WASHINGTON — As if it were not complicated enough, the debate over health care in Congress is becoming a battlefield in the fight over abortion.
Representative Bart Stupak, a Democratic opponent of abortion, is pressing for a ban on health care subsidies for abortions.
A blog from The New York Times that tracks the health care debate as it unfolds.
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The Takeaway With David D. Kirkpatrick Abortion opponents in both the House and the Senate are seeking to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. And the abortion opponents are getting enough support from moderate Democrats that both sides say the outcome is too close to call. Opponents of abortion cite as precedent a 30-year-old ban on the use of taxpayer money to pay for elective abortions.
Abortion-rights supporters say such a restriction would all but eliminate from the marketplace private plans that cover the procedure, pushing women who have such coverage to give it up. Nearly half of those with employer-sponsored health plans now have policies that cover abortion, according to a study by the Kaiser Family Foundation.
The question looms as a test of President Obama’s campaign pledge to support abortion rights but seek middle ground with those who do not. Mr. Obama has promised for months that the health care overhaul would not provide federal money to pay for elective abortions, but White House officials have declined to spell out what he means.
Democratic Congressional leaders say the latest House and Senate health care bills preserve the spirit of the current ban on federal abortion financing by requiring insurers to segregate their public subsidies into separate accounts from individual premiums and co-payments. Insurers could use money only from private sources to pay for abortions.
But opponents say that is not good enough, because only a line on an insurers’ accounting ledger would divide the federal money from the payments for abortions. The subsidies would still help people afford health coverage that included abortion.
Lawmakers pushing the abortion restrictions say they feel the momentum is on their side, especially because the restlessness of other Democratic moderates is making every vote count.
At least 31 House Democrats have signed various recent letters to the House speaker, Nancy Pelosi, urging her to allow a vote on a measure to restrict use of the subsidies to pay for abortion, including 25 who joined more than 100 Republicans on a letter delivered Monday.
Representative Bart Stupak of Michigan, a leading Democratic abortion opponent, said he had commitments from 40 Democrats to block the health care bill unless they have a chance to include the restrictions.
After months of pushing the issue, Mr. Stupak said in an interview, Mr. Obama finally called him 10 days ago. “He said: ‘Look, try to get this thing worked out among the Democrats. We want you to work it out within the party,’ ” Mr. Stupak said, adding that Mr. Obama did not say whether he supported the segregated-money provision or a more sweeping restriction. “We got his attention, which we never had before.”
After the president called, Mr. Stupak said, Ms. Pelosi agreed to meet with Mr. Stupak on Tuesday to discuss his proposals for the first time, her office confirmed. Her spokesman, Nadeam Elshami, said in a statement, “As we have throughout the process, we are meeting with our members to listen to their concerns, consulting with the administration, and making progress.”
The Senate Finance Committee is expected to vote this week on a proposed amendment from Senator Orrin G. Hatch, Republican of Utah, to restrict the use of federal subsidies.
Advocates on both sides said that if the committee does not adopt the amendment they expect a very close contest over the issue when the bill reaches the floor. Two Democratic abortion-rights opponents, Senator Bob Casey Jr. of Pennsylvania and Senator Ben Nelson of Nebraska, are pushing the issue.
Mr. Casey voted in the Senate health committee for a proposal to restrict the use of the subsidies; it was defeated by one vote. Mr. Nelson is considered a pivotal vote needed to pass the overall bill. “Senator Nelson does not believe that taxpayer dollars should be used in any way to fund abortion,” his spokesman said.
Jim Manley, a spokesman for the Democratic leader, Senator Harry Reid, said that Mr. Reid believes that the latest drafts of legislation already accomplish that goal.
Supporters of the current segregated-money model argue that 17 state Medicaid programs that cover elective abortions use a similar system, dividing their federal financing from state revenues they use to pay for procedures.
“The language of the compromise is very clear,” said Representative Rosa DeLauro, Democrat of Connecticut, “it prohibits the use of federal funds to pay for abortions.” (The bills would also mandate the availability in each state of at least one plan that covers abortion and at least one that does not.)
Nancy Keenan, president of Naral Pro-Choice America, argued that if the bill blocked the use of subsidies for abortion coverage, private insurers would stop covering abortion because those plans would be excluded from the federally subsidized programs.
“Women who already have this coverage would lose it,” Ms. Keenan said.
Advocates of tighter restrictions note that the health insurance program for federal employees complies with the ban on abortion financing by excluding any plans that offer abortion.
And under the Hatch amendment in the Senate or the Stupak proposals in the House, women would be free to pay extra for an insurance “rider” that would cover abortions.
The United States Conference of Catholic Bishops, which has lobbied for decades to persuade the government to provide universal health insurance, says it opposes the bill unless it bans the use of subsidies for plans that cover abortion.
“We have said to the White House and various Senate offices that we could be the best friends to this bill if our concerns are met,” Richard M. Doerflinger, a spokesman for the bishops on abortion issues, said in an interview. “But the concerns are kind of intractable.”
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