After attempts to block abortion funding in health care failed with the demise of the Senate’s health care bill early Friday morning, pro-life leaders vowed to keep fighting.

“Despite the Senate’s decision not to pass legislation to repeal and replace the Affordable Care Act last night, the task of reforming the healthcare system still remains,” Bishop Frank Dewane, chair of the U.S. bishops’ domestic justice and human development committee, said on Friday. “The current healthcare system is not financially sustainable, lacks full Hyde protections and conscience rights, and is inaccessible to many immigrants,” he said. “Inaction will result in harm for too many people.”

The Senate’s efforts to pass a bill repealing the Affordable Care Act (ACA) and replacing it met a narrow 51-49 defeat early Friday morning, with Sen. John McCain (R-Ariz.) providing the decisive “no” vote.

After the House passed the American Health Care Act, which both repealed and replaced the ACA, the Senate introduced its own replacement proposal, the Better Care Reconciliation Act. Both bills were determined by the Congressional Budget Office to result in deficit reductions, but also an increase in the number of uninsured persons over 10 years by 22-23 million.

The bills contained pro-life provisions, but pro-life leaders were concerned that a key pro-life provision — prohibiting any tax credits from paying for health plans with abortion coverage — would not survive in the Senate, as the Senate Parliamentarian could determine that it violated the Byrd Rule. That rule mandates that when a bill is passed through the process of reconciliation, reserved for budgetary measures and only requiring 50 votes rather than the normal 60 for passage, it must not contain “extraneous matter.” Thus, if a provision did not meet the standards for reconciliation, it would require 60 votes, a near impossibility in the closely-divided Senate.  

Any health care vote would be close, as Republicans currently hold a narrow 52-48 majority in the chamber but two of their members, Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) were already opposed to existing Senate health care proposals, along with the defunding of Planned Parenthood. Thus for any health care measure to succeed without the aid of Democrats, Republicans could suffer no more desertions from party members and would require the vote of Vice President Mike Pence to break a 50-50 tie.

Bishop Dewane had said that the House-passed bill — the American Health Care Act —and the Senate health care proposals included laudable pro-life protections against taxpayer funding of health plans with abortion coverage, but the House bill had “serious flaws,” and the Senate bill was “unacceptable.”

Both bills were flawed because of cuts to Medicaid funding and other provisions that would result in higher health care costs for the poor, the elderly, and the seriously ill, Bishop Dewane said. They also did not offer sufficient conscience protections for health care workers and doctors, he said.

The support of pro-life groups for the health care proposals hinged on two key provisions, Hyde language protecting tax credits from being used to pay for plans with abortion coverage, and stripping Planned Parenthood of federal Medicaid reimbursements for one year. Efforts to include the provisions in a Senate bill hit a snag on July 21, when the Senate Parliamentarian announced that the protections violated the Byrd Rule and would thus require 60 votes, making their passage all-but-impossible in the closely-divided Senate.

After Senate Republicans were unable to pass their own health care proposals — multiple versions of the Better Care Reconciliation Act — they successfully opened debate on Tuesday to repeal and replace the current health care law, although it was not clear at the time which replacement bill they would ultimately vote on. Then, the Susan B. Anthony List announced that they would be following the debate closely and working to ensure that the key pro-life provisions were included in a final bill.

“In the coming hours and days, we will be working amendment by amendment to make sure pro-life protections remain in the bill, knowing that all elements of the legislation could be subject to very close votes, as well as decisions by the parliamentarian,” Marjorie Dannenfelser, president of the Susan B. Anthony List, stated on July 25.

During debate on Wednesday and Thursday, multiple ACA replacement proposals were voted down. On Thursday, Senators quickly drafted what was ultimately the final proposal, called “skinny repeal.” The “skinny repeal” included stripping Planned Parenthood of Medicaid reimbursements and redirecting over $400 million to “federally-qualified health centers” that do not offer abortions. Planned Parenthood Action fought the proposal, saying in a tweet that it would “block patients…from coming to Planned Parenthood for care.”

