WASHINGTON -- As the debate dragged through Saturday evening, Marcy Kaptur was factoring a moral calculation.
The Democratic congresswoman from Toledo wanted to support a health-care bill that, with government money, would help millions more Americans get medical insurance. But she also wanted assurances that not a penny of that government money would ever pay for an abortion. What troubled her was the possibility that Republican hijinks would derail an anti-abortion amendment, forcing her to choose between one goal and the other.
"It creates a real dilemma for me," she told a Plain Dealer reporter just off the House floor. "The question I've been asking myself is, under which option do you lose more -- how many abortions occur a year, versus how many people die from no insurance every year?"
The question became moot because the amendment, the work of Democratic Rep. Bart Stupak of Michigan, passed, as did the broader health-care bill. But abortion-rights advocates and many Congressional liberals are outraged over the first vote, which creates a new challenge on the road to health reform.
The anti-abortion amendment got support from Kaptur, Tim Ryan and a handful of other Ohio Democrats, and from every House Republican. But it went too far for many other Democrats, because it would roll back a right for women.
It not only would bar the use of federal money for abortions, as existing law does. It also would make it impossible for new policies purchased through so-called insurance exchanges, or marketplaces set up through the health-care legislation, to pay for the procedure -- even if the woman seeking an abortion did not use a penny of federal money to buy her insurance. She would have to buy a separate rider or amendment that would specifically cover abortions, or pay out of pocket if she ever decided to have an abortion.
"Unacceptable," said Cecile Richards, president of the Planned Parenthood Federation of America. She said such abortion riders "do not exist because women do not plan to have unintended pregnancies or medically complicated pregnancies that require ending the pregnancy."
Ohio Secretary of State Jennifer Brunner, who is running for the U.S. Senate, called the health bill amendment "an insult to Ohio women and an assault on the right to privacy."
And Ohio Lt. Gov. Lee Fisher, also running for Senate, said the "discriminatory language" goes "far beyond existing law in restricting a woman's right to choose."
The problem is, House Democratic leaders said they had to include the amendment to get support for the overall health bill, which squeaked through with only two votes above the winning margin. Ohio Democrats voting for the amendment were John Boccieri of Alliance, Steve Driehaus of Cincinnati, Zack Space of Dover, Charlie Wilson of Bridgeport, Kaptur and Ryan.
This sets up a challenge for the bill's next step in the Senate. Senate Democrats including Sherrod Brown of Ohio say they will not accept such a stringent measure and expect a weaker amendment that would merely maintain the current ban on using government money.
"I don't think it will be in the Senate version," Brown said. "I hope it won't."
President Barack Obama told ABC News on Monday that he, too, hopes the Senate alters the language so that "we're not changing the status quo."
That and other changes would require the bill to go back to the House. The question for House Democrats like Kaptur, Ryan and Driehaus is whether they then would object to a weaker anti-abortion measure. If so, it could doom the broader health-care reform package.
Spokesmen for these Democrats said it was too early to answer definitively but that their goal is to preserve the current ban. Said Driehaus spokesman Tim Mulvey: "Congressman Driehaus doesn't want to speculate about what will be in the conference report with regard to abortion, but he will vote against any legislation that includes public funding for abortion."
The National Right to Life Committee takes a stricter view: It wants the Senate to include Stupak amendment-style language.
That is the "only thing that will prevent the health care bill from being 'an abortion bill,'" said legislative director Douglas Johnson.
Republican Sen. George Voinovich appears to agree.
"Senator Voinovich strongly supports the goals of the Stupak amendment to prohibit federal funding of abortions, and believes any health reform bill must protect all human life from conception to natural death," said spokeswoman Garrette Silverman. "It is safe to say he would support similar language in the Senate bill; however, we are still waiting for the text of a Senate bill to debate."
Plain Dealer reporter Sabrina Eaton contributed to this report.