WASHINGTON — Abortion opponents in the Senate are seeking tough restrictions in the health care overhaul bill, a move that could roil a shaky Democratic effort to pass President Obama's signature issue by year's end.
Sen. Ben Nelson, D-Neb., said Monday he could not support a bill unless it clearly prohibits federal dollars from going to pay for abortions. Nelson is weighing options, including offering an amendment similar to the one passed by the House this weekend.
"I want to make sure something comparable... is in there," Nelson said.
Senate Democrats will need Nelson's vote — and those of at least a half-dozen other abortion opponents in their caucus. They face a grueling debate against Republicans, who are unified in their opposition to a sweeping remake of the health care system.
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It's unclear how the abortion opponents would line up; the pressure on them will intensify once the legislation is on the floor.
The House-passed restrictions were the price Speaker Nancy Pelosi, D-Calif., had to pay to get a health care bill passed, on a narrow 220-215 vote. But they have prompted an angry backlash from liberals at the core of her party, and some are now threatening to vote against a final bill if the curbs stay in.
Obama said the legislation needs to find a balance.
"I want to make sure that the provision that emerges meets that test — 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," Obama said in an interview with ABC News.
Former President Bill Clinton, whose failed effort to revamp the health care system contributed to the Republican takeover of the House and Senate in 1994, was expected to speak to Senate Democrats about health care legislation during their weekly caucus today, officials said. They spoke on condition of anonymity because they were not authorized to discuss his schedule.
Senate Majority Leader Harry Reid is already facing a revolt among Democratic moderates over the government-sponsored health plan that liberals want to incorporate in the legislation as a competitor to private insurance companies.
Reid, who is opposed to abortion, will have to confront the issue directly as he puts together a Democratic bill for floor consideration. The committee-passed Senate versions differ on abortion, but none would go as far as the restrictive amendment passed by the House.
The House bill would bar the new government insurance plan from covering abortions, except in cases or rape, incest or the life of the mother being in danger. That's the basic rule currently in federal law.
It would also prohibit health plans that receive federal subsidies in a new insurance marketplace from offering abortion coverage. Insurers, however, could sell separate coverage for abortion, which women would have to purchase entirely with their own money.
At issue is a profound disagreement over how current federal restrictions on abortion funding should apply to what would be a new stream of federal funding to help the uninsured gain coverage.
Abortion opponents have sought to impose the same restrictions that now apply to the federal employee health plan, military health care and Medicaid, the federal-state health program for the poor. Abortion-rights supporters say such an approach would threaten women's right to a legal medical procedure already widely covered by private insurance.
The Senate health committee bill is largely silent on abortion, a stance that abortion opponents interpret as permitting coverage by private insurance plans that would receive federal subsidies.
The Senate Finance Committee bill attempts to craft a compromise, as the House unsuccessfully tried to do before this weekend's vote tightened restrictions.
The Finance plan would require insurance carriers to separate federal subsidy money from any funds used to provide abortions, and it would prohibit abortion coverage from being included in a minimum benefits package. It would require that state and regional insurance markets offer one plan that covers abortion, and one plan that does not.
Finance Committee Chairman Max Baucus, D-Mont., said he had thought the issue was settled. His panel rejected a number of Republican amendments to toughen abortion language.
Abortion opponents — including U.S. Catholic bishops — disagree. They spurned a somewhat similar approach to Baucus' bill in the House, saying that the approach of keeping federal funds separate amounted to little more than an accounting gimmick.
For now, liberals say they will fight. Abortion-rights supporters in the House were circulating a letter to Pelosi, threatening to vote against a final bill that restricts access to abortion coverage. At least 40 lawmakers had signed by early Monday.
"I think the Senate Finance Committee did a good job of putting up a firewall that would prevent federal funds from being used for abortion," she said. "Generally, I prefer the Senate approach."