A divided City Council on Wednesday signed off on a $5.5 million subsidy to Illinois’ largest Catholic health system, in spite of Presence Health’s anti-abortion policy, after an emotionally charged debate that focused on the volatile issues of race and a woman’s right to choose.

The vote to honor a tax-increment-financing (TIF) subsidy promise that persuaded Presence Health to build a downtown headquarters and build health clinics in four chronically under-served communities was 31 to 18. That’s one of the closest votes since Emanuel took office seven years ago.

No votes were cast by the following aldermen: Pat Dowell (3rd), Sophia King (4th), Leslie Hairston (5th), Susan Sadlowski-Garza (10th), George Cardenas (12th), Toni Foulkes (16th), Ricardo Munoz (22nd), Scott Waguespack (32nd), Deb Mell (33rd), Carlos Ramirez-Rosa (35th), Brendan Reilly (42nd), Michele Smith (43rd), John Arena (45th), James Cappleman (46th), Ameya Pawar (47th), Harry Osterman (48th), Joe Moore (49th) and Debra Silverstein (50th).

The vote followed a protracted debate on two hot-button political issues: abortion and race.

Proponents of the Presence Health subsidy made a racial argument. They argued that African-Americans on the city’s South and West Sides desperately need better access to health care and that Presence has agreed to provide that care – by opening clinics in Calumet Heights, Belmont-Cragin, Avondale and West Town.

“It’s not about reproductive health care. It’s about access to health care. And communities of color don’t have enough of it,” said Rules Committee Chairman Michelle Harris (8th).

“Women on the South Side and the West Side are not dying from the lack of access to abortion. They’re dying from the lack of accessibility to dialysis centers and cancer screenings.”

Opponents wanted to keep the subject fixed on abortion and a woman’s right to choose and Presence Health’s decision to follow the Ethical and Religious Directives for Catholic Health Care Services impacting contraception, sterilization and treatment for infertility and miscarriages.

“Communities of color have the highest [rates] of diabetes, obesity and unplanned pregnancy. The issue here…is not about that. It’s about using public dollars to support religious institutions that don’t support the right that we, as women, have in this country,” Hairston said.

After the vote, Mayor Rahm Emanuel gave an impassioned speech from the rostrum defending his support for the subsidy, even though he is “100 percent pro-choice.”

The mayor noted that there was “not a peep, not a sound” from aldermen when similar subsidies were granted to a parade of hospitals, including St. Anthony’s, Swedish Covenant and Mercy.

Emanuel said there should be no “litmus test,” simply because there’s an aldermanic and mayoral election around the bend.

“I have fought for the right of a woman to choose. It will never end in this city….[But] the notion that, all of the sudden as we get closer to another date not far off, we’re now gonna set a new litmus test” is absurd, the mayor said.

“I believe 100 percent pro-choice and 100 percent quality health care. Not an either-or-choice. But all of the sudden now, with all of the prior precedent [and] not a peep, not a sound, here is where we’re gonna have a litmus test.”

Emanuel noted that this City Council and its predecessors has been “really clear when it comes to hospitals and helping them economically,” and that includes Catholic hospitals.

“This chamber and chambers prior to this chamber have been really consistent when it comes to Catholic Charities delivering services to homeless and indigenous [people] without a litmus test. Nobody raised a question – ever. And I guarantee, when we deal with the redevelopment for the Archdiocese during the next session, nobody will raise a question,” the mayor said.

Emanuel’s address Wednesday was among the more emotional speeches he has ever delivered in the City Council chambers.

That’s apparently because improving and reforming health care has been a life-long crusade for the son of a pediatrician.

It’s also because the issue has the potential to hurt Emanuel with progressives who support a woman’s right to choose.

“I don’t care what your religion is. I know what my parents taught me: That access to health care was a right. That is what inspired me when I got into public life,” Emanuel said.

“I remember as little Rahm Emanuel walking with Dr. Emanuel through all of the hospitals that Ald. Tunney talked about closing – and more..To this day, people come up me and say what my father has done for them and their kids. And he never, ever turned anybody away who couldn’t pay. He did house calls when house calls were closed and out of business because it wasn’t efficient.”