The new health care law prohibits women from using premium affordability tax credits or cost-sharing payments to pay for abortions but also reinforces states’ ability to prohibit insurers from providing any form of abortion coverage within the exchange. On Monday, before President Obama even signed the the Senate health care bill into law, a Missouri Senate committee voted 5-1 to advance a bill that would deny insurers the right to offer abortion coverage in any government exchange.

Missouri is one of only 5 states that already prohibits abortion from being included in private insurance packages and requires women to purchase a separate abortion rider. SB747 would deny women the right to purchase a rider within the exchanges:

Under current law, health insurance policies are barred from providing coverage for elective abortions except through optional riders. This act extends this prohibition to health insurance policies offered through any health insurance exchange established in this state or any federal health insurance exchange administered within this state. In addition, no health insurance exchange operating within this state may offer coverage for elective abortions through the purchase of an optional rider.

If the law passes the Senate and the House and is signed by Governor Jay Nixon (a Democrat with a mixed record on choice) women would only be able to purchase an abortion rider in the unsubsidized (but newly regulated!) individual health insurance market. Planned Parenthood lobbyist Michelle Trupiano tells the AP that it’s rare “for Missouri women to be able to purchase an insurance policy addition for abortion coverage. So they often pay the full cost of an abortion, which she said is about $500 for a first-semester pregnancy.” Should this bill become law, women in the exchanges, (particularly poorer women) would have “no options for abortion coverage.”

Sen. Chuck Grassley (R-IA) — the ranking member of the Senate Finance Committee — supported the individual mandate in 1993, when he, along with Sen. John Chafee (R-RI), proposed an alternative to President Bill Clinton’s health care initiative that required every American to purchase health insurance coverage. He supported the mandate when he co-sponsored the Wyden-Bennet health care plan in 2007. And he endorsed the policy again in June of 2009, when he told Fox News Sunday’s Chris Wallace that there was bipartisan agreement that individuals should take responsibility for their own health care costs. But as the Senate Finance Committee prepared to release its health care bill, Grassley started arguing that the mandate is an “unprecedented” intrusion into the rights of the individual. In September of 2009, Grassley said that he was “very reluctant to go along with an individual mandate” since it would impose “a federal penalty against people who don’t have health insurance.”

Well today, MSNBC’s Andrea Mitchell asked Grassley about his evolving position. The senator admitted that he had supported the mandate in the past, before he knew it was unconstitutional:

GRASSLEY: If it was unconstitutional today, it was unconstitutional in 1993, but I don’t think anybody gave it much thought until three or four months ago when you start looking at what constitutional lawyers say about it because constitutional lawyers wouldn’t have been looking at the mandate for health insurance until it became an issue and it just became a issue lately. And so I think that’s the legitimacy of it being considered unconstitutional.

Watch it:

This is a fairly silly argument, particularly because constitutional lawyers believe that the health care mandate is as constitutional today as it was in 1993. “The mandate is lawful and clearly so,” this American Constitution Society brief argues, “pursuant either to Congress‟ authority to “regulate commerce among the several states,” or to its authority to “lay and collect taxes to provide for the General Welfare.”

In fact, even Mitt Romney (sometimes) agrees. Here he is Tuesday night describing the mandate in his Massachusetts reform plan as the ultimate conservative principle: “[R]ight now in this country, people that don’t have health insurance go to the hospital if they get a serious illness, and they get treated for free by government. My plan says no, they can’t do that. No more free riders. People have to take personal responsibility. I consider it a conservative plan.”

This afternoon, in a vote of 56-43, the Senate passed a package of fixes amending the bill President Obama signed into law on Tuesday. The reconciliation package now goes back to the House for a second vote later tonight, after Senate Republicans succeeded in slightly changing several technical provisions. In fact, a GOP aide acknowledged to Roll Call that the changes are largely inconsequential,” and admitted that Republicans were trying to force Democrats to cast “dozens of difficult votes.” The aide indicated that Minority Leader Mitch McConnell (R-KY) had been confident the parliamentarian “would rule in his favor throughout the vote-a-rama and kept the points of order in his back pocket until late in the evening to ensure Democrats made tough political votes.”

