Tentative House Medicare 'doc fix' deal opens rift among Dems over abortion

WASHINGTON – An emerging bipartisan House deal changing how Medicare reimburses doctors ran into turbulence in the Senate Thursday over abortion, spotlighting a rare public disagreement between Congress' two top Democrats.

Some Democratic senators — including Minority Leader Harry Reid, D-Nev. — expressed concern that the tentative House agreement would write restrictions on abortions at community health centers into law. The centers provide medical care for millions of low-income Americans in every state.

Aides to House Minority Leader Nancy Pelosi, D-Calif., said the Medicare agreement's health center abortion language would expire after two years and represents no change from existing restrictions.

The differing interpretations between Reid and Pelosi are particularly awkward for Democrats because the party widely views Pelosi as an undisputed champion for abortion rights.

The dispute comes as the Senate remains entangled in a separate abortion battle between the two parties that has stymied work on a popular bill aimed at helping victims of human trafficking.

There have been abortion curbs at community health centers for years. Senate Democrats say those limitations have been imposed by an Obama administration executive order that applied broad legal curbs on abortions to the health centers, and there is no need for a law that specifically targets those centers.

Under the so-called Hyde amendment, which Congress renews every year, federal funds cannot be used for abortions except for cases of rape, incest or when the mother's life is endangered. In a 2010 executive order, President Barack Obama said the Hyde language and other regulations prohibit community health centers "from using federal funds to provide abortion services" except for the Hyde amendment's exemptions.

Reid spokesman Adam Jentleson blamed the community health center problem on the GOP, saying: "Senator Reid sees this codification of the Hyde amendment as part of a systematic effort by Republicans to expand its scope."

Jentleson said Reid would wait to see what the House approves before deciding if he will support it or not.

Pelosi spokesman Drew Hammill said the proposed language "represents no change in current policy for health centers, and would have no operational impact at the health center level."

Hammill also said: "In contrast to the effort by Republicans on the Senate trafficking bill, this is not a codification of Hyde because the language expires when the funds do."

The roughly $200 billion Medicare deal between Pelosi and House Speaker John Boehner, R-Ohio, would block a 21 percent cut in doctors' Medicare fees that otherwise takes effect April 1. It would change how doctors are reimbursed for Medicare patients in the future and provide fresh money for a health program for low-income children.

The measure also contains $7 billion for the health centers over the next two years. Obama's 2010 health care law provided extra money for the health centers, but those additional funds end Oct. 1 and the $7 billion would keep the health centers at current levels.

House leaders are hoping to push the Medicare package through Congress by the time lawmakers begin a two-week spring recess after next week. Its fate is particularly uncertain in the Senate, whose members have been mostly bystanders in the House talks.

Also criticizing the House pact Thursday was Sen. Ron Wyden, D-Ore., a ranking member on the Senate Finance Committee. He has objected because the House deal would extend funds for the Children's Health Insurance Program for two years instead of four, and because the agreement would boost Medicare costs for seniors, though mostly for those with the highest incomes.

"There has also been talk of including an abortion policy rider — a complete nonstarter that has no place in a bill about access to care for America's seniors and children," Wyden said in a statement.

Cecile Richards, president of the Planned Parenthood Action Fund, called it "outrageous" that "some politicians are using important legislation to advance their anti-abortion agenda on the backs of the most vulnerable."

Aides to Boehner declined to comment.