This article is from the archive of our partner National Journal

Tensions are roiling between Harry Reid and Nancy Pelosi over an unusual point of contention for the two top Democrats: abortion policy.

The fight is serious enough that it could kill the House Minority Leader's ambitious deal with Republicans on the so-called "doc fix."

Even as Senate Democrats waged war over an expansion of the Hyde Amendment—which prevents federal funds from being used to cover abortions—on a human trafficking bill last week, Pelosi was penning a deal with Speaker John Boehner to eliminate the Medicare "sustainable growth rate" that includes another controversial Hyde Amendment provision.

Reid has made unambiguously clear to his counterpart in the House that such a deal would be unacceptable. And Senate Finance Committee Chairman Ron Wyden, who has championed a permanent solution for SGR—a routine congressional headache—indicated last week that Hyde-like language would be a "complete nonstarter" (though an aide emphasized that Wyden's statement was based on reports and that he hadn't seen the official language or discussed it with Pelosi).

(RELATED: "Doc Fix" Deal Still Has a Long Way To Go)

The two top Democrats have split repeatedly in recent months over when to compromise with the GOP and when to hold firm. In this case, Pelosi pushed forward anyway, including the Hyde Amendment language in the doc-fix bill House leaders were set to file Monday evening.

The bicameral tension among Democrats is coming to a head as Congress faces an ever-shrinking timeline to get some kind of deal—permanent or temporary—passed before doctors face a 20 percent payment cut from Medicare after March 31.

Pelosi disputes that the use of the Hyde Amendment in the measure she has worked on for weeks with Boehner constitutes an expansion. The funding for community health clinics at the center of the dispute already is subject to the Hyde Amendment, under an executive order signed by President Obama in 2010. 

A House Democratic aide said Monday evening that Pelosi had worked with members of the House Pro-Choice Caucus to get additional language in the SGR package making clear that the Hyde language would expire after two years, when funding for the community health clinics runs out. After that, Congress could alter the language. But over these next two years, the aide said, the House will be controlled by Republicans. The language reflects the executive order Obama signed as part of the Affordable Care Act. "The status quo is the status quo," the aide said.

(RELATED: Everybody Hates the "Doc Fix," and They Want It to Die)

But Senate Democratic leaders and scores of pro-abortion rights groups have said the change is much more serious than Pelosi is letting on. Because the funds already are subject to the Hyde amendment, the only point in adding this language is to insert it into U.S. code and expand the anti-abortion amendment's reach, opponents argue.

"If this language is included in the SGR with the agreement of the pro-choice members, it will embolden opponents to place it in other laws," the National Women's Law Center said in a review of the deal. "It is always much more difficult to remove language that has been enacted than to stop it in the first place. The best example of this is the Hyde provision itself, which was enacted 'just for one year' 37 years ago."

That this is coming on the heels of the Hyde Amendment fight in the Senate last week isn't helping Senate Democrats to see this from Pelosi's perspective. "In the absence of that, maybe the attitudes would have been a little bit different, but because of that there's a heightened sensitivity," a Senate Democratic aide said.

This is just the latest episode of squabbling between the two Democratic leaders. Back in December, Pelosi said she opposed the so-called "Cromnibus" strategy to fund the federal government, encouraging her members to oppose the bill that would undercut parts of Dodd-Frank. Reid said he supported it and worked with Pelosi's No. 2, Steny Hoyer, as well as the White House to pass the bill over her head.

When House Republican leaders floated a three-week continuing resolution to fund the Department of Homeland Security while they sought a long-term solution, Pelosi called it unacceptable. Reid said he was open to it.

In a turning of the tables, Reid's office now feels that Pelosi is actually giving up too much leverage in a situation where, a Reid aide said, she has Boehner "over a barrel." The House Speaker is tired of waging war with his conference over the doc fix every year (and sometimes even more frequently than that). Conservatives continue to cite the last doc-fix vote, which leadership passed under a voice vote while several conservative members were off the floor, as their ultimate breaking point with leadership.

(RELATED: House Leaders Want to "Jam the Senate" With Bipartisan "Doc Fix" Deal)

The House tentatively is expected to vote Thursday on the chamber's bipartisan doc-fix deal that's been hammered out in the last few weeks, a Republican leadership aide told National Journal. That leaves the Senate only Friday to take up the bill before it leaves for a two-week recess.

To get a vote in the upper chamber then would require unanimous consent. But that seems unlikely with Senate Democrats digging in against the reported deal because of the Hyde Amendment language and because it doesn't extend the Children's Health Insurance Program as long as they would like. There is also likely to be opposition from some conservatives who won't be happy it's not fully paid for.

That's a problem because the SGR patch expires March 31, and physicians would face a 20 percent payment cut from Medicare if Congress doesn't pass something. The Obama administration could potentially buy some time before the cuts took effect, but that might not matter with the impasse over the abortion language. A temporary patch, as has been done 17 times over the years, still is considered the fallback option, but congressional leaders are desperate to resolve the issue for good.

The $200 billion deal being discussed would eliminate the SGR formula, expand means-testing in Medicare and extend CHIP for two years. Democrats want a four-year CHIP extension, which their members on the Senate Finance Committee called a "necessity" over the weekend. About $70 billion of the cost would be directly paid for through beneficiary and provider cuts.

"Only way to process SGR before the end of the week is with unanimous consent, period," a Democratic aide said. "Gut reaction is that it'll be pretty darn hard to get a consent from either side on a bill that includes a ton of deficit spending, Medicare cuts and abortion language."

Even if members find a way around the doc-fix deadline, it's not clear that they'll have the votes to pass it in the Senate. Just four Democrats voted with Republicans last week to pass a human trafficking bill that had Hyde Amendment language attached. Even with the entire Republican conference on board—a big if with conservative objections on cost—they'd need six to pass the deal.

This article is from the archive of our partner National Journal.

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