President Obama, Vice President Biden and senior staff react in the Roosevelt Room of the White House, as the House passes the health care reform bill.(WOMENSENEWS)–Advocates for women’s rights decried the exclusion of abortion coverage in the House health reform bill passed late Sunday in a historic 219-212 vote.

But they were mixed in their ultimate up-or-down assessment of the legislation.

Despite final-hour restrictions that President Barack Obama made with Democrat Rep. Bart Stupak of Michigan on precluding all federal funding of abortion coverage, Planned Parenthood Federation of America President Cecile Richards applauded the bill, on balance, in a statement Sunday.

Richards called it a boon for tens of millions of women and families who would gain extended health care coverage, including family planning services. She also hailed expansion of family planning services under Medicaid, which would benefit millions of women.

Dr. Suzanne T. Poppema, board chair of Physicians for Reproductive Choice and Health, focused on abortion restrictions in her statement Monday. "Even as health reform expands access to insurance, it restricts coverage of one critical service. Abortion is essential health care–1-in-3 women will have an abortion in her lifetime–but millions of women could be denied coverage under this legislation."

Poppema said physicians already had the difficult task of telling women in the military, in government service and on Medicaid that their insurance denied coverage for the legal, safe, medical procedure.

Obama is expected to sign the health care legislation today, the same day the Senate is expected to start working on the set of fixes, or "sidecar" amendments, the House made in the reconciliation bill approved Sunday. Hours of debate are expected but Sen. Harry Reid, D-Nev., reassured House Democrats that he has the 51 votes necessary to pass the House sidecar.

Congress is scheduled to leave Washington Saturday for a two-week Easter break and many expect the Senate vote to be finished by then.

Battle Far From Over

But battle for health care reform is far from over.

The House’s sidecar has more generous federal subsidies for people who need financial help in purchasing insurance. It would give tax credit to families earning up to 400 percent of the federal poverty level–$88,000 a year for a family of four–so that they would spend a maximum of 9.5 percent of their income on insurance premiums in 2014.

The House sidecar also changes the way money is raised for health care reform by increasing Medicare taxes for high earners, defined as those with incomes of over $200,000 a year. A new 3.8 percent Medicare tax would also be imposed on the investment income of high earners.

The 153-page package of amendments to the Senate bill also increases fines for large employers that fail to offer employees coverage. The fine would be $2,000 per worker.

Individuals would be required to purchase insurance under either plan. The House fix-it bill calls for those who fail to do so to pay a penalty of $695 a year or as much as 2.5 percent of their income in fines.

House Democrats also amended the Senate bill, which imposes a 4 percent excise tax on the most generous employer-provided insurance plans. These are plans that cost more than $10,200 annually for individual coverage or $27,500 annually for family coverage. The tax would be 40 percent of the cost of the plan that exceeds these dollar thresholds.

This excise tax would hit several unions hard because they had accepted lower salaries over the years in exchange for higher benefits. The Senate wants the excise tax to begin in 2013; the House, which tends to favor labor, in 2018.

Many Changes Years Away

Even if the health care reform legislation passes this week and President Obama signs it, many changes won’t take place for years.

The legislation requires most people in the United States to buy health insurance, which would expand coverage by about 32 million people. However, the subsidies intended to make policy purchase affordable don’t kick in until 2014.

The new legislation prepares to close the "doughnut hole" in the middle of the Medicare Part D prescription drug coverage plan that ends coverage at a certain level of outlays and then resumes it at another point. But it won’t be closed completely until 2020. Seniors who fall through the doughnut hole this year, however, will get $250 to help them pay the costs.

One concern of health care advocates is that many of the positive features of the bill that make insurance affordable won’t be instituted because they don’t take effect until 2014.

If the Republicans win control of Congress in 2012 and 2014, and the Democrats lose the White House in 2012, legislation may be passed to roll back these measures, so that more people will be covered by insurance but lack the funds to pay for it.

Hours before the vote to approve an amended version of the Senate’s health reform bill, statements from women’s groups began pouring out on Sunday evening.

