Richard Doerflinger doesn't look the part of a high-powered political strategist. Bearded and bespectacled, he works in a small, cluttered office out of one of Washington's less fashionable neighborhoods, far from the lobbying bastions of K Street.
Yet as the United States Conference of Catholic Bishops' point man on abortion, Doerflinger has emerged as a major player in the health care debate, one likely to play a pivotal role in the outcome.
It was Doerflinger who orchestrated the bishops' successful campaign late last year to add a tough anti-abortion provision to the House legislation. The Senate adopted less stringent language.
Now, as President Barack Obama begins his last-ditch effort to pass final legislation, Doerflinger and his bosses are sending a clear message: If the Democrats want to succeed, they must include the House provision, or something equally restrictive, on abortion.
"The Senate may have to figure out whether it wants its abortion position or if it wants a health care bill," Doerflinger said in a recent interview. "That's the difficult decision (House Speaker) Nancy Pelosi made, and she chose a health care bill. The Senate decided it could have its cake and eat it, too. That is no longer true. Something's going to have to give."
The bishops have supported universal health care coverage since the days of Woodrow Wilson. But that won't stop them from opposing any bill lacking a strict ban on using federal funds to pay for abortions, Doerflinger warns.
"We have a simple position," he adds. "Everybody gets covered. Nobody gets deliberately killed."
The bishops' stand has encouraged abortion foes, outraged many women's groups and dismayed supporters - including some liberal Catholics - of the Democrats' health care legislation. They're worried an abortion impasse could derail the best chance in a generation to enact sweeping health legislation.
"We can't lose sight of what's at stake here," says Chris Korzen, a former labor leader who heads Catholics United, founded to counter conservative Catholic groups. "We're talking about extending health care coverage to millions of Americans who don't have it. That's highly consistent with pro-life values."
Abortion rights groups have criticized Doerflinger and the bishops, saying they are holding the health care legislation hostage to their agenda. "No one else drew a line in the sand," says Laurie Rubiner, vice president for public policy for Planned Parenthood Federation of America.
Working in "Little Rome"
The bishops' conference is headquartered in a neighborhood known as "Little Rome." Nearby is Catholic University and the largest Catholic church in the U.S., which has 65 million Catholics.
As associate director of the conference's Secretariat for Pro-Life Activities, Doerflinger cranks out reams of position papers, e-mails to congressional aides and letters from the bishops to lawmakers - not only on abortion, but also on euthanasia, embryonic stem cell research and physician-assisted suicide.
A self-described "policy wonk," Doerflinger leaves a lot of the schmoozing on Capitol Hill to colleagues, but doesn't miss crucial meetings, including one in House Speaker Nancy Pelosi's office the night before the House passed the health bill last year. He and John Carr, who also works for the bishops, were the lone outsiders, prompting criticism from abortion-rights supporters that Pelosi, who is Catholic and supports abortion rights, was taking her cues from Rome.
The two men helped craft the final wording of the anti-abortion amendment offered by Rep. Bart Stupak, D-Mich., that cleared the way for House passage of the health care bill by five votes.
"He's a real smart guy," says Stupak, referring to Doerflinger. "Pretty detailed guy who does his homework ."
Among friends and foes, Doerflinger is known for his in-depth knowledge. Last year, he was honored as one of six of the "greatest heroes" of the anti-abortion movement and awarded a $100,000 prize by the Massachusetts-based Gerard Health Foundation, which opposes abortion.
Critics say that Doerflinger can be bombastic and unyielding. "He doesn't subscribe to the theory that you can catch more flies with honey than you can with vinegar," says Sean Tipton, director of public affairs for the American Society for Reproductive Medicine.
In the late 1990s, Tipton recalls, then-Senate Majority Leader Trent Lott, a Republican, held a meeting to try work out a compromise on the contentious issue of federal funding for embryonic stem cell research. "It became apparent that Doerflinger and I could not do that," Tipton says. "When you're coming at the issue where a fertilized egg is a sacred human being with full constitutional rights, there's not a lot of room for compromise."
Doerflinger admits he's blunt, but adds, "I don't see a point in avoiding plain facts."
A wrenching family tragedy helped propel Doerflinger toward his life's work. When he was a teenager growing up on Long Island, his older brother, Eugene, was injured in a car accident and lapsed into a "vegetative state," Doerflinger says. One physician advised his mother to put Eugene in an institution and "forget you ever had a son," he says. Instead, she took Eugene home. Four months later, he woke up. Eugene lived near his family, although with severe mental and physical disabilities, until his death in 2008.
The experience of how a family can come together and care for a loved one who had a life that other people think is over affected my attitudes," Doerflinger says.
He has spent 30 years on the front lines of the culture wars, with the ultimate goal of overturning Roe v. Wade, the 1973 Supreme Court decision that legalized abortion. He sees the battle being won through incremental change.
But critics say it would be a colossal mistake to kill universal health care for an incremental victory on abortion. "The difference between the two bills is pretty thin," says Michael Sean Winters, a liberal Catholic author. "Doerflinger is so dug in, he's missing the point on the Senate bill, which is also pro-life."
The House health bill bars insurance companies from selling policies that cover abortion to anyone who receives federal subsidies to buy insurance. The Senate's less restrictive amendment permits insurers to offer abortion coverage, but requires customers to buy it with a separate check drawn on personal funds.
The Democrats' best shot at succeeding on health care is to have the House pass the Senate bill. Then both chambers would make some changes in that legislation by passing a second bill under complex budget rules.
But some anti-abortion House lawmakers say they won't vote for the Senate bill. And it could be difficult for the Senate to adopt the House abortion language because of political and procedural reasons.
Amid the wrangling, Doerflinger stays focused on what he says is the bottom line. "If the bill attacks life itself, in our view, it's not health care reform," he says. "You've undermined the foundation of the right to health care if you're weakening the right to life. We can't get over that. We can't walk away and say this is good enough. That's our moral position. We don't trade the two off."
This story was produced through collaboration between NPR and Kaiser Health News (KHN), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.