A Blue View

A New 'Morning-After Pill': More Effective, More Controversial

Wash Post:

A French drug company is seeking to offer American women something their European counterparts already have: a pill that works long after "the morning after."

The drug, dubbed ella, would be sold as a contraceptive -- one that could prevent pregnancy for as many as five days after unprotected sex. But the new drug is a close chemical relative of the abortion pill RU-486, raising the possibility that it could also induce abortion by making the womb inhospitable for an embryo.

The controversy sparked by that ambiguity promises to overshadow the work of a federal panel that will convene next week to consider endorsing the drug. The last time the Food and Drug Administration vetted an emergency contraceptive -- Plan B, the so-called morning-after pill -- the decision was mired in debate over such fundamental questions as when life begins and the distinction between preventing and terminating a pregnancy. Ella is raising many of those same politically charged questions -- but more sharply, testing the Obama administration's pledge to keep ideology from influencing scientific decisions.

Plan B, which works for up to 72 hours after sex, was eventually approved for sale without a prescription, although a doctor's order is required for girls younger than 17. The new drug promises to extend that period to at least 120 hours. Approved in Europe last year, ella is available as an emergency contraceptive in at least 22 countries.

Ella is being welcomed by many U.S. advocates for family planning and reproductive rights as a much-needed additional form of emergency contraception. Opponents of the drug, however, argue that the French company and the FDA would be misleading the public by labeling ella as an emergency contraceptive. Its chemical similarity to RU-486 makes it more like the controversial abortion pill, which can terminate a pregnancy at up to nine weeks, they say. RU-486 has soared in popularity since approval 10 years ago in the United States, raising the possibility that ella (ulipristal acetate) might become ubiquitous in American women's medicine cabinets.

Welcome To Arizona (cartoon)

 

Sunday Afternoon Relaxation

New Law Requires Women To Name Baby, Paint Nursery Before Getting Abortion

Abortion Fight Moves To The States

Wall St Journal:

Less than three weeks after the passage of the landmark national health-care bill, the abortion debate is being reignited: Lawmakers in least six states are pushing for legislation to block abortion coverage in some health plans.

After rancorous clashes over abortion coverage in the national bill, opponents were assured that federal funds wouldn't subsidize coverage of the procedure.

The final legislation requires insurers that sell plans in new government-run exchanges to segregate payments for abortion coverage from other premiums to ensure government subsidies won't go toward the procedure.

Still, many abortion opponents say that didn't go far enough.

So lawmakers are turning to another provision in the legislation that says states can choose to prevent plans offered through their exchanges from covering abortion altogether. That would likely affect most individual and small-group plans in a state, starting when the exchanges launch in 2014.

The new state-level proposals are likely to rekindle abortion as a political issue in November elections. Many state candidates, particularly those running for governor and state legislature, may be forced to take a position on abortion coverage, said John C. Green, director of the Ray C. Bliss Institute of Applied Politics at the University of Akron. "Once an issue like this starts being debated in a state, everyone could become involved," said Mr. Green, who studies how religion affects elections.

The debate could spill over to congressional races as well. But these are expected to largely turn on bigger-picture issues like the economy and the role of government, said Charlie Cook, who edits the Cook Political Report.

Since the beginning of this year, lawmakers in five states including Tennessee and Oklahoma have introduced bills that would generally block abortion coverage in exchange plans, according to the Guttmacher Institute, a research group that supports abortion rights.

In Mississippi, state Sen. Alan Nunnelee, who is a Republican candidate for Congress, plans to introduce a similar bill this month. The federal language in the health bill, Mr. Nunnelee said, is "absolutely not" enough to ensure that government funds don't support abortion. Mr. Nunnelee is in a competitive congressional race this fall, according to the Cook Political Report.

Missouri state Sen. Scott Rupp, a Republican, is also backing such a bill. The state law already says that private plans generally won't cover abortion, except through special riders, but "we had to move over the ban to the exchanges," he says.

At least one state, Kansas, has seen a bill introduced this year that would prohibit insurance plans generally—not just in an exchange—from covering abortion, with certain exceptions. Five states, including Missouri, have similar laws, which don't affect large self-funded employer plans that aren't overseen by state regulators.

Lawmakers in at least three other states have introduced bills to ban abortion coverage in plans for state employees. Twelve states currently have such laws, according to Guttmacher.

Why The Health Reform Law Is Here To Stay. Hear That Supreme Court?

Jeffrey Tobin:

I will leave the waxing eloquent on this historic day to my colleagues. I have three brief observations about the legal implications of the passage of health-care reform.

1. Abortion. The negotiations between Congressman Bart Stupak and the White House over the executive order on abortion funding may rank among the most consequential inconsequential disputes in American history. It was important because it now seems likely that health care reform would have failed if Stupak and his allies had not voted for it. But the executive order itself is nearly meaningless as a legal and practical matter. Federal funding of abortion has been illegal under the Hyde Amendment for almost two generations. The health-care reform bill did nothing to disturb that status quo. Anti-abortion forces mobilized against the legislation but without ever establishing that it would affect abortion at all. In short, nothing happened on abortion—and, apparently, that made all the difference.

2. Constitutionality. Various states have threatened to go to court to assert that Congress acted outside its authority in passing the health-care reform bill. Even with a conservative Supreme Court, these challenges seem bound to fail. For decades, the Court has upheld the extensive federal role in health care through such programs as Medicare and Medicaid. This new law is a change in degree, not in kind, and courts will likely stay out of the way.

However, it’s also worth noting that the courts, including the Supreme Court, will be interpreting the new health-care-reform law for many years to come. Any new law raises a multitude of questions for interpretation, and this one will raise many. What’s covered? Who pays? How does the transition to the new system work? ...

3. The future. Liberals in particular have noted with frustration that the Senate has become a tremendous roadblock to legislative progress. Now that filibusters are routine on almost all Senate business, it takes sixty votes to do almost anything. That sclerotic process may look pretty good to liberals now, because it means that this piece of legislation is almost repeal-proof. It would take sixty-plus Republicans and a Republican President to get the job done (or undone). That’s not happening soon (or maybe ever). This law may turn out to be popular or detested, prescient or misguided—but it is here to stay.

Stupak Passionately Defends Health Bill

His passionate, partisan, Pro-Life defense really surprised me.

Will An Executive Order Be Enough For Enough Of The House's Pro-Life Dems?

Wash Post:

House Democrats are working with the White House to craft an executive order that would clarify President Obama's intention to maintain a long-standing ban on federal funding of abortion, congressional Democrats said.

The effort was part of a hurried campaign by House leaders on Saturday to persuade a pivotal bloc of antiabortion Democrats to support far-reaching health insurance reforms.

House Speaker Nancy Pelosi (D-Calif.) and others huddled in a suite of offices just off the House floor, trying to come up with language that would satisfy six to 10 lawmakers, mostly Rust Belt Catholics, who voted for an earlier version of the health-care package but have threatened to vote against the $940 billion compromise expected to come before the House on Sunday. Those lawmakers have argued that the measure would open the door to federal funding for elective abortions. Democratic leaders counter that the measure would do no such thing.

"The intent is obviously to express what we said all along: that we believe the language that has been included in both bills seeks to accomplish . . . that there will be no use of public funds for abortion," House Majority Leader Steny Hoyer (D-Md.) said upon emerging from the meeting. Asked whether the document could win over a significant number of the holdouts, Hoyer said: "I'm hopeful." ...

Earlier Saturday, Pelosi confirmed that an executive order on abortion "might be a possibility."

Those close to the talks said it is likely at the very least to restate Obama's commitment to upholding the Hyde Amendment, a 32-year-old provision that bars the use of public funds for abortion except in cases of rape, incest or to save the life of the woman. Rep. Dianna DeGette (Colo.), a leader among Democrats who support abortion rights, said she would support that option, so long as Stupak's provision is not given another vote. "That would be fine by me," she told reporters Saturday of the executive order.

Stupak's office issued a statement declaring he would like the talks to continue: "Congressman Stupak remains open to working with Speaker Pelosi and the President to reach an agreement that would maintain current law which prohibits federal funding of abortions and health plans that cover abortion."

Pelosi remained determined to ensure that, by the time the vote is held Sunday, she would prevail. "We'll have the votes when we bring the bill to the floor," she said.

The Health Care Bills Side by Side

Want to really understand the differences between the Dec 24, 2009 Senate bill and the changes the House is making to it (eg, the Mar 18, 2010 Reconciliation bill)? ProPublica makes it easy.

Rift Between Catholics Who Favor Bill (Nuns) & Those Who Oppose (Bishops) Widens

NY Times:

In breaking publicly with Roman Catholic bishops over the health care bill, a group of nuns has once again exposed the long-running rift between liberal and conservative theology in the Catholic Church.

The issue dividing them is whether the Senate version of the legislation goes far enough in limiting the use of federal subsidies paid for insurance policies that cover abortion. Progressive Catholics, including the group of more than 50 nuns representing thousands more from various religious orders, said this week that they would support the Senate bill. The traditionalists, like the United States Conference of Catholic Bishops, said they would oppose it.

Although both the nuns and the bishops firmly oppose abortion, they have reached different conclusions about the bill, a divide that is also playing out more broadly among other groups that oppose abortion.

These include Democrats in the Senate like Bob Casey of Pennsylvania who are comfortable with the restrictions in the Senate health care bill and Democrats in the House like Bart Stupak of Michigan who are fighting for tighter restrictions. That divide is proving central to the outcome of the health care debate — Mr. Stupak and his allies were continuing to fight Friday night — as Democratic leaders scrambled to come up with the votes to pass the legislation.

“It is an utter mystery to me” how religious groups that oppose abortion could read the same bill so differently, said Sister Simone Campbell, the executive director of Network, a Catholic social justice lobbying organization that supports the bill.

Sister Simone, who described herself as anti-abortion, said she did not believe that the Senate version of the bill would make abortion more widely available. She did not directly criticize the bishops, but said “some people could be motivated by a political loyalty that’s outside of caring for the people who live at the margins of health care in society.”

The Senate bill allows any state to ban the use of federal subsidies to buy insurance plans that cover abortion. In other states, insurers would be required to place subsidy money in separate accounts from dollars for private premiums and use only the private money to pay for abortions.

The bishops argue that the Senate legislation, which the House is expected to adopt, could nonetheless result in federal money being used for abortions.

“In so doing, it forces all of us to become involved in an act that profoundly violates the conscience of many, the deliberate destruction of unwanted members of the human family still waiting to be born,” said Cardinal Francis George, the president of the United States Conference of Catholic Bishops, in a written statement this week.

