Abortion foes have scored a victory and traditional allies of the Obama administration are grumbling about a decision to ban most abortion coverage in insurance pools for those unable to purchase health care on their own.
The Catholic bishops "welcome this new policy," said Cardinal Daniel DiNardo, although he added the organization remains concerned that other provisions of President Barack Obama's health care overhaul law will promote abortion.
The issue flared after at least one state — New Mexico — initially decided to allow coverage of elective abortion in a newly launched, federally funded program to provide coverage for high-risk uninsured people turned away by private carriers.
Abortion foes also raised questions about Pennsylvania's plan, but state officials said the criticism was baseless.
Trying to head off more problems, the Health and Human Services Department announced last week the program will not cover abortions except in cases of rape, incest or when the mother's life is in danger — exceptions traditionally allowed under federal law.
That's a more restrictive policy than will be generally applied under Obama's new health care law.
Starting in 2014, the overhaul will allow federally subsidized health insurance plans to cover abortions, but only if policyholders pay for coverage separately and the money is segregated from government funds.
The current program for the high-risk uninsured was also authorized by the health care law, as temporary help for the most vulnerable, until the big coverage expansion in 2014. But Congress didn't spell out how to deal with abortion.
Abortion rights supporters say the Obama administration's restrictions go too far.
"We didn't expect that women would be treated differently here with regard to the high-risk insurance pool," said Nancy Keenan, president of NARAL Pro-choice America. "This is inexplicable and wrongheaded to us, and it puts women's lives in jeopardy."
The turnabout comes amid growing recognition among Democrats that the nation's unsettled political climate could cost them control of the House in the fall elections. The health care law remains a powerful motivator for opponents of Obama's policies, and no issue stirs deeper passions than abortion.
After abortion foes raised questions about the program for the uninsured, leading congressional Republicans pounced. They accused Obama of steering millions in federal funds to pay for abortions, breaking a promise he made when he signed an executive order that reaffirmed long-standing federal restrictions.
Anti-abortion Democrats in Congress — whose votes provided the margin for passage of the health care law — scrambled to head off the attack.
In interviews, some of these Democrats said the administration's decision proves that Obama's executive order has teeth.
The president signed the order as part of a negotiation to get anti-abortion Democrats in the House to vote for the overhaul bill. HHS invoked Obama's order in laying out the restrictions on abortion coverage for the uninsured.
"This is the first test, and it will show that there is no federal funding going to pay for abortion," said Rep. Kathy Dahlkemper, D-Pa., a first-term lawmaker seeking re-election from a Republican-leaning district.
Rep. Bart Stupak, D-Mich., a leader of anti-abortion Democrats in the House, said the administration's action should ease fears that the health care law would open a spigot of federal funding for abortion.
"New Mexico is an example of where the executive order actually worked," Stupak said, referring to that state's reversal on allowing coverage of elective abortion. "They have made it very clear abortions are not going to be covered."
The Preexisting Condition Insurance Plan, launched earlier this month, will provide coverage to uninsured people turned down because of a medical problem. Premiums vary by state but are roughly comparable to those paid by healthy people who purchase their coverage directly from an insurer. Applications are being taken and coverage is expected to begin Aug. 1.
Douglas Johnson, legislative director for National Right to Life, an anti-abortion group, acknowledged that his side had won a round.
"If they now do what they say they are going to do, that would be good," Johnson said of the Obama administration. "But in our view they are doing it because the spotlight has been put on them and we blew the whistle."
Health and Human Services statement
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