On the other side of the obstacle course that President Barack Obama must clear to get his health care overhaul, a final trapdoor is lurking: the divisive politics of abortion.
The issue pits House Democrats against each other just when Obama is calling on them to unite for one last push on health care in a perilous election year. The fate of the sweeping legislation to expand coverage and revamp the health insurance market hangs in the balance.
House Democrats opposed to abortion, as well as their counterparts who support abortion rights, are resisting funding restrictions on the procedure spelled out in the Senate health care overhaul bill. But the plan Democratic leaders have worked out for the health care endgame calls for House Democrats to pass that same Senate bill, with little prospect of changing the abortion language.
Although each chamber is also supposed to pass a companion package of agreed-upon changes, abortion funding is not among them. It doesn't appear likely to be included.
Speaker Nancy Pelosi vented her frustration Thursday, telling reporters she will not stand for health care legislation getting dragged down in a battle over abortion. "This is not about abortion," said Pelosi, D-Calif. "This is a bill about providing quality affordable health care for all Americans."
She may not have a choice, says a leading abortion foe.
Rep. Bart Stupak, D-Mich., says he and a dozen fellow Democrats who supported the House bill will vote against it this time unless the Senate language is replaced with stiffer restrictions previously adopted by the House. The House health care bill passed by 220-215 last November, only after Pelosi was forced to give Stupak a floor vote that incorporated his strict abortion funding provision in the measure.
Nothing has changed, said Stupak. "I don't think they have the votes to pass it," he said.
It's not clear, however, that every lawmaker who voted with Stupak the first time will stick with him.
Rep. Dale Kildee said he's keeping an open mind as he studies the Senate bill. "I'm looking at the language in the Senate bill to see if it carries out the purpose of the Hyde amendment," said Kildee, D-Mich. "If it does so to my satisfaction, I think I could go along with it."
The long-standing Hyde amendment bars federal funding for abortion except in cases of rape, incest or to save the mother's life.
Obama is pleading with Democrats to overcome divisions over abortion and other issues to seize a historic moment to remake the health care system.
On Thursday, he summoned more than a dozen House rank-and-file liberals and moderates to the White House. It's the opportunity of a generation, he told them — a chance to revive the party's agenda after his rough first year in office.
In back-to-back meetings in the Oval Office and Roosevelt Room, Obama urged lawmakers to focus on the positives rather than their disappointments. Lawmakers said Obama assured them the legislation was merely the first step, and he promised to work with them in the future to improve its provisions.
Settling the dispute over abortion funding remains one of his biggest challenges. Government policy on taxpayer funding for abortion has been settled for years, following the Hyde amendment. Obama insists he never wanted to alter that balance.
But that's exactly what happened. The Democratic bills created a new stream of federal money to help working households afford health insurance premiums. And those funds were not subject to the Hyde restrictions.
The House responded by adopting Stupak's amendment, although it was opposed by most Democrats. It says no health insurance plan receiving federal subsidies can pay for abortion, except under the three exceptions already allowed by federal law. Women who want insurance coverage for abortion would have to buy a separate policy.
The Senate bill took a different approach. It says health insurance plans operating in a new consumer marketplace can cover abortion, but it may only be paid for with private premiums. Money from federal subsidies would have to be strictly segregated from any funds used to pay for abortion. Consumers would have to write two checks to their insurance plan, one for the regular premium, the other for abortion coverage.
Leading abortion opponents — including the nation's Catholic bishops — say the Senate language is a fig leaf, opening the way for government subsidies for abortion. They're urging defeat of the health care bill unless it takes Stupak's approach.
Abortion rights supporters say both measures impose unreasonable restrictions on women's access to a legal medical procedure now widely covered by health insurance.
Rep. Diana DeGette, a prominent abortion rights supporter, said Pelosi should call Stupak's bluff.
"Ten or 11 votes is not going to kill the bill," said DeGette, D-Colo., explaining that many of the 39 conservative Democrats who voted against the House bill could well find the moderate Senate version more to their liking. DeGette also wants to change the Senate language, saying it's too restrictive.
Abortion rights supporters backed down once the last time. This time, if House Democratic leaders can't line up enough votes without placating Stupak, it's unclear how they will get the abortion language changed.
Pelosi says it can't be done in a companion package that would move through both chambers as part of deal worked out with Obama. Under congressional rules, the elements of that package would have to have a significant budget impact. A third piece of legislation may be needed.