The nuns who have endorsed the health care bill and their supporters say that is not so, suggesting that they see no need for the more restrictive language on abortion in the bill passed by the House last year.

“The bishops’ view is extremely purist,” said Morna Murray, president of Catholics in Alliance for the Common Good. “They are among the only ones who have read the language in this way.”

More Catholic Organizations Announce Support For Health Care Bill

First from Prescriptions:

According to the National Catholic Reporter, Catholics in Alliance for the Common Good, a Washington-based advocacy group, sent a letter to members of Congress on Friday urging support for the Senate-passed health care bill and expressing its view that the bill contains sufficient provisions to prevent the use of federal money to pay for insurance coverage of abortions.

Then the Wash Post:

A group representing Catholic hospitals Saturday rallied behind President Barack Obama's health care bill ahead of a House vote in which anti-abortion lawmakers could play a decisive role.

The chief executive of the Catholic Health Association, Carol Keehan, wrote on the group's Web site that although the legislation isn't perfect, it represents a "major first step" toward covering all Americans and would make "great improvements" for millions of people. The more than 600 Catholic hospitals across the country do not provide abortions as a matter of conscience.

The association's support widens a split among abortion foes on whether the bill goes far enough to prevent taxpayer funding for the procedure. House Democratic leaders are trying to turn that debate to their advantage as they press for a vote on Obama's bill as early as this coming week. Winning over even a handful of anti-abortion Democrats could help Speaker Nancy Pelosi, D-Calif., find a clear path to the 216 votes she needs for passage.

Major anti-abortion groups, including the U.S. Conference of Catholic Bishops and the National Right to Life Committee, are adamantly opposed to the legislation, preferring stricter restrictions passed last November by the House.

Keehan said in an interview that she believes the approach now in the bill would work just as well to keep federal dollars from being used to pay for abortion.

"On the moral issue of abortion, there is no disagreement," Keehan said. "On the technical issue of whether this bill prevents federal funding of abortions, we differ with Right to Life."

The current legislation would allow private insurance plans operating in a new insurance marketplace to cover abortions, provided they do not use taxpayer funds. What makes that tricky is that many of the plans' customers would be receiving federal subsidies to help pay their premiums. So the legislation requires plans offering abortion coverage to collect a separate premium from their policyholders. Those separate checks would have to be kept in a different account from money for other health care services.

Rachel Maddow Destroys Stupak's Fungible Money Agrument

"Stupak's abortion argument: Still more about class than choice"

Ezra Klein:

Matt Miller hits on one of the most important points in the abortion and health-care debate. The practical effect of Bart Stupak's position is not that the federal government will not subsidize abortion by subsidizing health-care insurance. It is that it will not subsidize abortion by subsidizing health-care insurance for poor women. We already spend much more subsidizing coverage that includes abortion for richer women:

This entire debate is ridiculous, because the feds already subsidize abortions massively, via the giant tax subsidy for employer-provided care. Today the feds devote at least $250 billion a year to subsidizing employer-based coverage, a subsidy that skews incentives horribly (but which big business and big labor wouldn’t let the politicians touch this year). A Guttmacher Institute study says that 87 percent of typical employer plans cover abortion, and a Kaiser study found that 46 percent of covered workers had abortion coverage.

As I've written before, the Stupak amendment is as much about class as it is about choice. Imagine if Stupak attempted to expand his campaign to the coverage employed women receive. It would, after all, be the same principle: Federal policy should not subsidize insurance that offers abortion coverage. But it wouldn't have a chance. That group is too large and too affluent and too politically powerful for Congress to dare to touch its access to reproductive services. But the poorer women who will be using subsidies on the exchange are a much easier target.

Change Comes To Federal Health Care: Pentagon To Offer Plan B, Morning After Pill

Wash Post:

The Department of Defense will begin making the morning-after pill Plan B available at all of its hospitals and health clinics around the world, officials announced Thursday.

The decision came after a recommendation by the Pentagon's Pharmacy and Therapeutics Committee, an advisory panel that voted in November to include Plan B and the generic Next Choice on the list of drugs all military facilities should stock. The Pentagon accepted the recommendation Feb. 3, a spokeswoman said.

The decision is the latest the Obama administration has made reversing politically sensitive policies involving women's health that were implemented during President George W. Bush's administration. Previously, the Obama administration has announced that it was rescinding a federal regulation that would have expanded the ability of health-care workers to refuse to provide medical care they found morally objectionable, including abortion and Plan B; has lifted federal restrictions on human embryonic stem cell research; and has restored funding to international family-planning groups.

Women's health advocates had long been pushing the Obama administration to allow the sale of the morning-after pill at military facilities. The same panel made a similar recommendation in 2002, but the policy was never implemented.

"It's a tragedy that women in uniform have been denied such basic health care," said Nancy Keenan of NARAL Pro-Choice America, which estimated that the decision would affect more than 350,000 women in the military. "We applaud the medical experts for standing up for military women." ...

While most medical experts consider the drug to be a form of emergency contraception, some abortion opponents consider it equivalent to a surgical abortion.

Factually-Based, Secular Abstinence-Only Curriculum Found To Be Effective

Maybe "Abstinence-only programs work, study says" is changing minds. Mine included. The NY Times:

A study of middle-school students that found for the first time that abstinence-only education helped to delay their sexual initiation is already beginning to shake up the longstanding debate over how best to prevent teenage pregnancy and sexually transmitted diseases.

“This is a rigorous study that means we can now say that it’s possible for an abstinence-only intervention to be effective,” Dr. John B. Jemmott III, the University of Pennsylvania professor who led the study, said Tuesday, hours after results of the study were released. “That’s important, because for some populations, abstinence is the only acceptable message.”..

Dr. Jemmott’s research followed 662 African-American students at urban middle schools, who were paid $20 a session to attend the classes, plus follow-up and evaluation sessions. The abstinence-only classes covered HIV, abstinence and ways to resist the pressure to have sex ...

The research, published in the Archives of Pediatric & Adolescent Medicine, appears just as the Obama administration is eliminating federal financing for abstinence-only programs, and starting a pregnancy-prevention initiative that will finance programs that have been shown in scientific studies to be effective.

Recognizing the political sensitivity of the research, and how unexpected are its results, the journal ran an accompanying editorial cautioning that public policy should not be based on the results of a single study and that policy makers should not “selectively use scientific literature to formulate a policy that meets preconceived ideologies.”

“The results may be surprising to some in that the theory-based abstinence-only curriculum appeared to be as effective as a combined course and more effective than the safer-sex only curriculum in delaying sexual activity,” the editorial said. “None of the curricula had any effect on the prevalence of unprotected sexual intercourse or consistent condom use.”

The executive director of the National Abstinence Education Association, Valerie Huber, said she hoped that the new study would lead to restored federal support for abstinence programs.

“The current recommendation before Congress in the 2011 budget zeroes out abstinence education, and puts all the money into broader comprehensive education,” Ms. Huber said. “I hope that either the White House amends their request or Congress acts upon this, reinstating abstinence education.”

Ms. Huber also said she found it especially interesting that African-Americans were the focus of Dr. Jemmott’s study since, she said, “our critics would contend that the abstinence message would be least effective with the most at-risk youth.”

Even longtime advocates of comprehensive sex education heralded the findings.

“This new study is game-changing,” said Sarah Brown of the National Campaign to Prevent Teen and Unplanned Pregnancy, in a statement. “For the first time, there is strong evidence that an abstinence-only intervention can help very young teens delay sex and reduce their recent sexual activity as well. Importantly, the study also shows that this particular abstinence-only program did not reduce condom use among the young teens who did have sex.”

Ms. Brown noted that the abstinence-only classes in the Jemmott study centered on people with an average age of 12 and that unlike the federally supported abstinence programs now in use, did not advocate abstinence until marriage.

The classes also did not portray sex negatively or suggest that condoms are ineffective, and contained only medically accurate information. Dr. Jemmott’s abstinence-only course was designed for the research, and is not in current use in schools.

Dr. Tiller's Killer Convicted Of 1st Degree Murder In Only 37 Minuntes

NY Times:

In the end, it took jurors 37 minutes on Friday to convict Scott Roeder, an abortion opponent, of first-degree murder in the death of George R. Tiller, one of the few doctors in the country to perform late-term abortions.

Mr. Roeder, who admitted in court to shooting Dr. Tiller in May and who said he felt it was the only way that he could halt the deaths of babies, stared straight ahead and showed no reaction at the verdict, which carries a sentence of life in prison.

For Wichita, it appeared to be a final chapter in the struggle over abortion that has focused on this city for three decades. Dr. Tiller, 67, who grew up here and had provided abortions here since the 1970s, had been attacked before (he was shot in both arms in 1993) but refused to stop his work and drew patients from all over the country. After his murder, his family closed the abortion clinic, leaving Wichita, so long a magnet for the debate, with no such facility.

But elsewhere around the country, the debate over abortion continued.

Nationally, abortion-rights supporters lauded Mr. Roeder’s conviction, saying it sent a powerful, unambiguous message to those who commit violence against abortion providers. But the trial, they said, also pointed up an urgent need for more law enforcement and further investigation into those who conspire to such violence. The federal Department of Justice has said it is investigating whether others were also involved in the killing of Dr. Tiller ...

The case divided abortion opponents. Leaders of the best-known national groups had denounced Mr. Roeder’s acts. But some others who say they believe the killing of an abortion provider can be justified had portrayed the trial as unfair, and said they were disappointed by the outcome. They also asserted that the result might breed more violence.

“People had said if he were acquitted it would be open season on doctors,” said Michael Bray, who served time in prison for a conspiracy involving abortion clinic bombings in the 1980s and who also attended Mr. Roeder’s trial. “But if you want to see what’s going to stimulate people to do something, you’re inviting more of the same by not giving him a fair trial.”

Serving as the only witness in his own defense, Mr. Roeder, 51, of Kansas City, Mo., took a highly unusual step on Thursday: he admitted to jurors that he had planned for many years to kill Dr. Tiller, that he had gone to the doctor’s church carrying a gun several times until he ultimately succeeded.

Dr Tiller Murderer Admits He's A Murderer On The Stand

NY Times:

Scott Roeder, the man charged with murder in the shooting of George R. Tiller, one of the few doctors in the country to perform late-term abortions, took the witness stand in his own defense on Thursday, and said that, yes, he did it.

Yes, he bought a gun. Yes, he took target practice. Yes, he had learned about Dr. Tiller’s habits, his home address, his security precautions. And, yes, he shot Dr. Tiller last May 31 as Dr. Tiller stood inside his church.

