House Democrats are at an impasse over whether their remake of the nation's health care system would effectively allow federal funding of abortion.
At least two dozen anti-abortion Democrats believe it would, and while their opposition is unlikely to stall the legislation in the end, they are at odds with Democratic leaders just weeks ahead of anticipated floor action on the bill.
Lawmakers on the other side say they've compromised as far as they can to address the anti-abortion lawmakers' concerns by specifying that people receiving government subsidies to buy health insurance couldn't use that money for abortions.
Negotiations to find common ground have not yielded fruit.
"We have a difference of opinion at the moment we cannot bridge," said Rep. Henry Waxman, D-Calif., chairman of the House Energy and Commerce Committee, where the abortion language was approved. "We have done everything we can to ensure that there will be no federal funds for abortion services."
Waxman said he's still working on the issue with Rep. Bart Stupak, D-Mich., the leader of the anti-abortion group. On Thursday the two had an earnest discussion on the House floor but afterward they said nothing had really changed.
Stupak, who's on the tall side, made a joking reference to Waxman's diminutive stature when asked whether their conversation had yielded a meeting of minds. "I'm a little taller. Our minds don't meet," Stupak said.
The main point of contention is the proposed new federal subsidies that would help lower-income people purchase health care coverage from private plans and potentially from a new government-sponsored plan - within a new purchasing exchange.
Currently a law called the Hyde amendment bars federal funding for abortion except in cases of rape and incest or if the mother's life would be endangered and applies those restrictions to Medicaid, forcing states that cover abortion for low-income women to do so with their own money. Separate laws apply the restrictions to the federal employee health plan and military and other programs.
But the Democrats' health overhaul bill would create a new stream of federal funding not covered by the restrictions.
Stupak says language specifying that someone obtaining an abortion must use her own money, not federal money from the subsidies, doesn't go far enough because it's impossible to clearly segregate funds in that way.
"Once you get the affordability credits (subsidies) in there, that's public funding of abortion. We're not going there," Stupak said. "How do you get past the affordability credits is really the issue. And we can't."
Waxman said that if the language is changed to Stupak's preference to bar any subsidy money from going to any insurance plan that includes abortion coverage the result would be to deny women legal and sometimes medically necessary procedures. The advocacy group NARAL Pro-Choice America is dissatisfied with the language now in the bill, contending that it "singles out abortion from other health care services, but apparently it was necessary to stop anti-choice politicians from continuing to use health care reform to attack a woman's right to choose," according to a statement from the group's president, Nancy Keenan.
NARAL recently sent a letter to supporters singling out Stupak for criticism and asking them to call their members of Congress to make sure he doesn't prevail.
On the other side, the U.S. Conference of Catholic Bishops said it can't support a health overhaul bill unless the anti-abortion language is strengthened.
Unless an eleventh-hour agreement is reached, Stupak intends to carry through on a threat he's been holding over House leaders for months: to block action on the larger health overhaul bill unless he's allowed to offer a stand-alone amendment during floor debate to include the Hyde amendment restrictions in the health overhaul bill.
Such an amendment would be almost certain to prevail, since it likely would attract the votes of most Republicans as well as some Democrats. So Democratic leaders won't let Stupak offer it.
Instead, it appears they may have to take the risk of letting Stupak try to block action on the underlying bill, which he intends to do by assembling "no" votes on a procedural measure that needs to pass before debate can begin.
In the Senate, where the leading health overhaul bill includes language similar to that in the House, abortion has been much less of an issue.