The issues of illegal immigration and abortion have split Nebraska's Republican-dominated politics, with some conservatives supporting a plan to offer state aid to pregnant women in the country illegally and others arguing that doing so would violate a bedrock GOP belief.
The measure has made opponents of typical allies, with Republican Gov. Dave Heineman pushing hard against the proposal, even while noting his strong opposition to abortion. The Republican speaker of the Legislature, Mike Flood, has taken the opposite position, supporting the measure while stating that he has always been against illegal immigration.
The measure would require the state to pay for prenatal care to low-income women who have entered the U.S. illegally. It would extend coverage to an estimated 1,162 fetuses each year at a cost of $650,000 in state money and $1.9 million in federal tax dollars.
The measure advanced through first of three required votes Tuesday night, 30-16. Fourteen of the "yes" votes came from Republicans, who joined with a contingent of typically out-numbered Democrats.
In an unusually terse news conference Wednesday, Heineman said he was "extraordinarily disappointed" with the Legislature's veto-proof vote to support the measure.
Lawmakers later Wednesday night advanced the bill through the second of three votes, 29-16, one vote short of being veto-proof.
Heineman singled out Flood, saying he and other lawmakers were wrong to support taxpayer-funded benefits to illegal immigrants, regardless of the reason.
"Unless you and the Legislature reverse course, the legacy of this session will be one in which illegals were given preferential treatment over legal Nebraska citizens," Heineman said, reading from a letter that his staff hand-delivered to the speaker's office. "This will be a session remembered for a tax increase on legal, working Nebraskan men and women while illegal aliens were provided taxpayer-funded benefits."
Heineman said the issue revolves around immigration, not abortion, and that the bill would turn Nebraska into "a magnet for illegal aliens."
He said churches and private charities, not the state, should support pregnant women who have entered the country illegally.
"I am one of the most pro-life governors in America," he said. "This is about illegal immigration, and Nebraskans know that."
Flood, who has sponsored legislation banning late-term abortions, said the immigration concern is important but trumped by the health concerns for unborn children who lack access to prenatal vitamins, ultrasounds, doctors and nurses. He said medical data do not support the notion that pregnant illegal immigrants would move to a state for prenatal care.
"For me, when you weigh the two issues, you have a baby's life and health in the balance," Flood said. "That's weighted more. Take illegal immigration and in-state tuition. That one, I think, is weighted differently, because there is no life at stake."
Abortion opponents said the vote marked an important victory to assuage their fears about the health of unborn children, and the prospect that women without access to care could seek abortions.
"This child's health and future and well-being are potentially at stake," said Greg Schleppenbach, a spokesman for the Nebraska Catholic Conference. "It should be weighted much more toward care for this human being, rather than strict adherence to immigration law."
Supporters argue that by helping women have a healthy pregnancy, the state would reduce infant deaths and ultimately save money by avoiding emergency births, long hospital stays and treatment for children who develop complications.
Opponents say the bill would reward unlawful behavior with taxpayer-funded benefits and could attract more illegal immigrants to Nebraska.
Roughly 870 illegal immigrants and 750 legal residents lost coverage in 2010, when the federal government ordered the state to stop offering the benefits through Medicaid. The bill would enroll women under the federal Children's Health Insurance Program, which allows fetuses to qualify federal- and state-funded care.
Opponents said the money is needed elsewhere.
"Nobody wants to see a baby suffer. Nobody wants to see a baby come into this world who has issues _ none of us do," said Ogallala Sen. Ken Schilz. "But on the other side of that, there is an absolute cost to all of this, and that cost has to be borne by someone."
A group of lawmakers tried in 2010 to create a federally sanctioned program that would have qualified fetuses for coverage, but the effort failed under the weight of anti-illegal immigration sentiment and election-year anxiety.
Some health care institutions, including a practice at the University of Nebraska Medical Center, have helped fill the void by providing free or discounted prenatal services to women who lost coverage. It's unclear how many benefited.
Health care providers that serve pregnant women say the loss of coverage has endangered women and their pregnancies.
Rebecca Rayman, executive director of the Good Neighbor Community Health Center in Columbus, said the loss of Medicaid coverage has drawn more women to her clinic, which is federally recognized and cannot deny service based on an inability to pay.
She said the cuts have also meant longer drives for women _ 150 miles, in some cases _ who often lack reliable transportation. The center's average patient load of 139 pregnant women in March 2010 surged last year to 366.
The amount the clinic received in Medicaid reimbursement fell to $333,000 last year, compared with nearly $524,000 in 2009, which forced cuts to dental services and other less-pressing needs. Rayman said four fetuses died after the subsidized care ended.
"The whole immigration argument is puzzling to me," she said. "When I think of the United States, we don't punish the innocent. And a newborn child is innocent. It's not an immigration issue. It's a health care issue."
Abortion is an especially important issue in Nebraska, which has become a national leader in efforts to limit the procedure. In 2010, the state became the first to ban abortions after 20 weeks of gestation based on the disputed notion that a fetus can feel pain at that point.
"That baby, at 20 weeks and one day, is a baby _ not a fetus," said Republican Sen. Sen. Bob Krist, of Omaha. "At 20 weeks, that is a future citizen of the United States, and a fellow Nebraskan. If you deny services for the baby or the life support system _ the mother _ you are harming a future Nebraskan."