“That is correct, yes,” Mr. Roeder told the jurors, in a calm, matter-of-fact voice.

But there was a twist.

Lawyers for Mr. Roeder, who provided the only testimony for the defense in a trial that has spanned several weeks, are hoping that jurors will consider Mr. Roeder’s motive: his growing opposition to abortion, which he deemed criminal and immoral, and his mounting sense that laws and prosecutors and other abortion opponents were never going to stop Dr. Tiller from performing them.

“I did what I thought was needed to be done to protect the children. I shot him,” he testified, adding at another point, “If I didn’t do it, the babies were going to die the next day.”

Was he remorseful? No, Mr. Roeder said without emotion. After the killing, he said, he felt “a sense of relief.”

And so, in a way, the hearing here, watched intensely by all sides of the abortion debate, turned into precisely what the presiding judge had said all along that it ought not to be — a trial over abortion. Judge Warren Wilbert has wrestled with requests from the prosecution and the defense over how to permit Mr. Roeder to mount a murder defense without allowing him to turn the case into a public forum on abortion.

But even with his pointed testimony, based on a ruling late Thursday by Judge Wilbert, Mr. Roeder continues to face a difficult legal hurdle in beating back a charge of first-degree murder.

Judge Wilbert ruled that he would not instruct the jury to consider a lesser charge when they begin deliberations on Friday. Mr. Roeder has pleaded not guilty to murder, but defense lawyers had argued that his beliefs about abortion might warrant a voluntary manslaughter conviction if jurors concluded that Mr. Roeder possessed, as Kansas law defines it, “an unreasonable but honest belief that circumstances existed that justified deadly force.”

Seated on the witness stand, facing a tiny courtroom gallery that included Dr. Tiller’s widow, Jeanne, abortion opponents from other parts of the country, and national abortion rights supporters, Mr. Roeder seemed quiet, almost lawyerly, in his responses to inquiries about the killing, in which Dr. Tiller was shot in the forehead, the gun pressed to his skin ...

Mr. Roeder acknowledged under cross-examination that he had, as early as 1993, thought about killing Dr. Tiller. A year before the shooting, he said, he had gone to Dr. Tiller’s church with a gun intending to shoot him. (Dr. Tiller was not there that day, he said.) And he said he considered other alternatives: cutting off Dr. Tiller’s hands with a sword, shooting him from a distance with a rifle, or finding him at his house.

Of his decision to go to the church, he said, “It was the only window of opportunity I saw that he could be stopped.”

Abortion opponents here, including some who have served time in jail for abortion clinic violence, praised Mr. Roeder for his testimony. But some complained bitterly that Judge Wilbert had severely limited the defense by barring the testimony of Phill Kline, a former Kansas attorney general who had unsuccessfully pursued criminal investigations against Dr. Tiller and by preventing jurors from considering some conviction short of murder.

Abortion rights supporters, meanwhile, called Mr. Roeder’s statements deeply chilling, and said they mandated nothing short than a first-degree murder conviction, which could carry a life sentence. “It should send a message that there is no justification for this,” said Vicki Saporta, the president of the National Abortion Federation, who sat in the court.

Do You Celebrate Conception Day?

 

Dr. Tiller Murder Trial Begins As ... A Murder Trial

NY Times:

Jurors in the trial of an abortion opponent accused of murdering Dr. George R. Tiller, one of the nation’s only late-term abortion providers, never heard the word “abortion” on Friday as a prosecutor here laid out her case in an opening statement.

Instead, Nola Foulston, the district attorney, began building a methodical case of times and names and forensic tests that might have been presented at any murder trial — a frantic 911 call, a witness’s swift noting of a getaway car license plate, blood splatters on the defendant’s black sneakers.

Still, though Judge Warren Wilbert of Sedgwick County District Court has said he will not allow the trial to be turned into a debate over abortion, the issue seemed unavoidable — unspoken, but always looming. Those on both sides of the question are watching tensely to see how much it will ultimately play into the jurors’ thoughts.

The defendant, Scott Roeder, of Kansas City, Mo., has pleaded not guilty, but the defense he intends to present to jurors was not revealed on Friday, the first day of testimony in his trial. His public defenders chose not to offer an opening statement until after the prosecution presents its case, which is expected to take a week or more.

Before the trial, Mr. Roeder publicly admitted to shooting Dr. Tiller inside the doctor’s church last May, and sought to be allowed to tell jurors that he had done so to save unborn babies. Judge Wilbert ruled that Mr. Roeder could not present such a “necessity defense.”

But the judge left open the possibility that Mr. Roeder might be allowed to present evidence that could support a conviction short of premeditated murder, like voluntary manslaughter, a notion that has outraged some abortion rights groups.

President Obama Interrupted By Anti-Choice Heckler At Coakley Event

Sunday Afternoon Relaxation: New Law Requires Women To Name Baby, Paint Nursery Before Getting Abortion

In the spirit of all of the other postings today, this S.A.R. is a bit more of a political warning of what could come to be, than the typical humorous fluff:

Murderer Of Abortion Doctor Can Argue On A Case-by-Case Basis That He Was Trying To Save Lives

NY Times:

It remained uncertain on Tuesday whether an abortion opponent accused of murdering a nationally known abortion provider would be permitted to argue that the shooting fell short of first-degree murder because he was trying to save lives.

In a hearing here, Judge Warren Wilbert of Sedgwick County District Court refused a prosecution request to bar the defendant, Scott Roeder, from presenting evidence that might support a voluntary manslaughter conviction. But the judge did not promise to allow such evidence, stating instead that he would make such decisions on a “witness by witness” basis as the trial, set to begin on Wednesday, goes along.

Under state law, “an unreasonable but honest belief that circumstances existed that justified deadly force” can constitute voluntary manslaughter.

The question has drawn intense attention from advocates on each side of the abortion debate. Abortion rights advocates say allowing such a defense, which could lead to a sentence far short of the life prison term that first-degree murder can carry, could jeopardize the safety of abortion providers everywhere.

A contingent of abortion opponents who contend that violence can be justified if it stops abortions says the case could mark a shift in the way the public thinks about abortion if Mr. Roeder is allowed to present such a defense.

Mr. Roeder has admitted in court documents to shooting Dr. George R. Tiller, who performed abortions as late as the third trimester of pregnancy, as Dr. Tiller served as an usher at a Sunday service in his church last May.

Jury selection, which was delayed Monday for debate on the manslaughter issue, is to begin Wednesday. In an unusual move, the judge has closed it to the public, saying the presence of others might have a chilling effect on potential jurors as they are asked about religion, abortion and Dr. Tiller. News organizations have challenged the closing, and the state’s Supreme Court was meeting on the matter late Tuesday.

Nuns & Catholic Hospitals Approve Senate Bill. Cover For Pro-Life Dems?

NY Times:

In an apparent split with Roman Catholic bishops over the abortion-financing provisions of the proposed health care overhaul, the nation’s Catholic hospitals have signaled that they back the Senate’s compromise on the issue, raising hopes of breaking an impasse in Congress and stirring controversy within the church.

The Senate bill, approved Thursday morning, allows any state to bar the use of federal subsidies for insurance plans that cover abortion and requires insurers in other states to divide subsidy money into separate accounts so that only dollars from private premiums would be used to pay for abortions.

Just days before the bill passed, the Catholic Health Association, which represents hundreds of Catholic hospitals across the country, said in a statement that it was “encouraged” and “increasingly confident” that such a compromise “can achieve the objective of no federal funding for abortion.” An umbrella group for nuns followed its lead.

The same day, the United States Conference of Catholic Bishops called the proposed compromise “morally unacceptable.”

The divide frames one of the most contentious issues facing House and Senate negotiators as they try to produce a bill that can pass in both chambers.

For months, the bishops have driven a lobbying campaign to bar anyone who receives insurance subsidies under the proposed overhaul from using them to buy coverage that included abortion. Citing the bishops, a group of House Democrats forced their liberal party leaders to adopt such a provision and threatened to block any final legislation that fell short of it. Abortion rights supporters, in response, have vowed to block any bill that includes such a measure.

Officials of the Catholic hospitals’ group and the nuns’ Leadership Conference of Women Religious declined to comment.

Catholic scholars say their statement reflects a different application of church teachings against “cooperation with evil,” a calculus that the legislation offers a way to extend health insurance to millions of Americans. For the Catholic hospitals, that it is both a moral and financial imperative, since like other hospitals they stand to gain from reducing the number of uninsured patients.

And in practical political terms, some Democrats — including some opponents of abortion rights — say that the Catholic hospitals’ relative openness to a compromise could play a pivotal role by providing political cover for Democrats who oppose abortion to support the health bill. Democrats and liberal groups quickly disseminated the association’s endorsement along with others from the nuns’ group, other Catholics and evangelicals.

“I think it is a sign that progress is being made, that we are getting there,” said Representative Steve Driehaus of Ohio, one of the Democrats who forced the House to adopt the stricter restrictions in its bill. The hospitals’ statement, he said, recognized the Senate’s compromise as a meaningful step, making him “optimistic” that Democrats could find a bill that he and other abortion foes could support.

Other abortion opponents argue that liberals are overstating the hospital association’s influence. “They don’t carry the same sway,” said Representative Bart Stupak, the Michigan Democrat who led the effort that resulted in the House bill’s including a full ban on abortion coverage in any subsidized health insurance plan.

Mr. Stupak said he still had commitments from at least 10 Democrats who voted for the House bill and pledged to vote against the final legislation if it loosened the abortion restrictions — enough to keep the bill from being approved. “At the end of the day we are going to have something along the lines of my language,” he said. Abortion rights supporters said the signs of openness from Catholic groups were helping some Democratic abortion foes accept the Senate compromise.

Comparsion Of The Senate & House Health Bills

Click this interactive graphic to learn more:

 

Negotiating For Abortion Compromise, Pro-Choice Dems Wouldn't Sit In Same Room As Nelson

From the Wash Post, a  fascinating, blow-by-blow account of the negotiations that led to Neslon signing onto the Senate bill:

The Democrats wouldn't even sit in the same room.

At one end of the majority leader's office, Ben Nelson (D-Neb.), the antiabortion senator whose support was crucial to health-care legislation, huddled with White House staff in a conference room. At the other end, Sens. Barbara Boxer (D-Calif.) and Patty Murray (D-Wash.), the chamber's leading advocates of abortion rights, hunkered as far from Nelson as possible, in the office of Reid's chief of staff.

Shuttling between the two parties Friday afternoon and evening were Majority Leader Harry M. Reid (D-Nev.) and Sen. Charles E. Schumer (D-N.Y.). Desperately trying to find a compromise, Schumer put his head in his hands early Friday afternoon. "What are we going to do?" he asked Reid.