Indeed, during the more than 20 hours of debate, conservative senators proposed a myriad amendments designed to sink the package, some of them not even germane to the actual bill. Sen. David Vitter (R-LA), in a throwback to an earlier effort that was ruled unconstitutional, introduced an amendment that would bar all federal funding for ACORN, which is already set to dissolve due to lack of funds. Sen. Tom Coburn (R-OK) proposed an amendment to deny erectile dysfunction drugs to sex offenders. Sen. Bob Bennett (R-UT) introduced an amendment that would require a public referendum in Washington, DC on same-sex marriage even though the DC government put it into law.

These distractions, however, shouldn’t take away from the importance of the accomplishment. While these fixes pale in comparison to the historic nature of the underlining Senate bill, the package of amendments — collectively known as the Reconciliation Act of 2010 — will make insurance more affordable for middle class families, completely close the Medicare Part D doughnut hole for seniors, strengthen the employer responsibility provisions, and move up the implementation date on the excise tax. It may not be everything progressives had hoped for, but it only strengthens the foundation for future reforms.

And of course, much remains to be done. Majority Leader Harry Reid (D-NV) has promised to hold a vote on the public health care option as a stand alone measure and there could be some interest in implementing Sen. Dianne Fienstein’s (D-CA) national rate review authority to prevent insurers from jacking up rates between now and when the exchanges become operational. Moreover, Congress is going to have to tackle the Sustainable Growth Rate formula (aka doc fix) before the next round of cuts on October 1st and will likely introduce legislation to increase Medicaid reimbursement rates to Medicare levels beyond 2014, to ensure that the newly insured enrolled population has adequate access to doctors.

Lawmakers will have to tweak reform in years to come, but for the millions of Americans without coverage and for those struggling to afford their premiums, things will begin to finally change.

Since the House passed health care reform on Sunday, Democratic lawmakers who voted for the bill have received death threats and been victims of vandalism. Vandals struck the Tuscon office of Rep. Gabrielle Giffords (D-AZ), the Monroe County Democratic Committee headquarters in upstate New York, Rep. Louise Slaughter’s (D-NY) Niagara Falls office, the Knox County Democratic headquarters in Ohio, and the Sedgwick County Democratic Party headquarters in Wichita, KS. Majority Whip James Clyburn (D-SC), the highest-ranking black lawmaker in the House, has said “he received an anonymous fax showing the image of a noose” and authorities in Virginia are investigating “a cut propane line” at the home of a brother of Rep. Tom Perriello (D-VA).

Republican leaders have condemned these incidents, but on Tuesday, Sarah Palin seemed to fan the flames of discontent by labeling a map of vulnerable lawmakers’ districts with crosshairs on her Facebook page and tweeting, “Commonsense Conservatives & lovers of America: “Don’t Retreat, Instead – RELOAD!” This morning, NBC’s Ann Curry asked Sen. John McCain (R-AZ) if he believed his former running mate should use less “incendiary” language. McCain condemned any violence but bristled at the suggestion that her use of such violent imagery was inappropriate in light of the atmosphere of threats against lawmakers. “Those are fine. They’re used all the time,” he said:

MCCAIN: Ann, I have seen the rhetoric of targeted districts as long as I’ve been in politics. Please. This is — any threat of violence is terrible, but to say that there is a targeted district or that we “reload” or go back in to the fight again, please….Those are fine. They’re used all the time… Those words have been used throughout of my political career…That rhetoric and kind of language is just part of the political lexicon. [...]

CURRY: I think it is the “reload” and “crosshairs” that’s caused a lot of people to be concerned, Senator.

MCCAIN: Maybe it has and we condemn any violence, any threats of violence. But I’ve heard all of that language throughout my political career…that anger should be channeled into voter registration and go continue the struggle that we’re in to regain America and stop mortgaging our children’s futures.

Watch it:

The targeted lawmakers, feel differently, however. Asked if he thought Republicans were doing enough to condemn the violence, Perriello criticized the GOP for not drawing a stronger distinction between people who “commit violence” and simply oppose health care reform. “People who are doing these things that are clearly outside the law…these people need to be prosecuted, not simply brought into the campaign room.”

“I think people have to be conscious of the things that they say.” “We should all be able to agree, whether you are a political leader or TV personality or whatever, that simply saying, this is absolutely unacceptable to harm or threaten to harm a member of their family. This isn’t a partisan thing. This is just a basic American value. I hope we will get stronger and clearer statements up here of that to make sure that that signal is very clear,” he said.