Saturday the U.S. Senate voted to begin debate on health system reform by a party line vote of 60-39. The Senate will consider H.R. 3590, the “Patient Protection and Affordable Care Act.” All Democrats and including independents voted for cloture, which allows debate to begin, while 39 Republicans voted against it.

Not all Senators who supported opening debate have said they will support the bill as it stands. There is expected to be vigorous debate on the bill, after the Thanksgiving holiday.

However, the addition of the ‘Stupak Amendment’ into the House bill, which pro-choice advocates are decrying and anti-choice advocates support, is putting Senate Majority Leader Harry Reid (Democrat, Nevada) into a difficult situation.

Pro-choice supporters say Stupak amendment exceeds the reach of the 1977 Hyde amendment, which prohibits public funding of most types of abortions. These supporters claim the Stupak Amendment would undermine a woman's ability to purchase plans that cover abortion, even if she pays the premiums on her own.

Senator Barbara Boxer and other Democratic senators held a meeting on November 10 to find a way forward with the bill, given the Stupak amendment. Some Senate Democrats may be willing to include language matching the Hyde amendment but may not be willing to go further than that.

Under the Stupak amendment, insurance companies that offer a plan under the proposed health insurance exchange that includes abortion coverage also must offer an identical plan without abortion coverage.

Also, Stupak's amendment would allow federal subsidy recipients to buy supplemental abortion coverage, or riders, using their own money. Such coverage so far has been offered in five states, according to Planned Parenthood: Kentucky, Idaho, Missouri, North Dakota and Oklahoma.