But by 10:30 p.m. Friday, a handshake deal sealed a hard-won compromise over abortion. Within minutes senators were on the phone with Obama, who was flying aboard Air Force One, having just forged his compromise with world leaders on global warming, according to senators and aides who participated in the negotiations. "We did it, Mr. President," Reid told Obama.

The deal faced an immediate assault from both ends of the abortion spectrum Saturday morning. The National Organization of Women dubbed it "cruelly over-compromised legislation" and the antiabortion Family Research Council dismissed it as a "phony compromise."

Under the new abortion provisions, states can opt out of allowing plans to cover abortion in the insurance exchanges the bill would set up. The exchanges are designed to serve individuals who lack coverage through their jobs, with most receiving federal subsidies to buy insurance. Enrollees in plans that cover abortion procedures would pay with separate checks -- one for abortion, one for any other health-care services.

This was an effort to comport with the 32-year prohibition against federal funding for abortions, but the Nelson compromise is a softening of the House language, which was written by Rep. Bart Stupak (D-Mich.). The Stupak amendment forbid any insurer in the exchange "to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion" -- a position that abortion rights advocates suggested would have led to many insurance providers dropping abortion coverage ...

Schumer, who spent more than 13 hours in Reid's office Friday, said the Medicaid issue was settled around lunchtime, and the final eight hours of the talks focused on the abortion language. Boxer estimated she spent seven hours in Reid's offices -- without ever once sitting in the same room, even though they were all of 25 steps apart.

Will Maine's Senators Step Up & Prevent Expanded Abortion Restrictions?

Though Senator Nelson Seems To Be The Lone Democratic Holdout, Joe Klein thinks Nelson will have to be worked around:

Amy's post on Ben Nelson's unwillingness to compromise on abortion reminds us of a central fact: while the left blogosphere and interest groups like the Dean Family Fundraisers have been behaving foolishly these past few days, not a single liberal Senator--with the possible exception of the Senator from Blagojevich, Roland Burris--has tried to scuttle this bill.

Meanwhile immoderate "moderates" like Nelson and Lieberman have been holding their votes hostage for reasons of extreme ideology, personal pique and showboat narcissism. If Ben Nelson scuttles this bill merely because he wants more extreme anti-abortion language than currently exists--the Hyde Amendment forbids the use of federal funds for abortions, which is more than enough, thank you--then his "pro-life" position somehow neglects the millions of people, already born, whose lives are in danger because they have no access to preventative and chronic care.

Paging the women from Maine.

Abortion Restrictions NOT Added To Senate Bill

Prescriptions:

The Senate on Tuesday voted against adding tougher abortion insurance restrictions to the health care bill. The vote rejected an amendment proposed by Senator Ben Nelson, Democrat of Nebraska, that would have barred any health plan purchased even partly with new federal subsidies from covering the procedure.

Abortion rights advocates said that Mr. Nelson’s proposed language, which would mirror restrictions included in the health care bill approved last month by the House, posed one of the greatest threats to women’s freedoms since Roe v. Wade, the landmark Supreme Court decision that established a right to abortion.

The vote was 54 to 45, with two Republicans, Senators Susan Collins and Olympia J. Snowe of Maine, joining 50 Democrats and two independents to defeat the Nelson proposal. Seven Democrats and 38 Republicans voted in favor of the proposal.

The defeat of the amendment was quickly hailed by the women senators who championed the battle against it, Senators Barbara Boxer of California and Barbara A. Mikulski of Maryland.

But it raised yet another question about the prospects of the larger health care legislation by casting further doubt on Mr. Nelson’s willingness to support the bill.

To wrap up debate and move to a final vote, the majority leader, Harry Reid of Nevada, will need the unanimous backing of all 60 members of his caucus, including Mr. Nelson. Or he will need to win over enough Republicans to make up for any defections.

So far, no Republican has expressed a willingness to support the broader bill, but the two senators from Maine, particularly Ms. Snowe, are being courted aggressively by both Mr. Reid and the Obama White House.

The vote also put the Senate’s language on insurance coverage for abortions at odds with the House, which approved tougher restrictions in an amendment that helped secure the votes needed for final approval of the bill.

That House amendment, sponsored by Representative Bart Stupak, Democrat of Michigan, was virtually identical to the Nelson amendment ...

The language that remains in the Senate bill would allow private plans to cover abortions. It would require at least one government-approved plan in each state to cover abortions and at least one government-approved plan in each state not to cover abortions.

Federal dollars could not be used to pay for abortions, so the Senate bill would require insurance plans to segregate privately paid premiums to use that money for abortions. Opponents of abortion rights have described the segregation of funds as a meaningless accounting trick ...

The defeat of Mr. Nelson’s amendment created an odd circumstance in which the normally more liberal House now has language in its bill that is more conservative than that of the normally more conservative Senate.

The House speaker, Nancy Pelosi, herself a staunch defender of abortion rights, had tried desperately to strike a deal on abortion language in the days leading up to the vote on the health care bill. She nearly succeeded. Mr. Stupak and other opponents of abortion rights were willing to accept a compromise, but defenders of abortion rights – including some of Ms. Pelosi’s own closest allies in the House – balked. After the compromise fell apart, the result was even tougher language on restricting insurance coverage of abortions.

In the House Tuesday, Representative Lois Capps, Democrat of California, and the author of an earlier compromise language on insurance coverage of abortions, issued a statement praising the Senate vote.

“This amendment was far too extreme, going well beyond current law to deny private health insurance coverage of abortion services in the U.S.,” Ms. Capps said in the statement. “Its adoption would have mean more women would have their reproductive health choices made by politicians and anti-choice zealots in Washington.”

But even some strong Democratic supporters of the health care legislation said that the current abortion language in the Senate bill posed an obstacle to final passage. Senator Kent Conrad, Democrat of North Dakota, and one of the seven Democrats to vote in favor of the Nelson amendment, said that further compromise would be necessary.

In addition to Mr. Conrad and Mr. Nelson, the other Democrats to vote in favor of the tougher language were Evan Bayh of Indiana, Bob Casey of Pennsylvania, Byron Dorgan of North Dakota, and Mark Pryor of Arkansas.

"The thought that killing Tiller might also succeed in closing another clinic—that’s my main reason for keeping open"

The NY Times on the next brave doctor willing to make himself a target so that woman have the right to choose (previous posts on Dr Tiller here, here, here, here and here):

The national battle over abortion, for decades firmly planted outside the Kansas clinic of Dr. George R. Tiller, has erupted here in suburban Omaha, where a longtime colleague has taken up the cause of late-term abortions.

Since Dr. Tiller was shot to death in May, his colleague, Dr. LeRoy H. Carhart, has hired two people who worked at Dr. Tiller’s clinic and has trained his own staff members in the technical intricacies of performing late-term abortions.

Dr. Carhart has also begun performing some abortions “past 24 weeks,” he said in an interview, and is prepared to perform them still later if they meet legal requirements and if he considers them medically necessary ...

The late-term abortions, coming after the earliest point when a fetus might survive outside the womb, are the most controversial, even among some who favor abortion rights. A few of Dr. Carhart’s employees quit when he told them of his plans to expand the clinic’s work.

Opponents of abortion, who had devoted decades to trying to stop Dr. Tiller’s business with protests and calls for investigations, are now turning their efforts to stopping Dr. Carhart. Troy Newman, the president of Operation Rescue, an anti-abortion group, said he had traveled from the group’s headquarters in Wichita, Kan., to Nebraska six times in recent months, portraying this suburb of fewer than 50,000 as a new battlefield in the abortion fight.

“We’re trying to get criminal charges against him, to get his license revoked, and to get legislators there to look at the law,” Mr. Newman said of Dr. Carhart ...

Abortion-rights advocates say the need exists for late-term abortions, in cases of extraordinary genetic defects and other dire health circumstances, and some had worried that only a few physicians would be willing to provide such care after Dr. Tiller’s killing, an act prosecutors say was carried out by an abortion foe.

“He’s standing up, and so are some others,” Vicki Saporta, president of the National Abortion Federation, said of Dr. Carhart.

2nd Senate Amendment Is Likely To Fail: No Stupak Abortion Restrictions

The Hill:

An amendment restricting abortions does not appear to have enough support to be attached to the Senate healthcare bill.

Senate Republican Whip Jon Kyl (Ariz.) said he expected that all but a few Republicans would support the Sen. Ben Nelson’s (D-Neb) amendment, which would restrict access to abortions for women who receive federal subsidies.But the amendment is likely to be subject to the Senate’s 60-vote threshold, and Kyl does not expect 20 votes on the other side to back the controversial change.

“Most Republicans will but I don’t think that will be enough to carry it through, it’s a 60-vote margin,” Kyl told The Hill Thursday afternoon ...

Liberal Democrats were confident the measure, based on an amendment Rep. Bart Stupak (D-Mich.) succeeded in adding to the House bill, would not pass the upper chamber.

“I don’t think Stupak is passing so I’m not worried right now, we’re going to defeat it,” said Sen. Barbara Boxer (D-Calif.), one of the most outspoken Senate advocates for abortion rights. 

Senate Majority Leader Harry Reid (D-Nev.) said earlier in the day that Nelson’s amendment would be one of the next to reach the Senate floor and that his colleague was trying to round up GOP support ...

The defeat of his amendment would be politically significant because Nelson has pledged to vote with Republicans to filibuster the health bill if it did not include the Stupak language.

The Pro-Choice, Generational Divide

NY Times:

Representative Louise M. Slaughter, Democrat of New York. At 80, she is co-chairwoman of the Congressional Pro-Choice Caucus — a member of what Nancy Keenan, president of Naral Pro-Choice America, calls “the menopausal militia.”

The militia was working overtime in Washington last week, plotting strategy for the coming debate over President Obama’s proposed health care overhaul. With the Senate set to take up its measure on Monday, a fight over federal funding for abortion is threatening to thwart the bill — a development that has both galvanized the abortion rights movement and forced its leaders to turn inward, raising questions about how to carry their agenda forward in a complex, 21st-century world.

It has been nearly 37 years since Roe v. Wade, the landmark Supreme Court decision that established a right to abortion, and in that time, an entire generation — including Mr. Obama, who was 11 when Roe was decided — has grown up without memories like those Ms. Slaughter says are “seared into my mind.” The result is a generational divide — not because younger women are any less supportive of abortion rights than their elders, but because their frame of reference is different.

