The health care overhaul passed by the House of Representatives over the weekend was almost scuttled by one issue: abortion.
Anti-abortion Democrats and their leaders tried unsuccessfully to come to agreement about abortion language before debate began.
Instead, House Speaker Nancy Pelosi allowed Rep. Bart Stupak (D-MI) to offer an amendment on the floor to restrict federal funding for abortion services, even in private health insurance plans. The vote was 240-194.
Anti-abortion groups say this only codifies current law, which already bans federal funding for abortion. "Our amendment does one very simple thing," Stupak said on the floor. "It applies the Hyde amendment — which bars federal funding for abortion except in the case of rape, incest or the life of the mother — to the health care bill."
Abortion rights advocates argued that the Stupak amendment expands the ban well beyond the language in the Hyde amendment, passed in 1976. Colorado Democratic Rep. Diana DeGette, a leader among abortion rights lawmakers, warned that if enacted, "This amendment will be the greatest restriction on a woman's right to choose to pass in our careers."
To get a clearer picture of what the Stupak amendment would do, it helps to take it out of context and just look at the language. Here's what it says:
Government Money: In general, government money cannot be used to pay for abortion. The government-administered health plan — often called the public option — will not cover abortion, unless a doctor certifies that a woman is in danger of death without one, or the pregnancy is the result of rape or incest.
If you get your health insurance through the government, or with help from the government in the form of a tax subsidy, your plan will not cover abortion. In this case, you would have the right to buy extra coverage — with your own money.
If you get your health insurance through your state, as in Medicaid, your state could buy supplemental abortion coverage for everyone it insures. And 17 states already do this under Medicaid.
The Exchange: The next section of the abortion amendment deals with the exchange. That's the government-administered service where people can buy insurance and join a risk pool. One of the reasons health care is so expensive for people who don't get it through their work is that they're not in a large risk pool. The bill tries to group them together and cut costs for everyone.
Private insurance companies that offer a health plan through the exchange are allowed to cover abortion. But if they're going to, the companies must also offer another plan that is identical in every way, except that it does not cover abortion.
So, say you're buying insurance with your own money, and you get it through the exchange. You can choose a policy that covers abortion, or one that doesn't. But if you're getting help from the government to buy that insurance — in the form of a tax subsidy — you may not choose a plan that covers abortion. You are still allowed to buy a supplemental policy with your own money.
Private Insurance: The Stupak amendment does not apply to private insurance bought with private money. It is also not close to becoming law. The Senate bill does not have similar language, though lawmakers on both sides of the debate are now looking at it.
The question now is how this might play out in a whole new medical system, and what it means in the broader narrative of abortion in America.