage. Everyone with such a plan -- even men or older women -- would need to make both payments.
Opponents have said that would not go far enough to keep federal money from subsidizing abortion. Democratic leaders disagree, saying it maintains the status quo.
Meanwhile, abortion rights advocates have grown increasingly convinced that the language would restrict the reach of abortion coverage nearly as much as the Stupak language in the House bill passed in December. That measure would have forced those who want abortion coverage to buy it in a rider.
Abortion rights groups and health-care analysts now are predicting that, under the Senate language, few plans would cover abortion because the requirement of two payments would be cumbersome for insurers and objectionable to customers.
"There will not be abortion coverage in the exchanges. There just won't be," said Linda J. Blumberg, a health policy analyst at the Urban Institute.
At the time of the deal with Nelson, Senate Democrats reassured abortion rights supporters by noting that many people would pay for their coverage via automatic bank debits, minimizing the impact of the separate payments. But abortion rights groups argue that the requirement of a separate check is almost tailor-made to spark public opposition to abortion, complete with protests of companies that offer plans covering it.
"It's clearly intended to be stigmatizing," said Laura MacCleery of the Center for Reproductive Rights.
The rules would not affect women with employer-based insurance, which often covers abortion. But the legislation envisions that more people over time would get their insurance through the exchange, giving its rules a potentially broad impact.
In making their case to the Stupak group, Democratic leaders point out that Nelson -- who initially fought for the Stupak provision but was rebuffed -- thinks his language is highly restrictive. That is not so much because it would discourage insurers from offering abortion coverage, his aide said, but because he thinks it preserves the ban on federal financing of abortion by segregating that money.
"He tried to figure out language that would be as close to Stupak as you could be without repeating the language," said Jake Thompson, his spokesman.
Some abortion opponents concede that it is possible that the two-checks rule will dissuade insurers from offering plans covering the procedure. But they say they still oppose the language on principle, because it would allow federal subsidies to help people buy plans with abortion coverage.
"The fact that the pro-abortion groups don't like it either doesn't make me support it," said Richard Doerflinger, a spokesman for the U.S. Conference of Catholic Bishops.
Abortion opponents also decry what they say are other loopholes in the Senate bill, warning, for instance, that a technicality could allow community health clinics to provide abortions, circumventing the federal ban.
Stupak said he rejected a proposal from congressional leaders to revisit the abortion language in the future. He has urged adding stricter language to the revisions of the Senate bill that both chambers are planning to pass. Leaders say rules allow only budget-related issues to be in this package, but Stupak notes that abortion changes could be added if 60 senators agreed.
Short of that, the only way forward will be to convince the Stupak contingent that the Senate language is as restrictive as abortion rights supporters fear it is -- and at the same time try to put those very fears to rest.
"The good news is that the Senate bill does allow" abortion coverage, said Rep. Diana DeGette (D-Colo.), co-chairman of the House's Pro-Choice Caucus. "But the question is: Would [the coverage] really be there?"
Staff writer Lori Montgomery contributed to this report.