A Climactic Chapter in Health Care Reform

Democratic leaders resolved the ongoing dispute over the abortion legislation that stood in the way of passing health care reform, leading to the 219 to 212 vote late Sunday evening.

The House still has to vote on a reconciliation bill that is a package of amendments to the bill the health care bill

Reps. Marcy Kaptur and Bart Stupak, two of the critical Democratic holdouts whose vote on health-care reform were uncertain leading to a final vote, voted in favor of the measure when it reached the House floor Sunday.

Stupak had been a holdout over concerns about taxpayer funding of abortion.

The White House announced that the President would issue an executive order after passage of the health care bill that reaffirms current law barring taxpayer dollars for abortion, except in cases of rape, incest, and a threat to the life of the mother.

Moments after the statement, Kaptur, Stupak, and five other anti-abortion Democrats announced they would back the health-care bill, giving it the votes needed to pass in the House.

“We're well past 216,” Stupak said of the number of votes needed to pass the bill.

“Make no doubt about it, there will be no public funds for abortion.”

The executive order requires the Department of Health and Human Services draw up a set of guidelines for states to follow to ensure that federal funds don’t pay for abortion coverage. The guidelines must be drawn up within the next six months.

“While the legislation as written maintains current law, the executive order provides additional safeguards to ensure that the status quo is upheld and enforced, and that the health care legislation’s restrictions against the public funding of abortions cannot be circumvented,” Communications Director Dan Pfeiffer said in a statement.

“The President has said from the start that this health insurance reform should not be the forum to upset longstanding precedent. The health care legislation and this executive order are consistent with this principle.”

Protestors on The Hill

Health care protests on Capitol Hill throughout the weekend turned ugly at times, officials said.

Demonstrators surrounded members of Congress as they crossed the street between their office buildings and the Capitol. Many yelled, "kill the bill," and others made racial remarks, aimed at black members of Congress.

Rep. Andre Carson (D-Ind.) told an Indiana newspaper that he and other black Congressmen endured racial slurs shouted by protesters opposing health care legislation.

Carson said that as he left the Cannon House Office Building on Saturday with Rep. John Lewis (D-Ga.), protesters shouted the "N" word several times.

About 300 people carrying American flags and homemade banners motioned out across a grassy area near the House side of the Capitol. One sign read, “Obamacare = death warrant for grandma.”

Adding to the health care chaos and protests, several thousand marchers from the earlier immigration reform rally marched between members of both sides of the health care debate, chanting in Spanish in support of the contingent in favor of the health care bill.

By the Numbers

The Democrats' health care bill would reduce the deficit over the long term by reining in the growth of health-care costs, according to the Congressional Budget Office. But the United States is still likely to spend much more on health care than other industrialized nations.

France and Germany, for example, spend about half as much, provide universal care, and reap better outcomes. The same is true of the Canadians.

The text of the pending executive order follows:

Executive Order ensuring enforcement and implementation of abortion restrictions in the patient protection and affordable care act

By the authority vested in me as President by the Constitution and the laws of the United States of America, including the "Patient Protection and Affordable Care Act" (approved March ­­__, 2010), I hereby order as follows:

Section 1. Policy.

Following the recent passage of the Patient Protection and Affordable Care Act ("the Act"), it is necessary to establish an adequate enforcement mechanism to ensure that Federal funds are not used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered), consistent with a longstanding Federal statutory restriction that is commonly known as the Hyde Amendment. The purpose of this Executive Order is to establish a comprehensive, government-wide set of policies and procedures to achieve this goal and to make certain that all relevant actors--Federal officials, state officials (including insurance regulators) and health care providers--are aware of their responsibilities, new and old.

The Act maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly-created health insurance exchanges. Under the Act, longstanding Federal laws to protect conscience (such as the Church Amendment, 42 U.S.C. §300a-7, and the Weldon Amendment, Pub. L. No. 111-8, §508(d)(1) (2009)) remain intact and new protections prohibit discrimination against health care facilities and health care providers because of an unwillingness to provide, pay for, provide coverage of, or refer for abortions.

Numerous executive agencies have a role in ensuring that these restrictions are enforced, including the Department of Health and Human Services (HHS), the Office of Management and Budget (OMB), and the Office of Personnel Management (OPM).

Section 2. Strict Compliance with Prohibitions on Abortion Funding in Health Insurance Exchanges.

The Act specifically prohibits the use of tax credits and cost-sharing reduction payments to pay for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered) in the health insurance exchanges that will be operational in 2014. The Act also imposes strict payment and accounting requirements to ensure that Federal funds are not used for abortion services in exchange plans (except in cases of rape or incest, or when the life of the woman would be endangered) and requires state health insurance commissioners to ensure that exchange plan funds are segregated by insurance companies in accordance with generally accepted accounting principles, OMB funds management circulars, and accounting guidance provided by the Government Accountability Office.

I hereby direct the Director of OMB and the Secretary of HHS to develop, within 180 days of the date of this Executive Order, a model set of segregation guidelines for state health insurance commissioners to use when determining whether exchange plans are complying with the Act's segregation requirements, established in Section 1303 of the Act, for enrollees receiving Federal financial assistance. The guidelines shall also offer technical information that states should follow to conduct independent regular audits of insurance companies that participate in the health insurance exchanges. In developing these model guidelines, the Director of OMB and the Secretary of HHS shall consult with executive agencies and offices that have relevant expertise in accounting principles, including, but not limited to, the Department of the Treasury, and with the Government Accountability Office. Upon completion of those model guidelines, the Secretary of HHS should promptly initiate a rulemaking to issue regulations, which will have the force of law, to interpret the Act's segregation requirements, and shall provide guidance to state health insurance commissioners on how to comply with the model guidelines.