The proposed health care bill is bringing a decades-old debate over abortion to something of a climax, pitting powerful abortion rights groups, women’s organizations and medical associations against the wealthy religious organizations and anti-abortion groups that most Republicans lean on. Funding for Planned Parenthood has been a perennial issue since Republicans won control of the House in 2010, and each time, Republican leaders have finessed it by saying the matter would be settled in a broader health care bill.
That broader bill is now here. The single-year funding cutoff has obscure roots. The Congressional Budget Office has ruled that cutting off money to Planned Parenthood would actually increase federal spending — by depriving women of birth control and increasing the number of births covered by Medicaid. Republicans are trying to maximize the deficit reduction in their health care bill.
But even if the defunding provision is for a single year, anti-abortion activists see a beachhead they must defend, then fight from.
“That one-year mark is not going to pass quietly,” said John Seago, legislative director at Texas Right to Life.
Groups on both sides of the debate have lobbying operations in place and millions of dollars at their disposal for the final sprint.
Planned Parenthood’s political wing invested $30 million to encourage voters to turn out in last year’s elections alone. That effort fell short, but it will introduce a blitz ahead of the Senate vote, using a surge of donations since Mr. Trump’s election to press supporters to call their senators. Protests are also planned in Washington.
“Sometimes you have this phenomenon where everyone freaks out in the moment, signs a petition and then goes back to their everyday life,” says Ilyse Hogue, president of Naral Pro-Choice America. “But that’s not what we’re seeing. We’re seeing really high levels of retention and engagement.”
Anti-abortion groups are also gearing up for the Senate vote. Ms. Collins plans to amend the health care bill to restore Planned Parenthood funding, giving Democrats a conundrum: They may strongly favor supporting Planned Parenthood, but Democratic aides say senators must decide whether the bill has a better chance of passing with or without the defunding provision. If they think the Collins amendment would help final passage, they are likely to vote against it, ensuring its defeat.
That would be fine for the anti-abortion forces.
“As the Republicans start negotiating with the Democrats or with more moderate members, this is one of the hot-button topics that comes up that they try to negotiate away,” Mr. Seago said. “We will keep pressure on the Texans in D.C. to ensure this isn’t a bargaining chip to make sure this bill goes across the finishing line.”
Kristan Hawkins, the president of Students for Life of America, an anti-abortion group, toured 80 college campuses this spring, preparing for this moment.
“We can’t afford to wait around. We can’t afford to rest on our laurels,” Ms. Hawkins said.
The proposed legislation, which Planned Parenthood labels “the worst bill for women’s health in a generation,” would strip the organization of federal funding for one year and bar any federal tax credits from being used to help buy private health plans that cover abortions.
With over 600 affiliate health centers across the country, Planned Parenthood serves 2.4 million people a year, three-quarters of whom have incomes at or below 150 percent of the federal poverty level.
The election of Mr. Trump has in some ways helped the group’s financial footing. Since November, contributions have poured in from big-name patrons such as Facebook’s chief operating officer, Sheryl Sandberg, and smaller donors alike.
But those new funds do not come close to compensating for the money that the bill would strip away. The national office and affiliates of Planned Parenthood together rely on reimbursements and grants from the government for more than 41 percent of their total $1.35 billion in revenue, according to the group’s latest annual report.
The showdown is hardly a surprise. Republicans threatened to shut down the government over continued Planned Parenthood funding two summers ago. Abortion dominated the budget fights of 2011, right after the Tea Party influx to the House. With a Republican in the White House, Planned Parenthood can no longer count on a veto as it did with Mr. Obama. The group has held over 2,200 events as diverse as marches and phone banks. It has delivered almost a million petitions and made over 157,400 calls to Congress as its volunteer base has ballooned.
“We basically have a pink army that we’re able to deploy,” said Paul Dillon, a spokesman at Planned Parenthood of Greater Washington and North Idaho.
This activism has been teamed with contingency planning at some affiliates in the event that the legislative battle is lost.
“A lot of us across the country are doing that, shoring up of our business, being more efficient and looking for alternative funding,” says Vicki Cowart, chief executive of Planned Parenthood of the Rocky Mountains, which serves about 100,000 patients a year across Colorado, southern Nevada, New Mexico and Wyoming.
Affiliates, and even individual clinics, face a different threat level based on geography and politics.
A Planned Parenthood center near Aspen, Colo., for example, receives generous funding from the affluent residents of the skiing community, Ms. Cowart explained. Two centers in Las Vegas just got part of a $1 million donation by the casino magnate Elaine Wynn.
Planned Parenthood of Orange and San Bernardino Counties in California sends both money and staff to other states in need of extra resources. And Planned Parenthood Southeast, which serves several Southern states, is now providing advice to teams elsewhere in the country on how to operate in an environment without generous government funding and local support.
“So much of this threat is something that we’ve been living with for decades already in the south,” said Staci Fox, head of Planned Parenthood Southeast, which has seven health centers in Georgia, Alabama and Mississippi.
But without federal assistance, such planning can go only so far. Remote centers serving poor patients without alternative health care providers have no fallback.
After last year’s election, Planned Parenthood of the Rocky Mountains decided to close six of its 29 health centers.