“Here is a generation that has never known a time when abortion has been illegal,” said Anna Greenberg, a Democratic pollster who studies attitudes toward abortion. “For many of them, the daily experience is: It’s legal and if you really need one you can probably figure out how to get one. So when we send out e-mail alerts saying, ‘Oh my God, write to your senator,’ it’s hard for young people to have that same sense of urgency.”

Polls over the last two decades have shown that a clear majority of Americans support the right to abortion, and there’s little evidence of a difference between those over 30 and under 30, but the vocabulary of the debate has shifted with the political culture. Ms. Keenan, who is 57, says women like her, who came of age when abortion was illegal, tend to view it in stark political terms — as a right to be defended, like freedom of speech or freedom of religion. But younger people tend to view abortion as a personal issue, and their interests are different.

The 30- to 40-somethings — “middle-school moms and dads,” Ms. Keenan calls them — are more concerned with educating their children about sex, and generally too busy to be bothered with political causes. The 25-and-under crowd, animated by activism, sees a deeper threat in climate change or banning gay marriage or the Darfur genocide than in any rollback of reproductive rights. Naral is running focus groups with these “millennials” to better learn how they think.

“The language and values, if you are older, is around the right to control your own body, reproductive freedom, sexual liberation as empowerment,” said Ms. Greenberg, the pollster. “That is a baby-boom generation way of thinking. If you look at people under 30, that is not their touchstone, it is not wrapped up around feminism and women’s rights.”

Chris Matthews Corners Catholic Bishop Who Barred Kennedy Communion

Pro-Choice Forces Rev Up Thanks To Stupak

NY Times:

Lobbying over abortion was turning into a sleepy business. But the health care debate has brought a new boom, and both sides are exploiting it with fund-raising appeals ...

Abortion-rights groups got into the act two weeks ago, when the House of Representatives adopted an amendment sponsored by Representative Bart Stupak, Democrat of Michigan, to block the use of federal subsidies for insurance policies that cover abortion. “Stop Abortion Coverage Ban!” declares an online solicitation from Naral Pro-Choice America, warning that “women could lose the right to use their own personal, private funds to purchase an insurance plan with abortion coverage in the new health system.”

“Stop Stupak!” is the headline of a new online petition that doubles as a fund-raiser for Emily’s List, which raises money for female candidates who support abortion rights. The group’s president, Ellen Malcolm, said in an interview that she had not seen such an outpouring of support since Webster vs. Reproductive Health Services, the 1989 Supreme Court decision that appeared to re-open the question of a right to abortion.

“Women are up in arms,” Ms. Malcolm said, adding that her group had made an exception to its no-lobbying policy to pressure the women it helped elect.

This week the Web site of Cosmopolitan magazine carried a “Secrets and Advice” column with the headline “Are Your Rights in Jeopardy?” that directed readers to a similar “Stop Stupak” Web site from the Planned Parenthood Federation of America. A third “Stop Stupak” campaign, by a group called the Progressive Change Campaign Committee, has raised more than $23,000 from more than 700 donors since it started Nov. 11, according to its host, the online fund-raising venture ActBlue.

“We have seen money coming in at every level,” said Ms. Richards of Planned Parenthood, which is also patching calls into lawmakers’ offices in several states. “Congressman Stupak managed to crystallize this movement in a way that is hard to replicate.”

Veteran observers of the abortion fight say that each side feels a real threat from the legislation. “It is not like burning your house down to collect the insurance,” said Rachel Laser, of the moderate Democratic group Third Way.

But the practical stakes for abortion are in some ways quite narrow. No one in the debate proposes adding or removing restrictions on the procedure itself. And leaders of both parties say their goal is to avoid using federal tax money to pay for abortion while subsidizing insurance coverage.

Democratic leaders favor requiring insurance companies to segregate any federal subsidies they receive from private premiums that they could use to cover abortion. Abortion opponents in Congress call that an accounting gimmick and want to prevent women from using the subsidies to buy plans that cover abortion no matter which dollars the insurer uses to pay for it. Women could still use their own money to pay for the procedure. In any case the provisions would directly affect roughly 15 percent of the population [about 8 million women] not currently receiving health coverage from either employers or the government.

Reaction To Harry Reid's Health Bill

Learn about the bill. Here's the Wash Post's report of its backstory and future:

Senate Majority Leader Harry M. Reid presented an $848 billion health-care overhaul package on Wednesday that would extend coverage to 31 million Americans and reform insurance practices while adding an array of tax increases, including a rise in payroll taxes for high earners.

Democratic leaders were jubilant that the nonpartisan Congressional Budget Office determined that the Senate bill would cut federal deficits by $130 billion over the next decade. That projection, released shortly before midnight Wednesday, represents the biggest cost savings of any legislation to come before the House or Senate this year, but the measure's effective date also was pushed back by one year, to 2014. Democrats said the savings could prove more significant in the long run, though the CBO said they "would probably be small," amounting to around 0.25 percent of the overall economy, or no more than $650 billion between 2019 and 2029.

Those projected reductions could prove critical in winning the support of three wavering moderate Democrats whose votes Reid (D-Nev.) must secure to bring the legislation to the floor before the Senate breaks for Thanksgiving. But Reid also stacked the bill with provisions sought by liberals, including a public insurance option, albeit a version with an opt-out clause for states.

The legislation received a positive response from across the Democratic spectrum. "This is the bill that we've been fighting for," said Sen. Sherrod Brown (Ohio), a liberal who pressed Reid to revive the public option. Sen. Kent Conrad (N.D.), the budget chairman and a leading Democratic fiscal hawk, said after a briefing on the bill, "I was very impressed by what Senator Reid has done."

But Republicans dismissed it as "another trillion-dollar experiment," in the words of Senate Minority Leader Mitch McConnell (Ky.). Sen. Judd Gregg (N.H.) said the bill "may claim to be deficit-neutral, [but] it uses sleight-of-hand budgetary tricks by assuming unrealistic tax increases and Medicare cuts that members of Congress will not be willing to follow through on."...

The bill's first test is expected on Friday or Saturday, with a procedural vote required to start debate. Republicans are expected to rally all 40 of their senators to block the legislation from advancing, requiring Reid to keep all 60 members of his Democratic caucus in line.

GOP leaders pledged to use all their parliamentary powers to delay a final vote. "This will not be a short debate," McConnell said.

But Reid said Wednesday night that he was "cautiously optimistic" that he could move the bill to the floor, and one of the three undecided Democrats -- Sen. Ben Nelson (Neb.) -- suggested in a statement that he would support Reid's effort.

"It is a motion to start debate on a bill and to try to improve it," Nelson said of the upcoming vote. "If you don't like the bill, then why would you block your own opportunity to amend it?"

Analysis Of Harry Reid's Merged Health Care Bill

Read the the Senate bill Harry Reid is bringing forward to the Senate. Read the CBO's analysis of it. Read the bill's backstory and prognosis.

The Wash Post compares the Senate & House bills:

and writes about how it handles abortion:

Reid took a different approach [than the House] that may or may not pass muster with abortion opponents, proposing to establish a "firewall" that would segregate private premiums from federal funding if abortion coverage were offered in the public insurance plan.

Few details were available Wednesday, but Sen. Barbara Boxer (D-Calif.), an abortion rights advocate who was working to forge a compromise on the issue, said, "I couldn't be happier. For those who want to keep abortion out of this bill, Senator Reid did it the right way."

The National Right to Life Committee, however, called the firewall "completely unacceptable" and said it utilizes "layers of contrived definitions and hollow bookkeeping requirements" to permit federal funding of abortion.

Then NY Times' discusses the rest of it:

Under Mr. Reid’s bill, the government would establish a new public insurance plan, which would compete with private insurers. States could opt out of the public plan by passing legislation ...

Though broadly similar to the House bill, Mr. Reid’s proposal differs in important ways. It would, for example, increase the Medicare payroll tax on high-income people and impose a new excise tax on high-cost “Cadillac health plans” offered by employers to their employees.

Mr. Reid’s bill would not go as far as the House bill in limiting access to abortion. And while he would require most Americans to obtain health insurance, he would impose less stringent penalties on people who did not comply.

Many provisions of Mr. Reid’s bill, including the creation of insurance markets, or exchanges, would take effect in 2014, a year later than similar provisions of the House bill. The delay is intended primarily to reduce the cost of the legislation.

Both bills would create a voluntary federal program to provide long-term care insurance and cash benefits to people with severe disabilities.

Desperately seeking money to pay for the legislation, Mr. Reid came up with a new source of financing: a 5 percent tax on elective cosmetic medical procedures. The tax would be paid by patients, but collected by doctors and clinics and forwarded to the government.

The tax would be calculated as 5 percent of the amount paid for an elective cosmetic procedure, whether by the patient, insurance or other sources. The tax would not apply to cosmetic surgery for people with congenital abnormalities, disfiguring diseases or traumatic injuries.

The official cost analysis released by the nonpartisan Congressional Budget Office shortly after 11 p.m. showed that Mr. Reid’s bill came in under the $900 billion goal suggested by Mr. Obama. But 24 million people would still be uninsured in 2019, the budget office said. About one-third of them would be illegal immigrants.

The Congressional Budget Office has said the House bill would reduce deficits by $109 billion over 10 years and cover 36 million people, but still leave 18 million uninsured in 2019.

Republicans and some independent budget analysts said, however, that the savings might not be fully achieved because they were based on unrealistic assumptions about a sustained increase in the productivity of health care providers and much slower growth in Medicare spending ...

The proposed tax on “Cadillac health plans” is among the most contentious provisions of the bill.

Poll: The More Americans Know About Health Reform, The More They Support It. And They Don't Like Stupak.

Two particularly interesting findings from this new poll:

• Stupak is unpopular: 56% of Americans favor allowing women in the Public Option to use their own money to pay for their abortions (what a weird sentence to write ... as if other people should have any say in how Americans spend their money)
  
• Knowledge leads to support: Of the people who have a "good, basic understanding" of the changes being proposed, 56% support health reform. Of those who do not, 57% oppose it.
  

The Wash Post (for other results from this poll, see Obama's Favorability "holding steady" & Watch Out Incumbents):

As the Senate prepares to take up legislation aimed at overhauling the nation's health-care system, President Obama and the Democrats are still struggling to win the battle for public opinion. A new Washington Post-ABC News poll shows Americans deeply divided over the proposals under consideration and majorities predicting higher costs ahead.

But Republican opponents have done little better in rallying the public opposition to kill the reform effort. Americans continue to support key elements of the legislation, including a mandate that employers provide health insurance to their workers and access to a government-sponsored insurance plan for those people without insurance.

