The Senate has started debate on the much-anticipated health care reform bill. As they discuss the bill, senators face a crucial decision on abortion. The Senate must remove language in the house bill that would otherwise reduce access to abortion coverage for millions of American women.

The house bill includes an amendment by Representatives Bart Stupak (D-Mich.) and Bart Pitts (R-Pa.). The Stupak amendment would prohibit using federal subsidies to purchase heath insurance plans that cover abortion, except in cases of rape, incest or danger to the mother’s life.

Proponents argue that the Stupak amendment would only continue current restrictions on using federal funds for abortion. The amendment’s supporters note that public insurance programs such as Medicaid are already prohibited from covering abortion; this restriction would also apply to any government-run public option.

But the Stupak amendment would go much further than current restrictions on abortion coverage.

Both the Senate and House versions of health care reform would create a Health Insurance Exchange, where eligible Americans could choose from competing private insurance policies or the public option. Both versions also offer federal subsidies: known as affordability credits: to help people purchase health insurance who are making up to four times the federal poverty level.

The Stupak amendment would prohibit using these subsidies to purchase any health insurance plan that covers elective abortions. Women who want to purchase a health care plan that covers abortion could use affordability credits to buy a basic health insurance plan, but would have to use personal funds to purchase a supplemental plan to cover abortion.

The Stupak amendment would jeopardize reproductive health care for working poor and lower middle class Americans. According to the Los Angeles Times, 400 percent of the federal poverty level for a single woman represents an annual income of $43,000; the majority of women buying health coverage on the exchange would have lower incomes. Many of these women could not afford purchasing a supplemental insurance plan.

But the effects of the amendment would be even more drastic. Because many: if not most: women using the Exchange would not be able to afford to purchase a reproductive health care supplement, insurers would see little demand for these plans. Many pro-choice groups convincingly argue that it would make little business sense for insurers to even offer supplemental plans, given the additional expense of administering them separately. Thus, even women who could afford to purchase abortion coverage might be unable to do so.

If the Stupak amendment, or similar language, is included in the final health care reform bill, lower- and middle-class women will face reduced access to reproductive health care. The amendment will, in effect, make abortions available only to the very poor (who receive coverage through state-administered health programs) and the wealthy.

Thankfully, this week the Senate voted down an amendment that would have inserted a similar amendment into their version of the health care bill. When the Senate passes the bill, a joint House-Senate conference committee will decide on a final version to be voted on by both houses. The Democrats must make sure that the Stupak amendment stays out of the final product.