"With women’s insurance premiums costing up to 48 percent more than men and over 15 million women having no coverage, health care reform could not wait," Siobhan "Sam" Bennett, president of the Women’s Campaign Forum, said in a statement ahead of the vote. "However, throughout this health care debate, one thing has remained clear: Women’s health continues to be used as a bargaining chip instead of valued. Instead of focusing on improving the health care needs of all Americans, U.S. Congress debated further restrictions to reproductive health. Once again, we watch as women’s health falls to the cutting room floor."

Dealing Away Women’s Rights

Catholics for Choice President Jon O’Brien said in a statement that his organization has strongly supported comprehensive health care reform, so that those with no coverage or inadequate coverage can afford and receive the care they need.

However, O’Brien added: "But let us be clear that reforming the health insurance system has led to a significant tightening of restrictions on coverage for abortions. Both sides had a tacit agreement that the battle over health care reform would not become a battle over abortion. However, the congressional Democratic leadership allowed the anti-choice lobby to amend the final legislation with the result that it will be almost impossible to get coverage for abortions, even with one’s own money. The Democratic party has a pro-choice platform, yet its leaders chose to deal away women’s rights in order to pass a law."

National Organization for Women President Terry O’Neill issued a statement after the bill was passed saying it fails to address, among other things, restrictions on funding for abortions and restrictions on the ability of immigrants to access health care.

The passage of the historic health care insurance law, the centerpiece of Obama’s presidency, was assured at 4 p.m. Sunday when Stupak agreed to cast his vote in the House in favor of passage of the Senate version of the bill. In exchange, Obama agreed to issue an executive order that no federal funds may be used to pay for abortions.

Some media accounts said it’s not clear that the executive order actually changes anything, as the Senate bill wouldn’t have allowed taxpayer funding of abortion.

Stupak, an anti-choice Democrat and co-author of the ban on abortion funding in the House version of the bill, passionately explain his switch on live television before the vote.

He emphasized that the Senate bill, which the House was about to approve, was in fact pro-life because it provided medical care for 32 million Americans, including providing prenatal and post-natal care.

Planned Parenthood Federation of America’s Richards said that this was one of the reasons her organization is applauding the bill’s passage, despite regretting that Obama was forced to sign the executive order.

All Republicans voted against the bill and 219 Democrats supported it, as has been widely reported. On Monday, The Hill Web site published a list of the 34 Democrats who crossed the aisle to vote against the bill; they were reported as follows:

Rep. John Adler (N.J.)

Rep. Jason Altmire (Pa.)

Rep. Michael Arcuri (N.Y.)

Rep. John Barrow (Ga.)

Rep. Marion Berry (Ark.)

Rep. Dan Boren (Okla.)

Rep. Rick Boucher (Va.)

Rep. Bobby Bright (Ala.)

Rep. Ben Chandler (Ky.)

Rep. Travis Childers (Miss.)

Rep. Artur Davis (Ala.)

Rep. Lincoln Davis (Tenn.)

Rep. Chet Edwards (Texas)

Rep. Stephanie Herseth Sandlin (S.D.)

Rep. Tim Holden (Pa.)

Rep. Larry Kissell (N.C.)

Rep. Frank Kratovil (Md.)

Rep. Dan Lipinski (Ill.)

Rep. Stephen Lynch (Mass.)

Rep. Jim Marshall (Ga.)

Rep. Jim Matheson (Utah)

Rep. Mike McIntyre (N.C.)

Rep. Mike McMahon (N.Y.)

Rep. Charlie Melancon (La.)

Rep. Walt Minnick (Idaho)

Rep. Glenn Nye (Va.)

Rep. Collin Peterson (Minn.)

Rep. Mike Ross (Ark.)

Rep. Heath Shuler (N.C.)

Rep. Ike Skelton (Mo.)

Rep. Zack Space (Ohio)

Rep. John Tanner (Tenn.)

Rep. Gene Taylor (Miss.)

Rep. Harry Teague (N.M.)



For more information:

The Last House Vote Is Just the Beginning of Reconciliation:

The Kaiser Family Foundation, Health Reform: