While Congress and the White House dither on healthcare reform, state lawmakers across the country grapple with the practicalities of the uninsured, discriminatory gender rating and mandated care.

In Colorado, a seemingly feel-good bill to require insurance plans to cover maternity care and contraception is fraught with problems that could have and should have been solved by the long-delayed federal legislation.

However, in today’s highly charged political realm with spiraling state budget deficits and the lingering effects of a recession that just won’t quit, even motherhood and apple pie can’t get a unanimous vote in a crucial election year.

A reproductive healthcare mandate bill passed its first major hurdle on a largely party line 37-27 vote Tuesday in the Colorado House with some surprising defections by pro-choice lawmakers.

A peek behind the legislative sausage-making curtain exemplifies the deep political divisions being created with incremental approaches by states to fix an intractable and unsustainable national healthcare crisis.

Emilie Ailts, executive director of NARAL Pro-Choice Colorado, laid down a pre-vote challenge to conservative lawmakers to channel their much ballyhooed family values:

Will the anti-abortion, anti-birth control, anti-comprehensive sex education politicians vote their purported values, which they claim are about healthy babies and healthy families? House Bill 1021 provides a clear opportunity for these anti-choice lawmakers to enact responsible policies that can reduce the need for abortion by ensuring women have access to the prenatal care they need for healthy pregnancies.

Twenty-six of the “no” votes were cast by GOP members. None of the dozen Republican House members with longstanding anti-choice records who voted against the bill, including some who amended and approved it in committee days before, returned calls for comment. The amendments that significantly watered down the bill and specifically noted that abortion care was not covered were eventually thrown out by the House after flexing its 11-vote majority.

However, the biggest danger with the bill is the caustic stew of ideological posturing, political gamesmanship and over-promised and under-delivered healthcare reform that could leave a bitter taste in the mouths of an increasingly surly mid-term electorate.

Two unexpected opposition votes from pro-choice lawmakers are especially telling about the skittish local mood.

Concerns about insurance affordability for rural women

Rep. Ellen Roberts, a moderate Republican from rural southwest Colorado, expressed reservations about how the bill was being fast tracked through committee and ultimately voted against it.

“It’s not content specific,” said Roberts explaining her pained vote against maternity care. “I’ve always been a strong supporter of women’s issues.”

Roberts primary beef is the already limited options for rural communities to buy into healthcare plans. Few insurance carriers offer individual or small group plans in remote regions of the state. That’s coupled with broad public perceptions that a coverage mandate — even a widely popular one like maternity care — would increase premiums to the point of becoming unaffordable

“My constituents are contacting me seriously two to three times a week telling me ‘no more mandates’ because we are going to have to drop our insurance,” said Roberts.

Those with the gold make the rules

The Durango Republican was also miffed that House Democratic leaders knuckled down and bypassed the state’s Commission on Mandated Health Benefits which provides nonpartisan cost benefit analysis to lawmakers.

“That’s the kind of information I need to make an educated vote,” said Roberts acknowledging that both Republicans and Democrats alike have ignored the cumbersome committee when pushing though legislation. The 11-member commission of insurance experts, health policy advocates and consumers has been widely criticized for its slow pace in reviewing bills often introduced at a breakneck pace during the state’s three-month legislative session.

Roberts co-sponsored legislation with fellow Western Slope lawmaker Rep. Kathleen Curry, U-Gunnison, to reform the commission created by state statute in 2003 and which is set to expire in July.

They proposed handing the mandate review process to the nonpartisan Legislative Council and implementing a one-year timeout on any new state mandates while Congress sorts out its overdue national healthcare reform plan. The internal bickering over the mandate process at the state capitol became so heated that Curry, a staunch pro-choice Democrat, resigned from the party in December.

As expected, at the behest of statehouse leadership, their bill was killed in committee.

“Obviously in a political year you don’t enjoy making some of these votes because it will be used against you in the campaign cycle.” said Roberts. “I can’t be guided by that. I have to try to do the right thing.”

While Roberts and Curry duke it out over a seemingly obscure policy issue the state legislature risks losing two stalwart pro-choice voices. Roberts is term-limited and is seeking a Senate seat in a evenly partisan district. Meanwhile, Curry, who voted to support the maternity mandate bill, is now an unaffiliated candidate. She must petition onto the ballot to seek reelection in 2010. And she’s already drawn a conservative, anti-choice Republican challenger.

Solomon’s choice for a pro-choice Dem

The decision to vote against the mandate was also a difficult one for Rep. Jim Riesberg, chairman of the House Health and Human Services Committee.

“Primarily, I’m in support of what this bill is trying to do,” explained Riesberg, a pro-choice Democrat from rural Greeley. “But what I’m more concerned about is the 700,000 people in Colorado who have no insurance whatsoever, many of whom are women.”

Riesberg claims 85 percent of insured Colorado women already have access to maternity care in their policies. Yet, on the flipside, he said he would have supported a bill to solely mandate coverage of contraceptive care since that’s less likely to be covered by insurance than childbirth expenses.

“I’m very concerned that an insurance company would pay for a pregnancy but wouldn’t to tie a woman’s tubes,” he said elaborating on his vote conundrum. “I mean that doesn’t make sense to me. I just hate to expand coverage for those who have something instead of expanding coverage for those who have nothing.”

Riesberg also confirmed that the maternity care mandate will effect a very small number of women because many health insurance plans are not subject to Colorado law. About half of insured Coloradans have policies regulated by the federal Employee Retirement Income Security Act (ERISA), such as self-funded employer insurance plan and publicly-funded programs, like Medicare, Medicaid and federal employee benefits.

Even the Colorado Division of Insurance can’t pinpoint the precise number of women with private insurance policies the mandate could potentially benefit. But both Roberts and Riesberg echoed the same concern: it’s likely that few women could afford to maintain their coverage with reproductive health mandates since premiums for individual plans are already skyrocketing with annual double-digit increases.

Despite Roberts and Riesberg’s concerns, the bill now moves to the Democratically-controlled Colorado Senate where the upper chamber co-sponsor predicts easy passage.

Senate sponsor vows to fight

“It’s a good strong health care bill for families that buy individual policies,” remarked Sen. Joyce Foster. “For me, it’s my most important bill this session. This bill is long overdue.”

Foster’s co-sponsor is Sen. Betty Boyd, a veteran lawmaker with a strong history of passing pro-choice, pro-family bills through the contentious chamber.

Foster is undaunted by the prospects of going up against a fierce ultra-conservative bloc of Republican senators whose anti-choice antics are legendary. Colorado Springs Sen. Dave Schultheis last year said the HIV testing of pregnant women encourages sexual promiscuity. Not to be outdone, a week later, Sens. Larry Liston and Kevin Lundberg raised the old, tired canard that oral contraception is just a fancy word for abortion.

“Bring ’em on,” she taunted.