Senate Republicans working on high-stakes health care legislation are anticipating problems with abortion restrictions that their House counterparts have already passed.
As a result, they're considering ways to channel new financing for health insurance through existing government programs that bar the use of taxpayer dollars for abortion, according to sources familiar with the policy discussions. Those options include the Children's Health Insurance Program.
The sources spoke on condition of anonymity to discuss details of closely held discussions about a Senate version of the health care bill. GOP aides said nothing has been resolved. Republican leaders are pressing for a Senate vote on health care, which could come before the July 4 holiday.
Senate GOP leaders want their bill to bar federal funds for abortions. Failure to include such restrictions would jeopardize support from conservative Republican senators, whose votes will be needed for passage.
Disputes about how to handle abortion coverage almost sank former President Barack Obama's health care law, and now it looks like the thorny issue may complicate GOP efforts to unravel the 2010 Affordable Care Act, or "Obamacare."
For 40 years, a federal law known as the Hyde Amendment has barred the use of government money for abortions, except to save the life of the woman, or in cases of rape or incest.
The Obama-era ACA created a new category of federal health care financing by subsidizing premiums for private insurance plans.
Under the Democratic compromise that ultimately secured the bill's passage, insurance plans that cover abortion could receive government subsidies, provided they collected a separate premium to pay for abortions. The law kept the two financing streams strictly separate.
Abortion opponents saw the compromise as undermining the Hyde Amendment and have been battling to reverse it ever since. Twenty-five states have banned abortion coverage by health plans in their ACA insurance markets.
The GOP health care bill passed by the House would apply Hyde Amendment language to future subsidies for individually-purchased private insurance.
The problem is that the House provision may not meet the test for inclusion in the Senate's health care bill under special rules that let that chamber pass budget-related legislation by simple majority instead of 60 votes. Those rules prohibit including "extraneous matter" in the legislation.
The House did not have that problem because it has different rules that allow for a simple majority to pass most legislation.
A GOP aide familiar with the discussions said Senate staffers have known for months about the potential problem, and they've been trying to design workarounds that would essentially achieve the same results as the House bill.
One option would involve channeling a new $100 billion insurance market stabilization fund that the GOP bill creates through the Children's Health Insurance Program, a federal-state partnership already under the umbrella of the Hyde Amendment.
If the maneuver succeeds, it could have a chilling effect on insurers. Companies wishing to rely on the stabilization fund envisioned in the Republican bill would have to think long and hard about covering abortions. That would make it more difficult for women who want coverage that includes all reproductive health options.
Abortion is a legal medical procedure, and is covered by the vast majority of employer-sponsored health plans. But opposition to abortion has left some areas of the country with no doctors willing to perform them.
Two states — New York and California — require insurers to cover all medically necessary services, including abortion. If the GOP bill passes, it's anticipated it would result lawsuits from those states.
Democratic Sen. Patty Murray of Washington said she thinks the House abortion restrictions will have "a real problem standing up" under Senate rules. A Senate official called the parliamentarian will make the call as Sen. Majority Leader Mitch McConnell, R-Ky., prepares to take the health care legislation to the floor.
"It's very clearly an ideological policy change and not a budget change," she said. "And under Senate rules, it has to be budget-related."
Associated Press writer Alan Fram contributed to this report.