That amendment, sponsored by Majority Leader Mitch McConnell, repealed the ACA’s individual mandate that everyone purchase health insurance or risk being penalized with heavy fines. Susan B. Anthony List supported this proposal, saying that Americans would no longer be forced to purchase health insurance “even if their only insurance options cover abortion,” as was previously the case in several states.

According to a 2014 report by the Government Accountability Office, the health exchanges in five states — Connecticut, Hawaii, New Jersey, Rhode Island, and Vermont -- offered only plans with abortion coverage, and none without abortion coverage. However, Hyde language establishing sufficient safeguards against tax credits being used to pay for abortion coverage still needed to be included in the bill.

Sen. Luther Strange (R-Ala.) introduced an amendment on Thursday which he said would survive the Parliamentarian’s standards. Previously, the Affordable Care Act had actually opened up avenues for taxpayer funding of abortion coverage, through federal subsidies and tax credits being used to pay for plans with abortion coverage offered on the exchanges. Although an executive order by President Obama forbade the subsidies and credits from being used to pay for abortion coverage — abortions were meant to be billed separately from other coverage in federally-subsidized plans — such promises amounted to only an “accounting gimmick,” former Congressman Joe Pitts explained in a February op-ed in The Hill. They did not constitute real protections against taxpayer funding of abortions, he said.

March for Life Action estimated that, according to numbers from the Guttmacher Institute, 100,000 abortions per year were performed under this ACA “reimbursement plan.” And although the amount of money in available tax credits would shrink under the Senate proposal, the funding of abortions would continue, they said.

Strange’s amendment, the senator explained in a speech on the floor, would protect tax credits from being used to pay for abortion coverage. It would drop the value of tax credits paying for abortion coverage to 10 percent. “The remaining 90 percent,” he said, would be “made available as Hyde-protected monthly payments to insurers to benefit the same people who relied on those tax credits.”

“For too many, access to healthcare coverage comes only with the restriction of deeply-held personal convictions about the sanctity of human life,” Sen. Strange said on the Senate floor. “The amendment before us offers us the opportunity to end the flow of taxpayer dollars to abortion procedures, once and for all. It allows Hyde protections to be extended to all funds appropriated through the healthcare legislation we are considering today.”

Finally, the health care bill came to a vote on the Senate floor in the middle of the night on Thursday. Sen. McCain proved to be the deciding vote against the measure, as it failed 51-49. The failure left pro-life groups committed to fighting the funding of abortion coverage under the ACA, which still continues.

“Leaving Capitol. Fight for another day,” Dannenfelser tweeted early on Friday morning.

Later Friday morning, Bishop Dewane said that the current health care system still needs to be reformed, and outlined the principles that must guide future reform. “A moment has opened for Congress, and indeed all Americans, to set aside party and personal political interest and pursue the common good of our nation and its people, especially the most vulnerable,” he said. Reform must not include changes to Medicaid and the safety net that would result in reduced coverage or higher costs for “the poor, immigrants, or any others at the margins,” he said. However, it must include the pro-life protections against taxpayer funding of abortions, as well as conscience protections that were lacking in the House and Senate bills, he said. And it must “address the real probability of collapsing insurance markets and the corresponding loss of genuine affordability for those with limited means.”

Dannenfelser said that the defeat of the health care bill was only a temporary loss amidst historic pro-life gains. “With a pro-life House, Senate, and White House, last night we were poised for a big win. It was not the night for that win,” she said. “This is a set-back in the middle of a succession of tremendous gains. It is emblematic of all successful human rights movements in our nation’s history. The power of the movement which strikes at the human heart and the inexorable march of gains, while interrupted at times, cannot and will not cease until clear and certain victory. Then and only then will we rest.”

The organization will be active in promoting pro-life Senate candidates in next year’s elections, she said, to produce “a bigger, bolder, more courageous pro-life majority” in the Senate. “SBA List’s field operation — which knocked more than 1.1 million doors in 2016 — has already begun in two 2018 battlegrounds, Florida and Ohio, with an aggressive plan to move into more battlegrounds by the end of the year,” she said.