Abortion poses hurdle for Senate healthcare bill

Abortion poses hurdle for Senate healthcare bill
© Greg Nash

Abortion has emerged as a potential stumbling block for Senate Republicans as they seek to craft an ObamaCare repeal-and-replace bill that can garner 51 votes.

Senators are fretting that a provision in the House healthcare bill that bars financial assistance from being used to buy plans covering abortion will be stripped out under the Senate’s rules of reconciliation. Republicans hope to use that special budgetary procedure to bypass a Democratic filibuster.

If the Senate parliamentarian rules that the abortion provision is out of bounds, Republicans could have a problem on their hands.

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Prohibiting federal funds from going to abortion is a core Republican principle, and it will be difficult to get the healthcare bill to President Trump’s desk without it being followed. 

Senate Majority Whip John CornynJohn CornynTough road ahead for McConnell on ObamaCare McCain returns to applause, casts deciding vote to advance healthcare bill Live coverage: Senate begins debate on ObamaCare repeal MORE (R-Texas) said it’s unclear how the parliamentarian will rule. 

“There’s a discussion on that ongoing — no clear determination to my knowledge yet,” Cornyn (R-Texas) told The Hill. He declined to speculate about whether the elimination of the provision could pose a problem for anti-abortion senators.

Sen. Mike LeeMike LeeSenate rejects ObamaCare repeal, replacement amendment Trump turns up heat on AG Sessions over recusal GOP senators back Sessions after Trump attacks MORE’s (R-Utah) office said the ruling by the parliamentarian on the abortion provision is a concern for him. A reconciliation bill can only involve budget-related items, so it can’t include policies that don’t have any fiscal impact. The decision on what can ultimately be in the bill rests with the Senate parliamentarian. 

If the provision doesn’t meet the reconciliation guidelines, “there would have to be some sort of solution,” Conn Carroll, Lee’s spokesman, wrote in an email. 

Carroll said he doesn’t know what the solution would be “but a fix would be essential,” he added. 

Sen. Ted CruzTed CruzScaramucci: We are moving to a ‘freer’ healthcare system Trump targets Murkowski after healthcare votes McCain votes to advance ObamaCare repeal, replace after vowing to oppose MORE (R-Texas), a vocal ObamaCare critic who now has a seat at the table helping in crafting the ObamaCare replacement, also said it would be an issue for him if the provision was stripped out.

“I think virtually every Republican agrees that we should not be spending taxpayer funds to pay for abortions,” he told The Hill. “An overwhelming majority of Americans agree that taxpayer funds should not be paying for abortions, and so any plan we adopt needs to honor that principle.”

A 1976 statute, known as the Hyde amendment, has barred federal funding from covering abortions. That policy has been renewed over the years, often through a policy rider on appropriations bills. 

The House healthcare bill prohibits tax credits from going toward plans that fund abortion both on and off the exchanges.

ObamaCare is a bit different. It lets insurers cover abortion on the same policy, but carriers in marketplace plans have to segregate the funds into separate accounts so no federal dollars are used for abortion, except in cases of rape, incest or where the mother’s life is in danger. The law also allows states to limit or bar plans in the health marketplaces from covering abortions, and as of March, 25 states had done so, according to the Kaiser Family Foundation. 

Under the House bill, people can buy a separate policy for abortion coverage — or a plan that covers abortion — but they can’t use their tax credits to help make their premiums more affordable.   

According to Alina Salganicoff, Kaiser’s vice president and director of women’s health policy, separate abortion-only plans or riders do not exist, to her knowledge.

The Senate’s rewrite of the House’s bill to repeal and replace ObamaCare is a balancing act. The product can’t be moved too far to the right, for fear of losing moderates. And it can’t be moved too far to the center, for fear of losing conservatives.   

With Republicans only having a slim 52-48 majority, there’s little margin for error.

Even if the abortion measure stays in the bill, senators will have to determine if that language can pass through its chamber. 

There’s a “strong recognition that none of us want to see any funding for abortion any more than we absolutely have to allow to get something through,” Sen. Mike Rounds (R-S.D.) told The Hill. “Where we end up in that is yet to be determined in terms of what it actually says within a bill.” 

If the Senate removes the House language, even because of the rules governing reconciliation, it could pose a conflict for some in the House once it comes time to negotiate the final legislation.

“It's going to be a major issue if there is a conference,” Rep. Trent FranksTrent FranksSenate spending plan boosts House moderates House briefed on anti-ISIS campaign progress Republicans rally around Sessions after Trump criticism MORE (R-Ariz.), a co-chair of the Pro-Life Caucus, told The Hill. “I don’t know if there will be — they may try to pass a different bill, but when it comes over here than we're going to have a fight about that because killing children is not healthcare.”

He also repeatedly slammed the Senate’s rules. 

“This country deserves a Senate where we can deliberate before the American people the issues of the day and right now we can’t do that,” he said. “That’s why we have to do this process of reconciliation.”