A bill to prevent coverage for most abortions under the insurance marketplace being set up as part of the federal health care overhaul is on its way to the Pennsylvania Senate after approval Tuesday by the House.

The House voted 144-53 in favor of the proposal that would provide exceptions only for rape, incest or when the mother’s life is in danger.

During hours of heated debate, Democratic opponents portrayed the measure as a new restriction on reproductive rights, and a needless risk to women’s health.

Rep. Erin Molchany, D-Allegheny, said the end result would be to create two health care classes, making it more difficult for low- and middle-income women to get abortions.

"This House should be ashamed of itself for sacrificing Pennsylvania women in the interests of politics," Molchany said.

Republicans described it as a continuation of the state’s longstanding policy against taxpayer-funded abortions.

“No tax dollars are used for elective abortions in Pennsylvania,” said Rep. Matt Baker, R-Bradford. "We want to keep it that way."

The bill would not allow people, even using their own money, to buy health coverage that includes abortion services through the Affordable Care Act’s marketplace, known as an exchange. They could attempt to obtain coverage outside the exchange on their own, but critics said such policies are not available and there is no reason to think they will be.

"We’ve been shown no proof that there are carriers out there that are willing to underwrite those policies," said Rep. Steve Santarsiero, D-Bucks. "We’ve heard nothing about what the price would be."

The ongoing, high-profile trial of Philadelphia abortion provider Dr. Kermit Gosnell was brought up by Rep. Kathy Rapp, R-Warren, who argued that some people might agree with the legality of abortion without wanting to help pay for a health care exchange that facilitates the procedure, and those with strong anti-abortion positions would be even more opposed.

"The track record for abortions in our nation right now is around 54 million,” Rapp said. “To me, that’s the real war on women."

Rep. Tim Krieger, R-Westmoreland, said supporters of the bill were engaged in an "ideological struggle."

"Someone said that somehow, all the sudden, conservatives are for big government and this is a big government idea," Krieger said. "I would say to you, if government doesn’t have a role in protecting innocent life, then what is government’s role?"

The bill “flies in the face” of Republicans’ stated free market values, said Rep. Brian Sims, D-Philadelphia.

“This legislation is about advancing an ideology of oppression and suppression,” Sims said. “Each of us put our hands on the Bible and swore to uphold the Constitution. We did not place our hands on the Constitution and swear to uphold the Bible.”

The vote was not close, as 36 Democrats crossed party lines in support of the measure, but only two Republicans were against it. Many of the Democratic “yes” votes came from members who represent more rural districts, particularly in western Pennsylvania.

Similar legislation was recently approved by a state Senate committee. Both chambers approved competing versions in the last two-year legislative session, but the bills died when a compromise was not reached.