Over the past few months, public opinion has solidified, leaving Obama and the Democrats with the political challenge of enacting one of the most ambitious pieces of domestic legislation in decades in the face of a nation split over the wisdom of doing so. In the new poll, 48 percent say they support the proposed changes; 49 percent are opposed.

With the bill through the House, Senate Democrats are now looking for the votes to enact their version of the legislation and keep the reform effort moving forward. Whatever the outcome of the health-care debate, it will have a powerful influence in shaping the political climate for next year's midterm elections.

The House bill contains a highly controversial provision prohibiting abortion coverage for those insured under a new public insurance plan as well as those who received federal subsidies to purchase private insurance. In the poll, 61 percent say they support barring coverage for abortions for those receiving public subsidies, but if private funds were used to pay for abortion expenses, the numbers flipped. With segregated private money used to cover abortion procedures, 56 percent say insurance offered to those using government assistance should be able to include such coverage.

The new poll provides ammunition for both advocates and opponents of reform. For opponents, a clear area of public concern centers on cost -- 52 percent say an altered system would probably make their own care more expensive, and 56 percent see the overall cost of health care in the country going up as a result.

Few see clear benefits in exchange for higher expenses. Rather, there has been a small but significant increase in the number (now 37 percent) who anticipate their care deteriorating under a revamped system, putting that number in line with opinion in July 1994, just before President Bill Clinton's health-care reform efforts fizzled.

Among those with insurance, three times as many continue to see worse rather than better coverage options ahead (39 to 13 percent), and fewer than half of those who lack insurance see better options under a changed system. Six in 10 see it as "very" or "somewhat" likely that many private insurers would be forced out of business by a government-sponsored insurance plan, a potential result that GOP leaders frequently warn about.

But reform proponents have other findings to bolster their case. Two-thirds of those surveyed support one of the basic tenets of the reform plan, a new requirement that all employers with payrolls of $500,000 or more provide health insurance coverage for their employees or face fines.

If We Really Had "Pro-Life" Legislators (cartoon)

 

The Stupak Amendment Does Not Preserve The Status Quo. Instead It Violates Abortion Neutrality in Three Significant Ways.

From the Third Way, a group that "develops and advances the next generation of moderate policy ideas":

The Stupak-Pitts Amendment, which was included in the final version of the House bill, is not abortion neutral, and it would disrupt the delicate federal balance already in place. We believe that by upsetting this balance, health care reform is now in jeopardy. Below, we explain the three ways in which the Stupak-Pitts Amendment is not abortion neutral and why the pro-life Ellsworth Amendment represents a far better approach that adheres to common ground.

The Stupak-Pitts Amendment Violates Abortion Neutrality in Three Ways

1. The Stupak-Pitts Amendment changes a decades-long balance of existing federal law on abortion coverage.

The Hyde Amendment, which has been on the books for over 30 years, prevents federal funds from being used to pay for abortion in the Medicaid program, except for cases of life endangerment, rape or incest. The Stupak-Pitts Amendment goes much further, by preventing even private premiums from being used to pay for abortion in the Exchange. The Stupak-Pitts Amendment prohibits health insurance plans in the Exchange that receive any federal funding from covering abortion, even with segregated private funds. Because all Exchange plans will likely receive federal tax dollars through subsidies to individuals, individuals will not be able to purchase health insurance that covers abortion, even with their own premiums. The fact that the millions of Americans participating in the Exchange will not have abortion coverage is also a dramatic change from the status quo, since the majority of Americans with health insurance have plans that include abortion coverage.

The logic of the Stupak-Pitts Amendment also rejects the current noncontroversial scheme whereby year after year, hundreds of billions of dollars are consistently used to subsidize health insurance policies that cover abortion. Until the Stupak-Pitts Amendment emerged, none of this funding was deemed controversial in any way by pro-life stalwarts from President Ronald Reagan to President George W. Bush.

The employer deductibility of health coverage has yielded trillions of dollars in federal tax subsidies for insurance plans, whether or not they covered abortion. Flexible Savings Accounts (which started in 1978 and grew in popularity under President Reagan) allow for individuals to deduct the direct cost of abortions from their taxable income. Health Savings Accounts (which started under President Bush) allow for tax-favored savings to be used to pay for abortions. 

Each of these tax subsidies has, at one time or another, received the support of nearly all members of Congress—whether ardently and unequivocally pro-life or pro-choice. Yet as far as we can tell there has never even been a debate about whether these subsidies could cover plans that offer abortion coverage, even though most do.

2. The Stupak-Pitts Amendment changes longstanding policies regarding the segregation of funds.

Supporters of the Stupak-Pitts Amendment dismiss efforts at finding a compromise on abortion in health care reform through the segregation of funds as an “accounting trick.” Whether or not one believes this argument, supporters of the Stupak-Pitts Amendment must now reconcile this view with longstanding policies that allow the segregation of funds in order to let religious organizations accept federal money.

The reasoning of the Stupak-Pitts Amendment would call into question countless activities by religious organizations that rely on federal funds, including Head Start, homelessness relief, food banks, substance abuse counseling, prison fellowship, afterschool programs for troubled youths, adoption services, ESL programs for immigrants, and veterans’ services.2 Of course, in the context of abortion, the segregation of funds is also accepted in Medicaid, where 17 states supplement the federal program with abortion coverage.

3. The Stupak-Pitts Amendment means no plans in the Exchange would offer abortion coverage.

Even though there is a provision in the Stupak-Pitts Amendment that would allow the purchase of separate supplemental coverage of abortion, it is implausible that insurance companies would offer this coverage. Unintended pregnancies are unplanned by definition, so demand would likely be low. And unlike other medical
procedures, abortions are relatively inexpensive. That is why in the five states where abortion coverage is prohibited except through such “riders,” there are only isolated examples of insurers actually offering such coverage, , and even then only as part of a small group package, rather than to individuals.

Another Pragmatist Argues For Keeping The Abortion Amendment In Perspective

Though I don't think he read my post, Are The New Abortion Restrictions Worth Drawing A Line In The Sand Over?, Jeffrey Rosen seems to agree with me. Do you?

How many women would the Stupak amendment affect? It wouldn’t immediately impinge on the roughly 60 million women ages 18-64 who presently get health insurance through their jobs or their spouses’ jobs rather than Medicare. At least in the short term, nothing would change for these women because they wouldn’t receive any federal funds. But most of them aren’t reimbursed for abortion coverage under the current system. There’s a debate about how many private health care plans cover abortion--estimates have ranged from 46 percent to nearly 87 percent. But, regardless of the number, the Guttmacher Institute found that only 13 percent of all abortions in 2001 were directly billed to private insurance companies. Some women may have filed for reimbursement on their own; others may have been reluctant to file claims because they didn’t want their employers or spouses to know they had abortions; and other women were uninsured. Nevertheless, 74 percent of women who had abortions paid for them out of pocket ...

In short, abortion is one area where the common ground Obama seeks may not exist. In that case, the president may conclude, like Nancy Pelosi, that it’s not worth sacrificing health care reform over an important but ultimately peripheral battle in the culture wars. If giving millions of uninsured women access to life-saving procedures like dialysis and chemotherapy requires making it harder for a much smaller number of self-insured women to get abortion coverage, the pragmatic calculation is understandable. But that doesn’t make it any less frustrating.

Sign the petition Telling Harry Reid To Stop The Abortion Coverage Ban. It has to be signed before noon today.

Today's Health Care Cartoons

Welcome Back, Culture War

Amy Sullivan:

It's like you never left. How heated are emotions are either side of the abortion debate right now? Some pro-choice liberals have begun referring to the Stupak Amendment as the "Coat Hanger Amendment." And Stupak himself has declared that if his language doesn't make it into the Senate version or is altered in conference committee, "There will be hell to pay."

Stupak immediately followed the threat by insisting, "I don't say it as a threat." He continued, however, "but if they double-cross us, there will be 40 people who won't vote with them the next time they need us--and that could be the final version of this bill." Which, of course, seems like the very definition of a threat. It's unclear why altering the language of Stupak's amendment in conference would be double-crossing him--Pelosi agreed to an up-or-down vote on his amendment; she didn't, and couldn't, promise that it would end up in the final version of health reform.

I'm also not sure that Stupak can count on 40 pro-life Democrats to oppose health reform in the final hour. The best estimates from House Whip James Clyburn--which match what I'm hearing from calling around--are that the Stupak amendment moved about ten Democrats who would otherwise have opposed health reform. Given the very small margin of victory, the Democratic leadership needed all ten. But it also looks likely--and I'll have more on this later--that a compromise short of the Stupak amendment would have assuaged almost everyone but Stupak.

It's worth noting as well that at least 40 pro-choice Democrats led by Congresswoman Diana DeGette have vowed to oppose a final version of health reform if it includes the Stupak language. I've talked to a lot of people this week who outright dismiss that possibility because "these are liberals--they want health reform. They won't vote against it." But that's the same thing we heard for months about the Stupak coalition. "They're just making noise. They'll vote for it in the end." And while, yes, some of those pro-life Democrats were also conservatives who opposed health reform--and voted against it anyway--on other grounds, many were Catholics who want health reform for social justice reasons.

Bottom line: this fight isn't going away. Polls may show that voters care far more about the economy and other matters than social issues right now. But in Congress, decades of old wounds over abortion fights have been reopened.

Clyburn: Stupak Amendment Netted About 10, Not 40, Votes

Tell Harry Reid To Stop Abortion Coverage Ban. Sign Petition Before 11/13.

An email from NARAL Pro-Choice America President Nancy Keenan urging everyone to sign before 12:00 on Nov 13th:

Anti-choice politics shouldn’t trump women’s health in Congress. It’s unacceptable.

Yet that’s what happened when the House passed the last-minute anti-choice Stupak-Pitts amendment to its health-reform bill.

We cannot let this attack stand in the Senate.

We need to deliver our petitions to Majority Leader Reid by the end of the week before the bill is brought to the floor, so add your name by 12 noon (EST) on Friday, November 13.

I can’t stress this strongly enough: we must win in the Senate to keep millions of women from losing their private insurance coverage for abortion in the new health-care system.

A vote to ban insurance coverage for abortion in the new system will come down to the wire, so we must call on Majority Leader Reid to stand strong against this attack from the outset.

We need to deliver our petitions to Majority Leader Reid by the end of the week before the bill is brought to the floor, so add your name by 12 noon (EST) on Friday, November 13.

Here is what will happen if the Senate adopts the same Stupak-Pitts amendment that passed in the House bill:

• It will be virtually impossible for private insurance companies that participate in the new system to offer abortion coverage to women.
• This would have the effect of denying women the right to use their own personal, private funds to purchase an insurance plan with abortion coverage in the new health system — a radical departure from the status quo. Presently, more than 85 percent of private insurance plans cover abortion services.

