Of the remaining issues with the potential to bring down the entire health overhaul effort, the one that lawmakers fear most is abortion.
Abortion is such a politically hazardous issue that sponsors of both the House and Senate health bills have said their object was to maintain the status quo. "It is not the intention of this bill to, as the speaker has said, to change the policy that has been in place for three decades," House Majority Leader Steny Hoyer (D-MD) said on Tuesday. Hoyer was referring to what is known as the Hyde Amendment. It has barred federal funds from being used to pay for abortions since 1977.
But keeping the health bills abortion-neutral has proved impossible. And now the abortion language in the Senate-passed bill in particular could threaten the strategy Democratic leaders hope to use to get a final measure to President Obama's desk for a signature.
The bill the House passed in November barred abortion funding in programs directly funded by the federal government. But it also banned it in private insurance plans that cover abortion if those plans are federally subsidized.
Abortion-rights groups say the problem with the House bill is that it would roll back coverage for abortion many women now have in private insurance.
"Anyone receiving a subsidy for their premium from the government would not be allowed to choose a plan that includes abortion, and that would apply to about 85 percent of people participating in the exchange," said Jessica Arons, director of the Women's Health and Rights Program at the Center for American Progress, a liberal think tank. The exchange is the new insurance marketplace the bills would create.
The bill passed by the Senate in December, however, doesn't go quite as far. But it's even more confusing. It, too, would bar most direct federal funding of abortion. But it would let private plans cover abortions — if people are willing to write a separate check each month for that coverage. Arons says that's something abortion-rights groups find really distasteful.
"I think that some of the language is not just intended to wall off public money from paying for abortion services, it actually is intended to stigmatize abortion and treat it as something other than health care, and discourage people from choosing health insurance plans that offer abortion coverage," she said.
But while abortion-rights groups may not like the Senate bill, anti-abortion groups downright hate it. "In total, the Senate bill is the most pro-abortion single piece of legislation ever to reach the floor of the House of Representatives," said Douglas Johnson, federal legislative director for the National Right to Life Committee. "The so-called abortion limits that are in the Senate bill are all very narrow, loophole ridden, or booby-trapped to expire," he said.
He cites as an example a last-minute addition to the bill of $7 billion for community health centers, "from which abortions could be paid with no restriction."
Arons says that's not the case. "It's a boogeyman. No one is intending to use public money from the bill to fund abortion services."
Still, National Right to Life's opinion on the bill counts, because it scores votes as being anti-abortion or not. And Johnson has made it clear how his group will score this vote. "No member of the House of Representatives who is pro-life or who wishes to have a record against federal funding of abortion could possibly vote for the Senate bill."
That raises a big red flag for Democratic leaders in both houses. That's because the way they are hoping to finish work on their health overhaul is for the House to pass the Senate's bill — abortion language and all. Then they plan to pass a second bill that will incorporate a number of compromises between the House and Senate. For that, they'll use the so-called budget reconciliation process that only requires 51 Senate votes.
But as House Speaker Nancy Pelosi acknowledged Tuesday, those compromises probably won't include a change in abortion language. "In order to be in part of the budget bill, it has to be central to the budget. That's the rule. And it's a very strict rule," she said.
Which means anti-abortion House Democrats who originally voted for the House health bill will likely face this choice: Vote for a Senate bill that's more lenient on abortion or vote against health overhaul. And it will make it that much harder for House leaders to get the majority they need to pass the bill.