Inside Congress, battles over federal funding for abortion have posed the latest threat to health care reform legislation.
The Senate bill to be considered by the House this month includes some restrictions on the use of federal subsidies to pay for private insurance plans covering abortions. House Democratic leaders on Thursday gave up on trying to find a compromise within their own ranks on the abortion language, gambling that even if some antiabortion Democrats defect, they can still find the votes they need to pass the sweeping health care overhaul.
But relative to the rest of the bill, there's little money at stake in covering abortion. It's a debate that hinges on philosophical differences more than finances.
And it has little to do with the reality of how abortions are funded today: Most women pay out of pocket for the procedure, which costs about $400 to $1,800.
There were about 1.2 million abortions in the United States in 2005, the last year for which data is available. Of those, 74 percent were paid directly by the woman, with her own money or funds from a partner or family.
Guttmacher Institute, the source of these figures, stressed that the statistic included all women receiving abortions, whether insured or uninsured. And it doesn't account for women who may later have sought reimbursement from their insurers.
About 87 percent of all employer-provided health care plans now include at least some abortion coverage. But the Guttmacher study found that only 13 percent of women having abortions had their insurers billed directly by clinics. Women may prefer paying in cash, surveyors said, to preserve confidentiality.
Federal funding of abortions has been limited for decades. Since 1977, the Hyde amendment, which is renewed annually, has banned the use of federal money for abortions except in cases of rape, incest or a threat to the mother's life.
The Guttmacher study found that 13 percent of abortions were reimbursed by Medicaid, the federal health program for the poor. Most of those were in 17 states that permit funding in broader circumstances than allowed under the Hyde amendment.
The Senate version of the health care bill includes a provision allowing people who don't have access to affordable insurance to buy private plans through a state-based exchange. Most buyers would be eligible for federal subsidies of their premiums.
And that's where the focus of the current debate lies.
Antiabortion groups insist that no federal subsidies should be allowed for insurance plans that cover abortions beyond those allowed under the Hyde amendment. So the Senate bill would force everyone who buys an exchange plan with broader abortion coverage to make a separate payment to the insurer every month.
States would also have the option of prohibiting plans in the exchange from covering abortions.
The National Right to Life committee criticized the Senate fix as a "convoluted bookkeeping scheme inconsistent with the principles of the Hyde Amendment." Earlier this month, the group issued a release, saying any member of Congress who votes for the Senate bill will be casting "a career-defining pro-abortion vote."
But Thursday there were signs of splintering among the antiabortion forces. Even before the House Democratic leaders made their announcement, a group of 25 Catholic theologians and evangelical leaders sent a letter to Congress supporting the legislation. The group, Faith in Public Life, said it believed restrictions on federal funding for abortion are maintained in the bill, which they support because it would expand affordable health coverage to tens of millions of Americans, including "vulnerable pregnant women."
Abortion rights groups, meanwhile, worry that the Senate's restrictions on exchange plans would have a spill-over effect on the entire insurance industry. In addition to the headache of collecting what could be as little as $1 a month from every policyholder, insurers would be forced to publicize the fact that they're offering abortion coverage.
Nancy Kennan, president of NARAL Pro-Choice America, said in a news release, "Women should not lose ground in the new health care system."
Sara Rosenbaum, a professor of health law and policy at George Washington University, predicts that under the Senate's requirements, most insurers would simply drop coverage for all customers, rather than deal with blowback from abortion opponents. "Quite frankly, I think it's the end of the sale of insurance that covers abortion," she said.
Today most major insurers automatically include coverage for abortions and give employers the choice to opt out. But few companies or their employees may even realize they have the coverage. Late last year, the Republican National Committee discovered that its policy through Cigna had covered abortions since 1991.
The antiabortion group immediately said it intended to eliminate the coverage.
Times researcher Will Gorham contributed to this report. Kris Hundley can be reached at firstname.lastname@example.org or (727)892-2996.