We must win in the Senate. That’s why we need to fight back today.

Stand up for women’s access to abortion and sign our petition to Majority Leader Reid.

Thank you for standing with us during this fight.

Obama Comes Out Against Expansive Abortion Amendment

If the MSM's narrative about the abortion amendment is that it preserves the status quo and simply continues the Federal ban on abortion funding, we're going to lose. If on the other hand, it becomes the amendment changes the status quo by adding new restrictions that take away middle class women's right to use their own money as they see fit, then it's going down. That's why President Obama's interpretation yesterday could be crucial. The NY Times:

President Obama suggested Monday that he was not comfortable with abortion restrictions inserted into the House version of major health care legislation, and he prodded Congress to revise them.

“There needs to be some more work before we get to the point where we’re not changing the status quo” on abortion, Mr. Obama said in an interview with ABC News. “And that’s the goal.”

On the one hand, Mr. Obama said, “we’re not looking to change what is the principle that has been in place for a very long time, which is federal dollars are not used to subsidize abortions.”

On the other hand, he said, he wanted to make sure “we’re not restricting women’s insurance choices,” because he had promised that “if you’re happy and satisfied with the insurance that you have, it’s not going to change.”

Before passing its health bill on Saturday, the House adopted an amendment that would block the use of federal money for “any health plan that includes coverage of abortion,” except in the case of rape or incest or if the life of a pregnant woman is in danger.

Some private insurance now covers abortion. Under the bill, most private insurers would receive federal subsidies on behalf of low- and middle-income people.

The Senate is working on its own version of health legislation ... The House and Senate bills differ in at least five ways: how to configure a new government insurance plan; whether to require employers to provide coverage to employees; whether to finance the legislation with a tax on high-income people or a tax on high-cost insurance plans; how strictly to limit coverage of abortion; and whether illegal immigrants should have access to new insurance marts, or exchanges.

The House bill imposes more stringent restrictions on the coverage of abortion.

Ms. Collins said the Senate Finance Committee “did a good job of putting up a firewall that would prevent federal funds from being used to finance abortions.” But she added, “If Congress makes the mistake of establishing a new government-owned insurance company, it would need to extend the prohibition to that company because it is using federal funds.”

Are The New Abortion Restrictions Worth Drawing A Line In The Sand Over?

The House bills denial of insurance coverage for abortion to poor & middle class women using the new Health Care Exchange, even for those who use their own money (Sophie Made Her Choice: Pro-Choice Dems Vote For The Bill), is surely going to be a hot issue as the Nation's focus shifts to the Senate, and later, Conference Committee. One startling thing to keep in mind, however, is that the House wasn't really as discriminatory as it might appear on the surface because, as it turns out, very few women of any economic level have their abortions paid for by insurance today.

According to the NY Times:

• only about half of those who receive insurance coverage from their employers have coverage of abortion,
• the federal employees’ health insurance plan and most state Medicaid programs ban coverage of abortion and
• 5 states—Idaho, Kentucky, Missouri, North Dakota and Oklahoma—entirely bar private insurance plans from covering elective abortions.

The net result: only 13% of abortion procedures were billed to insurance companies in 2003.

Given this reality, do you think the language quoted by the Wash Post below is justified or hyperbole? Is this truly, "the greatest restriction on a woman's right to get an abortion" and is it worth potentially killing overall health reform over?

Nancy Keenan, president of NARAL-Pro Choice America, said that although the vote was "extremely disappointing and outrageous," the "fight isn't over." DeGette said she remains hopeful that the amendment will be dropped as more Democrats who voted for it -- and their constituents -- realize it goes beyond the status quo of limiting federal funding for abortions. Some of those House Democrats are not against abortion rights, just against federal funding, and she surmised that they may have misunderstood the amendment.

She said her House allies have requested a meeting with Obama, saying they "need him to back us up" after lying low on the issue.

"This would be the greatest restriction on a woman's right to get an abortion with her own money in our lifetime," she said. "The stakes could not be higher."

What do you think?

Lone House Republican Backed Health Bill After Abortion Was Limited

Wash Post:

When Republican Anh "Joseph" Cao won a stunning victory in a heavily Democratic district in New Orleans last December, the GOP was so thrilled that House Minority Leader John A. Boehner sent a memo to his colleagues headlined "The Future is Cao."

But on health care, Cao had for months considered bucking the party that embraced him, while the White House wooed his vote. And this weekend, as a group of Democrats gained momentum in an effort to limit abortion in the health-care reform bill, Cao, a staunch opponent of abortion, dialed up the White House. He said he might be able to offer his support if the abortion limits were included in the bill.

By Saturday afternoon, President Obama was on the phone trying to close the deal. Cao pressed Obama for more federal funds for his district, still recovering from Hurricane Katrina four years ago.

Cao said Obama didn't make him any guarantees. But the abortion amendment gave Cao, a former Jesuit seminarian, a way to stay true to his beliefs while trying to win a second term in a district that Obama won with 75 percent of the vote.

So on Saturday, Cao, the first Vietnamese American elected to Congress, surprised Democrats and Republicans by becoming the only one of the 177 House Republicans to support the health-care bill.

"I felt last night's decision was the right decision for my district, even though it was not the popular decision for my party," Cao told CNN on Sunday.

The decision, he said, was a lifeline to the poor and uninsured in his district, rejecting the idea that it had anything to do with reelection hopes. Members of both parties privately said, however, that Cao's prospects are doomed unless a large number of Democrats in his district embrace him.

In a statement released by his office, Cao touted the abortion limits in the health bill, which had been insisted upon by the U.S. Conference of Catholic Bishops. Cao's office also quoted Gregory M. Aymond, archbishop of New Orleans, who said, "I am grateful to Congressman Cao for his courage and determination to defend life."

Democrats in Washington and New Orleans, noting how Cao has voted with Republicans on other issues, including opposition to the $787 billion economic stimulus package, said his record cannot be erased by his health-care vote. Democratic Party officials view Cao as one of the nation's most vulnerable Republicans.

"He votes along party lines more than for the district," said state Rep. Cedric Richmond, a Democrat who hopes to unseat Cao next year.

Cao is well aware of his potentially short Washington career.

Obama Pushes Senate To Act Quickly On Its Health Bill

NY Times:

The White House, growing concerned that the Congressional timetable for passing a health care overhaul could slip into next year, is stepping up pressure on the Senate for quick action, with President Obama appearing Sunday in the Rose Garden to call on senators to “take up the baton and bring this effort to the finish line.”

Mr. Obama’s remarks came just 14 hours after the House narrowly approved a landmark plan that would cost $1.1 trillion over 10 years and extend insurance coverage to 36 million uninsured Americans; the president called it “a courageous vote.” But the votes had barely been counted when the White House began turning its attention to an even bigger hurdle: getting legislation passed in the Senate.

In the Senate, where proposals differ substantially from the House-passed measure on issues like a government-run plan and how to pay for coverage, the bill is stalled while budget analysts assess its overall costs. The slim margin in the House — the bill passed with just two votes to spare, and 39 Democrats opposed it — suggests even greater challenges in the Senate, where the majority leader, Harry Reid of Nevada, is struggling to hold on to all 58 Democrats and two independents in his caucus.

Mr. Obama has staked his domestic agenda on passing comprehensive health legislation, a goal that has eluded presidents for decades. While Democrats were forced to make major concessions on insurance coverage for abortions to win House passage of the bill, they were nonetheless ebullient on Sunday, with many saying the vote gave them momentum to push the bill forward.

“For years we’ve been told that this couldn’t be done,” Mr. Obama said in the Rose Garden. Of the American people, he said, “Moments like this are why they sent us here.”

But for all the exultation, there was a sense inside the White House and on Capitol Hill that the hardest work is yet to come. The House debate highlighted the pressures that will come to bear on senators as they weigh contentious issues like federal financing for abortion, coverage for illegal immigrants and the “public option,” a government-backed insurance plan to compete with the private sector.

In the Senate, Mr. Reid has merged two bills into one. The fine print is not public, but the broad outlines are known. Unlike the House bill, which pays to extend coverage by taxing individuals who earn more than $500,000 a year and couples who earn more than $1 million, the Senate bill imposes a 40 percent excise tax on so-called Cadillac plans that cost more than $8,000 a year for an individual or $21,000 for a family.

And unlike the House bill, which includes a national public plan, the Senate measure would allow states to opt out. But even that is too much government involvement for moderates like Senator Joseph I. Lieberman of Connecticut, a Democrat-turned-independent, who pledged Sunday to wage a filibuster to block any plan with a public option in it.

“If the public option plan is in there,” Mr. Lieberman said on “Fox News Sunday,” “as a matter of conscience, I will not allow this bill to come to a final vote.”

Apart from substantive hurdles, the Senate bill faces procedural ones; Mr. Reid cannot bring it to the floor for debate until he gets an analysis, or “score,” from the nonpartisan Congressional Budget Office, expected later this week. The delay could push Senate consideration of the bill until after Thanksgiving, which could in turn make it very difficult for Congress to meet Mr. Obama’s goal of signing a health bill into law by the end of this year.

The timing is crucial. Administration officials say Mr. Obama wants to wrap up work on health care so that he can turn his attention to other legislative priorities, including passing an energy bill and revamping financial regulations. But White House officials also know that the closer the final vote comes to the November 2010 midterm Congressional elections, the more difficult it will be to pass legislation.

House Democrats Pass Historic Health Reform Bill

They finally did it (read the bill, watch members speeches)! Here's the Wash Post's account:

Hours after President Obama exhorted Democratic lawmakers to "answer the call of history," the House hit an unprecedented milestone on the path to health-care reform, approving a trillion-dollar package late Saturday that seeks to overhaul private insurance practices and guarantee comprehensive and affordable coverage to almost every American.

After months of acrimonious partisanship, Democrats closed ranks on a 220-215 vote that included 39 defections, mostly from the party's conservative ranks. But the bill attracted a surprise Republican convert: Rep. Anh "Joseph" Cao of Louisiana, who represents the Democratic-leaning district of New Orleans and had been the target of a last-minute White House lobbying campaign. GOP House leaders had predicted their members would unanimously oppose the bill.

Democrats have sought for decades to provide universal health care, but not since the 1965 passage of Medicare and Medicaid has a chamber of Congress approved such a vast expansion of coverage. Action now shifts to the Senate, which could spend the rest of the year debating its version of the health-care overhaul. Majority Leader Harry M. Reid (D-Nev.) hopes to bring a measure to the floor before Thanksgiving, but legislation may not reach Obama's desk before the new year.

