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Now at the same time they consider a lifetime appointment to the high court, senators are negotiating historic changes to health care. President Obama has the momentum of his election win, a Democratic Congress to work with, and at least in public, the supportive parts of the health care industry. There is still at least one issue that could derail the whole thing.

NPR's Julie Rovner reports.

JULIE ROVNER: Iowa Republican Senator Chuck Grassley has been working all year to try to negotiate a bipartisan health bill. He's known for being willing to deal, but way back in March, Grassley issued this warning about one issue in particular.

Senator CHUCK GRASSLEY (Republican, Iowa): I take a view that there's almost anything compromise-able in public affairs except probably - the issue of abortion.

ROVNER: That was on display yesterday at the Senate Health and Education Committee, which was beginning the fourth week of a marathon effort to craft an overhaul bill. Senators turned back several abortion-related amendments. One amendment in particular would have barred people who get government insurance subsidies from purchasing private insurance plans that include abortion coverage.

Oklahoma Republican Senator Tom Coburn said the principle is the same as the one that currently bans funding for abortion in the Medicaid program for the poor.

Senator TOM COBURN (Republican, Oklahoma): The rest of the people in this country should not be paying for that services through their tax dollars.

ROVNER: But Rhode Island Democrat Sheldon Whitehouse said that was a stretch.

Senator SHELDON WHITEHOUSE (Democrat, Rhode Island): The next step in this logic will be to require anybody seeking these services to walk to the clinic, lest they use federal highways, supported by federal highway funds.

ROVNER: The amendment was defeated 12 to 11, as were several other amendments to write into law health care worker's rights to refuse to provide abortions and other potentially controversial services.

But it's clear that the question of abortion represents a chasm in the health care debate that won't be easy to bridge. Douglas Johnson of the National Right to Life Committee says extending the abortion funding ban to people who will be getting tax payer funds, even to buy private coverage, simply continues a long string of laws passed by Congress over the years.

Mr. DOUGLAS JOHNSON (National Right to Life Committee): Within the sphere of government subsidized health care, abortion is not covered. There has been a consensus at the congressional level since the mid-1970s that taxpayer funds should not be used to pay for elective abortion, and that's simply the principle that we seek to preserve here.

ROVNER: But Democratic pollster Mark Mellman says lawmakers should think long and hard about banning abortion coverage in private health plans, particularly since many plans include it now.

Mr. MARK MELLMAN (Democratic Pollster): To some extent, what they're talking about on Capitol Hill is taking away the coverage that people already have. Americans want health care reform, but they will oppose health care reform if it takes away the coverage they now have for things like abortion, contraception and for women's reproductive health.

ROVNER: Johnson of the Right to Life Committee says what his side fears most is an effort to use a health overhaul as a way to give abortion rights a government-backed boost.

Mr. JOHNSON: These bills give federal officials the authority to define what benefits must be carried in all health insurance plans, both private and the government plan that's proposed. And there is no doubt whatever that abortion, elective abortion, would be among those services mandated.

ROVNER: But Mellman says his polling makes it clear that the public doesn't want Congress to legislate either way on the sensitive issue. It wants someone else entirely to make the decisions about what should and shouldn't be covered.

Mr. MELLMAN: Voters overwhelmingly want decisions about coverage made by an independent commission of medical professionals and citizens. They do not want politicians making health care coverage decisions. In fact, they want to keep the politicians as far away from these coverage decisions as possible.

ROVNER: But some politicians seem intent on remaining involved in the abortion issue. Last month, a group of 19 House Democrats who oppose abortion wrote to speaker Nancy Pelosi. They vowed to vote against any health overhaul bill unless it explicitly excludes abortion as a covered or subsidized benefit.

Julie Rovner, NPR News, Washington.

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