In an election year battle mixing birth control, religion and politics, Democrats narrowly blocked an effort by Senate Republicans to overturn President Barack Obama's order that most employers or their insurers cover the cost of contraceptives.
The 51-48 vote on Thursday killed a measure that would have allowed employers and insurers to opt out of portions of the president's health care law they found morally objectionable. That would have included the law's requirement to cover the costs of birth control.
Sen. Olympia Snowe, who this week dropped her re-election bid and cited frustration with the polarized Congress, cast the lone Republican vote to block the measure. Two Democrats up for re-election and one who is retiring voted against Obama's requirement.
Majority Democrats said the legislation would have allowed employers and insurers to avoid virtually any medical treatment with the mere mention of a moral or religious objection.
"We have never had a conscience clause for insurance companies," said Sen. Barbara Boxer, D-Calif. Insurers, she said, don't need an invitation to deny coverage for medical treatment. "A lot of them don't have any consciences. They'll take it."
Republicans argued that the requirement under the health care overhaul violates the First Amendment's guarantee of religious freedom by forcing insurers and employers to pay for contraception for workers even if the employers' faith forbids its use. Roman Catholic leaders have strongly opposed the requirement.
The Senate vote aside, the debate "won't be over until the administration figures out how to accommodate people's religious views as it relates to these mandates," said the measure's sponsor, Sen. Roy Blunt, R-Mo. "This is a debate that might be settled at that building across the street," he said, referring to the Supreme Court.
Such cultural issues have been prominent in this presidential election year, with Republican presidential candidates casting Obama's health care law as government overreach into the most personal types of medical decisions. The contraception policy in particular touches on religious and women's rights important to the activists at the core of each party.
A majority of Americans support the use of contraceptives. The public is generally in favor of requiring birth control coverage for employees of religiously affiliated employers, according to a CBS News/New York Times poll Feb. 8-13. The survey found that 61 percent favor the mandate, while 31 percent oppose it. Catholics support the requirement at about the same rate as all Americans.
The legislative fight came after the controversy had already forced the White House to budge somewhat. The administration initially ruled that religious-affiliated institutions such as hospitals and universities must include free birth control coverage in their employee health plans. As protests mounted from Catholic leaders and many Republicans, Obama announced an adjustment: Religious employers could opt out, but insurance companies must then pay for the birth control coverage.
Defending the White House stand on Thursday, Vice President Joe Biden also gave voice to the way it came together.
Said Biden: "It got screwed up in the first iteration."
Republicans say it's still not fixed since many employers pay insurers to cover their workers and in effect underwrite the contraception coverage.
GOP senators insisted on attaching Blunt's amendment to an unrelated transportation bill. Democrats cast the move as just one of a number of attempts by the GOP to roll back long-established women's rights.
Both sides protested strenuously that an issue affecting millions of Americans was being used for political gain. But in reality, virtually the entire four-day discussion in the Senate was about election-year strategy. With the presidency and congressional majorities at stake, both sides used the issue to rally their bases of support.
Republicans sought to hold together conservatives and others in the midst of their party's unsettled battle for the presidential nomination. And for Obama, there is no constituency more crucial to his re-election chances than women.
In the end, the vote hung on a handful of centrists as Democrats chose a parliamentary maneuver that required only 50 votes to kill the amendment.
Snowe, R-Maine, had said the GOP amendment was written too broadly for her to support. Democrats voting in favor of the measure were Joe Manchin of West Virginia and Bob Casey of Pennsylvania, both up for re-election, and Ben Nelson of Nebraska, who is retiring.
Democrats saw broader symbolism in Snowe's decisions. "If Republicans keep this up, they're going to drive away independent voters, women and men, just as they are driving moderates out of their caucuses," said Sen. Chuck Schumer of New York.
But Republicans kept one such lawmaker in the fold on the vote, Snowe's fellow senator from Maine. Susan Collins kept all sides on edge until minutes before the vote, saying on the Senate floor that she was troubled that the administration could not assure her that faith-based self-insured organizations would be protected from the mandate to cover contraception.
"I feel that I have to vote for Senator Blunt's amendment," she said.
On the presidential campaign trail, GOP front-runner Mitt Romney apparently stumbled over a question of whether he supported the amendment, in the end saying that he did, "of course." His main challenger, former Pennsylvania Sen. Rick Santorum, has said that contraception conflicts with his Roman Catholic beliefs.
The Obama administration and congressional Democrats said Blunt's measure was so broad it could allow employers to opt out of virtually any kind of medical treatment.
"This proposal isn't limited to contraception, nor is it limited to any preventive service. Any employer could restrict access to any service they say they object to," said Secretary of Health and Human Resources Kathleen Sebelius. "The Obama administration believes that decisions about medical care should be made by a woman and her doctor, not a woman and her boss."
Associated Press writer Larry Margasak contributed to this report.