At the Capitol, Obama urged the few Democrats who were still wavering on Saturday afternoon to put aside their political fears and embrace the bill's ambitious objectives. "Opportunities like this come around maybe once in a generation," he said afterward. "This is our moment to live up to the trust that the American people have placed in us. Even when it's hard. Especially when it's hard. This is our moment to deliver."

The House legislation would for the first time require every individual to obtain insurance, and would require all but the smallest employers to provide coverage to their workers. It would vastly expand Medicaid and create a new marketplace where people could obtain federal subsidies to buy insurance from private companies or from a new government-run insurance plan.

Though some people would receive no benefits -- including about 6 million illegal immigrants, according to congressional estimates -- the bill would virtually close the coverage gap for people who do not have access to health-care coverage through their jobs ...

The debate on the House floor extended for about 12 hours and settled into a civil, if predictable, pattern, after a heated start.

Sophie Made Her Choice: Pro-Choice Dems Vote For The Bill

As  predicted yesterday in Sophie's Choice Coming For Pro-Choice Dems, these Democratic House members held their noses and voted for the bill even after the Stupak amendment was added (by a vote of 64 Dems and all 176 Republicans; see map).

Here's their going forward strategy, as reported by the NY Times before the vote:

“If enacted, this amendment will be the greatest restriction of a woman’s right to choose to pass in our careers,” said Representative Diana DeGette, Democrat of Colorado, one of the lawmakers who left Ms. Pelosi’s office mad.

But Ms. DeGette, Ms. DeLauro and other defenders of abortion rights said they would nonetheless vote in favor of the health care bill and fight for changes in the final version, to be negotiated with the Senate.

Single Republican Votes For Health Reform; Abortion Amendment Was Crucial

Prescriptions:

House Democrats were thrilled by the passage of their major health care legislation, but perhaps no development on Saturday tickled them more than winning the vote of a single Republican: Representative Anh “Joseph” Cao of Louisiana.

Mr. Cao, a freshman from New Orleans, was elected last year in an upset victory over Representative William J. Jefferson, a Democrat who was under indictment on federal corruption charges at the time and has since been convicted. (Mr. Cao’s name is pronounced g-OW).

“Tonight, I voted to keep taxpayer dollars from funding abortion and to deliver access to affordable health care to the people of Louisiana,” Mr. Cao said in a statement posted on his Web site.

“I read the versions of the House bill. I listened to the countless stories of Orleans and Jefferson Parish citizens whose health care costs are exploding — if they are able to obtain health care at all. Louisianans needs real options for primary care, for mental health care, and for expanded health care for seniors and children.”

In the statement, Mr. Cao also said that he had secured a personal commitment from President Obama on health issues important to Louisiana, including disparities in federal reimbursement rates for Medicare. And while many Democrats complained that tighter restrictions on insurance coverage for abortions had threatened support for the bill on their side, Mr. Cao said that those tougher restrictions encouraged him to support the bill.

Mr. Cao’s vote offered a rare break in ranks for the House Republican minority, which has tried hard to stay unified on major political issues. On the economic stimulus measure, for instance, the Republicans voted unanimously in opposition.

But it was not the first time Mr. Cao broke with his party. He was one of 29 Republicans to join Democrats earlier this year in voting to reauthorize the Children’s Health Insurance Program.

Democrats, teasingly, immediately claimed a mantle of bipartisanship for their health care legislation.

“This was, as you observed, a bipartisan vote,” the House majority leader, Representative Steny H. Hoyer, Democrat of Maryland, said at a news conference to celebrate the passage of the bill.

Mr. Cao, who made his decision near the end of the 15-minute voting period, quickly slipped out of the House chamber and eluded news reporters. He is certain to enjoy political celebrity in the days ahead, though it is unclear it will help his political prospects.

Democrats are already lining up to challenge Mr. Cao next year, and analysts consistently rate his district is among the most likely to switch to Democrat from Republican control.

Mr. Cao, a lawyer, is a minority in several senses: a Republican amid a crowd of Democrats; a Vietnamese-American in an overwhelmingly black district.

In his election campaign last year, Mr. Cao promised ethics and integrity. He was born in Vietnam (he is the first Vietnamese-American member of Congress) and he fled with two siblings after the Fall of Saigon in 1975, moving to live with an uncle in Indiana ...

His vote in favor of the health care legislation contrasted with the “no” vote by Representative Charlie Melancon, a Democrat from southern Louisiana, who is running for the Senate next year. Senator Mary Landrieu, Democrat of Louisiana, has expressed reservations about the health care legislation, particularly the proposal for a government-run insurance plan or public option. She is being courted aggressively by Senate Democratic leaders who need all 60 members of the Democratic caucus to advance the health care bill.

Sophie's Choice Coming For Pro-Choice Dems

It seems the House vote today on health reform is far from a done deal (“This is a much heavier lift than we thought it would be”). Here's the Wash Post on the reason why: Pro-Life Dems want to prevent poor women from having any access to abortion and they're willing to kill the entire deal over it.  Are the Pro-Choice Dems similarly determined?

House Democratic leaders agreed Friday night to settle an impasse over abortion by letting the entire House vote on a proposed solution, a risky decision that could determine the fate of their trillion-dollar overhaul of the nation's health care system.

Under the agreement, anti-abortion Democrats will be permitted to offer an amendment on the House floor to the health-care overhaul bill. The amendment would prohibit a new government-run insurance plan created by the health-care bill from offering to cover abortion services, congressional sources said. It would also block people who received federal subsidies for the purchase of health insurance from buying policies that offered coverage for abortions.

The deal clears the way for the dozens of Democratic lawmakers who oppose abortion to lend their support to the health care package, the most dramatic expansion of health coverage in more than 40 years. It also satisfies the demands of the U.S. Conference of Catholic Bishops, which had threatened to oppose the House bill.

If the amendment from Rep. Bart Stupak (D-Mich.) passes, said Richard Doerflinger, associate director of the bishops conference, "we become enthusiastic advocates for moving forward with health care reform."

The amendment is expected to pass with the combined support of more than 40 anti-abortion Democrats and virtually every House Republican. That likelihood meant that leaders of the much larger group of Democrats who support abortion rights were not happy to learn of the deal.

"There will be no abortion, not just with public funds, but with private funds under the public option, and that's not acceptable," said Rep. Diana DeGette (D-Colo.).

House leaders met with that bloc of Democrats late Friday to try to quell their frustration., but the agreement makes clear that they believe abortion-rights Democrats will find it difficult to vote against the health-care bill even with such a restriction attached to it.

"This is a small facet of the bill that's very important to a lot of people," said House Majority Leader Steny Hoyer (D-Md.), adding that the greater goal is to pass legislation that makes health care "affordable and accessible to all Americans."

Abortion-rights Democrats said Friday that they were willing to accept only limited revisions to the health-care package.

Upon learning of Friday night's deal, the Planned Parenthood Federation of American quickly fired off a statement from president Cecile Richards opposing the amendment. Such a measure, Richards said, would effectively force private insurers to drop coverage of abortion in order to offer their policies through the new insurance exchanges.

"The fact is, the majority of private health insurance plans currently offer abortion coverage," Richards said, adding that the Stupak amendment "upends the carefully crafted compromise in the House bill and unambiguously restricts women's access to care."

The House Health Vote: “This is a much heavier lift than we thought it would be”

The NY Times on the back room maneuvering on the health reform bill (See Sophie's Choice Coming For Pro-Choice Dems to learn the details about how the abortion fight derail the whole bill):

House Democrats put the finishing touches on their health care legislation on Friday, but failed to bridge an internal divide over the politically treacherous issue of insurance coverage for abortions, as party leaders and the White House pushed to lock in votes on the eve of a historic floor debate.

Democratic leaders said they were confident that they would have the 218 votes needed to pass the bill, but they continued to scramble behind the scenes. A planned visit to the Capitol by President Obama was postponed until Saturday so that a face-to-face appeal would have greater impact on wavering lawmakers just before the vote.

Vice President Joseph R. Biden Jr., cabinet secretaries and other senior officials, including the White House chief of staff, Rahm Emanuel, worked the phones, imploring undecided Democrats to vote yes on a bill that they said would be remembered as a landmark achievement.

“What I explained to the president is my district is a difficult district on this,” said Representative Jason Altmire, Democrat of Pennsylvania, who received calls from Mr. Obama, Mr. Emanuel and two cabinet secretaries. Mr. Altmire said he remained undecided. He quoted Mr. Obama as saying, “The only two options are failure or move the ball down the field.”

As rank-and-file members of both parties girded for hours of boisterous floor debate on Saturday, lines began to harden and attention was focused on Democrats coming out in opposition to the bill, including several centrists from rural districts.

With Democrats controlling 258 of 435 House seats as of Friday, they can afford only 40 of their members breaking ranks and still win approval for the health measure.

As of Friday evening, Democratic officials counted just more than 205 certain votes and were hopeful that a successful resolution of the abortion and immigration issues would produce the final commitments to ensure passage of the bill.

Speaker Nancy Pelosi was devoting significant individual attention to holdouts. Securing the final supporters was proving difficult, officials said.

“This is a much heavier lift than we thought it would be,” said a top Democratic official who did not want to be named when talking about the internal lobbying efforts ...

The House majority leader, Representative Steny H. Hoyer, Democrat of Maryland, said the vote, tentatively scheduled for Saturday evening, could end up taking place on Sunday or even early next week depending on Republican tactics.

“We will be successful in the next two or three days,” Mr. Hoyer said.

Not one of the 177 House Republicans is expected to support the bill. And as they prepared for a showdown, Republican leaders said they were less inclined to mount a full-fledged guerrilla war on the floor to slow the bill than simply to make their case against it and let Democrats live with the potentially sour political consequences.

But Republican leaders also acknowledged that they could not necessarily control all of their colleagues and that combative parliamentary tactics were still possible.

After weeks of intraparty wrangling, Democratic leaders offered additional concessions to abortion opponents on Friday. Failing to reach a compromise during late-night negotiations between foes and supporters of abortion rights, Democrats said party leaders would allow a vote on an amendment that would bar the use of government subsidies to buy a health plan that covers abortion.

Democrats who support abortion rights said they were furious, but it seemed unlikely that they could prevent the amendment from being approved, especially if many Republicans joined Democrats who oppose abortion to support it. And party leaders seemed to be calculating that supporters of abortion rights, despite their anger, would vote for the health care bill.

Ms. Pelosi, who is a strong supporter of abortion rights, had no choice but to make the concessions because Democrats who oppose abortion seemed to control enough votes to endanger the bill.