Bipartisan Deal on Health Care Issues Hits a Snag Among Senate Democrats

WASHINGTON — The deal is as politically remarkable as it is substantive: a long-term plan to finance health care for older Americans, pay doctors who accept Medicare and extend popular health care programs for children and the poor. It was cobbled together by none other than House Speaker John A. Boehner and Representative Nancy Pelosi, the leader of House Democrats, who rarely agree on anything, with the apparent blessing of a majority of their respective members.

Then along came a surprising impediment: Senator Harry Reid of Nevada, the minority leader, along with other Senate Democrats, objected to abortion restrictions in the bill and limits to an extension of a health insurance program for children. They have begun to undermine what was poised to be a sweeping bipartisan solution to several policy problems that have long vexed Congress.

It is a role in which Mr. Reid is becoming increasingly comfortable as he exploits his leverage in the minority to thwart his political opponents, even if that means an unusual split with Ms. Pelosi.

The House is expected to vote on the plan Thursday, but its fate in the Senate is unclear. The disagreements over the bill — aired in an unusually open fashion among leaders of the same party — were surprising and unsettling for Ms. Pelosi, whose staff members were privately questioning Mr. Reid’s strategy.

“This is what we could get done in the House,” Ms. Pelosi said on Tuesday. “I’m very proud of the product.”

While Senator Mitch McConnell of Kentucky, the majority leader, could possibly muster enough votes from his own party and Democrats to drag a House-passed bill to passage, the conflict reflects a new dynamic in Congress, in which Senate Democrats are assuming the role played for years by House Republicans — waging an ideological fight from a disadvantaged position — and Republicans are eager to prove themselves good stewards of government.

At the same time, the debate over abortion is increasingly surfacing in legislative battles. Abortion rights supporters, concerned about a provision in the House bill, say they are continuing to lose ground in Congress with measures that seek to trim away at access. “We are trying to change that history, and we keep losing,” said Senator Dianne Feinstein, Democrat of California, on the floor of the Senate last week, when a bill to aid victims of sexual trafficking stalled over another abortion component.

Mr. Reid is using his power to filibuster bills and toss up chaff — a role Senate Republicans enjoyed for several years — to push back on anything Mr. McConnell may wish to accomplish. “There seems to be a pattern of Harry Reid whipping his members into a frenzy,” said Senator Shelley Moore Capito, Republican of West Virginia.

For years, Congress has had to settle for temporary patches to prevent deep cuts in Medicare payments to doctors, like a 21 percent cut scheduled to take effect April 1 if Congress does not intervene.

The House measure would permanently remove the threat of such cuts, and would require some higher-income Medicare beneficiaries to pay higher premiums, a change Republicans hail as a major reform. It also would renew the popular Children’s Health Insurance Program and provide $7.2 billion for community health centers — crucial to both rural and urban areas where doctors are scarce — over two years.

The compromise between Mr. Boehner and Ms. Pelosi had something for everyone to dislike. Democrats for the most part were not happy about the premium increases and the fact that the children’s health program extension lasts two years rather than four. And some Republicans were displeased that over half the cost of the package, which is estimated to total $200 billion over 10 years, was not paid for.

But many Senate Democrats have expressed opposition to the bill because they believe the measure codifies abortion restrictions beyond the longstanding language already in many health care spending laws.

“I don’t like it,” Ms. Feinstein said. Over the weekend, several Democrats on the Senate Finance Committee, led by Senator Ron Wyden of Oregon, expressed distress about the bill. “We want to be clear that any legislation of this magnitude sent to the Senate must be balanced,” the senators wrote. “Unfortunately, our current understanding of what the House is negotiating does not sufficiently pass that test.”

Mr. Reid took up the fight as well. “I’ll stand up for women against Republican efforts to codify and expand the scope of Hyde restrictions,” he wrote in a Twitter message on Friday, referring to the Hyde Amendment, which generally prohibits taxpayer funds from being used for abortions. On Tuesday, he said he was waiting to read the bill.

For their part, House Democrats, now well accustomed to life in the minority, said their Senate colleagues ought to embrace the bipartisan deal. Abortion rights advocates in the House also pushed back on the idea that the measure imposes additional restrictions.

“We will be supporting this bipartisan compromise,” said Representative Louise M. Slaughter, Democrat of New York, and Representative Diana DeGette, Democrat of Colorado, in a joint statement. “And we encourage other members of the Pro-Choice Caucus to do the same.”

Since the 1970s, Congress has imposed restrictions on the use of federal money for abortions. A day after signing the Affordable Care Act in 2010, President Obama issued an executive order stating that money provided in the law to community health centers generally could not be used for abortion services, except in cases of rape or incest, or when the life of the woman would be endangered.

Mr. Obama had promised to issue the order as part of his effort to win the support of several anti-abortion congressional Democrats whose votes were needed for passage of the Affordable Care Act.

Daniel R. Hawkins Jr., a senior vice president of the National Association of Community Health Centers, which represents 9,000 clinics around the country, said he was perplexed by the furor.

“I do not know of a single community health center that has performed a single abortion any time anywhere in my 45 years in the business of working with community health centers,” Mr. Hawkins said. But he added, “Community health centers provide prenatal care, delivery services and postpartum care to half a million women a year.”

Most Senate Republicans are expected to support the measure. “I think we have to bite the bullet,” said Senator Orrin G. Hatch, Republican of Utah and chairman of the Senate Finance Committee. “I understand Pelosi is taking this quite personally.”

Should the bill receive a strong vote from both parties on Thursday in the House, Senate Democrats will be under pressure to help push it over the line. “For an issue that has been plaguing us for years,” said Senator Mark Warner of Virginia, “if there is a bipartisan compromise that comes out of the House, it deserves a look.”

However, nearly a dozen Democrats expressed skepticism. “The Democrats are going to stick together here,” said Senator Sherrod Brown, Democrat of Ohio. “I don’t see how you say yes to doctors and no to 10 million children.”