For the past week, HealthcareHorserace.com has been reporting on a behind-the-scenes battle over the role the federal government would play in funding abortion procedures under healthcare reform. For the time being, that battle appears to have been won by pro-choice advocates compliments of the Democrat majority.

Last week, Senator Barbara Mikulski successfully attached an amendment to the Senate HELP (Health Education Labor and Pensions) Committee’s Quality, Affordable Health Coverage for All Americans bill. The Women’s Health Amendment - co-sponsored by Senator Chris Dodd - would require insurance agencies (public or private) to contract with “essential community providers” to provide healthcare services to Americans earning less than 400% of the poverty level ($88,000 for a family of four) or risk losing the right to participate in mandatory state “American Health Benefit Gateways” as established under the HELP bill. 

The term “essential community providers” is intentionally vague by design. During an exchange with Senator Orrin Hatch, Mikulski acknowledged that, for instance, Planned Parenthood - which provides abortions to low-income women and teens - would qualify as an “essential community provider.”

The poverty level language is also critical as the same language is a trigger for federal subsidies. Another-words, the federal government will provide insurance for these folks with taxpayer dollars. Taken one step further, the federal government will therefore be required to contract with these same “essential community providers” using taxpayer dollars. This raises the question of abortions. Will the government be therefore required to pay for abortion procedures?

Democrats say the intent of this language is to provide services to low-income women and teens who may still be left out of the 97% of Americans that healthcare reform is expected to insure. Conservatives aren’t buying it.

Senators Orrin Hatch and Bob Casey (a Democrat) called Mikulski’s bluff during a HELP Committee debate last week.

(Editor’s note: Thanks to CNS News for the video.)

Mikulski’s admission that Planned Parenthood qualified as an “essential community provider” combined with her unwillingness to qualify in her amendment that she was requiring insurance companies to cover “any service deemed medically necessary or medically appropriate” by these “essential community providers” amounts to an aboriton mandate in the eyes of many conservative and pro-life advocates.

“It’s ironic that Senator Mikulski (D-MD) and the committee Democrats would consider taxpayer-funded abortions to be a health care benefit since the baby gets no health care benefit from abortion. President Obama and the Democrat leadership claim they want to ‘reduce’ abortion*, but you don’t reduce abortion by funding it.” (Family Research Council president Tony Perkins.)

* Editor’s Note: Perkins is referring to President Obama’s recent meeting with the Pope, during which Obama promised to work to reduce the number of abortions in America.

Senator Hatch went so far as to offer an amendment of his own aimed at ensuring federal money would not be used to pay for abortion procedures. His amendment was defeated 12-11 along party lines with the exception of Senator Casey who voted with the Republicans. The Mikulski Amendment would go on to pass 12-11 along the same lines.

Passage of the Mikulski Amendment was widely hailed on the left by pro-choice groups including the NARAL Pro-Choice America.

For America’s pro-choice majority, the HELP Committee bill is significant because pro-choice senators defeated repeated attempts by anti-choice legislators to politicize the bill with divisive amendments. Moreover, the committee adopted important new provisions that will improve women’s access to family-planning care.

It is important that we mark this progress while acknowledging the challenges ahead.

We are working day and night (going from office to office across Capitol Hill) to fight back against anti-choice politicians who are trying to push measures that would interfere in the doctor-patient relationship and take away health-care services many Americans already have. (NARAL Pro-Choice America president Nancy Keenan.)

If the HELP bill were to become law, it would undo more than 30 years of the Hyde Amendment (1976). The amendment forbids Medicaid (and by precedent the federal government) from paying for abortions with federal money. All but 17 states have since followed suit and banned the use of state funds for abortion procedures with 13 of those requiring a court order to do so.

Of course, there is concern that launching a public option insurance plan without coverage for abortion procedures could trigger legal challenges of its own as reported on HealthcareHorserace.com last weekend.

Of course, specifically excluding the procedures could be seen as a challenge to the landmark 1973 Supreme Court decision in Roe v. Wade which forbids federal and state governments from denying a woman the right to chose whether to abort an unwanted pregnancy. It could also create a question as to whether denying the procedures constitutes a violation of the Fourteenth Amendment’s Equal Protection Clause as nearly 90% of private insurers currently include abortion procedures in their coverage according to the reproductive health watchdog Guttmacher Institute.

A third alternative is the status quo - not addressing abortion procedures in the legislation and waiting on activist judges to take the issue up in their courtrooms. This may prove the most politically expedient option for lawmakers not wanting to debate abortion on the floors of the House and Senate, but leads to the same Supreme Court showdown as the aforementioned scenarios.

While the abortion debate would appear to be far from over on Capitol Hill as it will surely come up during any debate ahead of a floor vote in the Senate, the issue will most likely be settled by the courts should healthcare reform indeed pass. And, it will most likely end up in front of the Supreme Court as a the first credible challenge to the Roe v. Wade decision in nearly 40 years.