Washington -- Abortion has become one of the fiercest fights in the health care reform battle, largely due to the doggedness of a congressman little known outside Michigan -- Bart Stupak.
Stupak, D-Menominee, forced Democratic leaders to hold a vote late Saturday on his amendment to prohibit coverage of abortions in the proposed government-run health care plan, except in instances of rape, incest or where the life of a pregnant woman is threatened.
It would also ban health plans receiving federal subsidies in a new insurance marketplace from offering abortion coverage. The insurers could sell separate coverage for abortion, which women would have to buy with their own money.
The House passed the overall health care bill, which included Stupak's amendment. Stupak's success is expected to embolden abortion opponents in the Senate, where the action has moved.
"We are sticking to our principles," said Stupak, a 57-year-old Catholic first elected in 1992 who chairs the House Energy and Commerce subcommittee on oversight and investigations.
"We are in contact with senators to make sure our language holds. The other side is playing with fire," added Stupak.
The Stupak amendment passed the House, 240-194, with the help of 64 Democrats.
Without the Stupak amendment, the bill would let women use federal subsidies to buy any health care plan, but then require them to pay for an abortion out of their own pocket.
President Barack Obama weighed in Monday in an interview with ABC News.
"There needs to be some more work before we get to the point where we're not changing the status quo" on abortion, Obama said in the interview. "And that's the goal."
He added: "I want to make sure that the provision that emerges meets that test -- that we are not in some way sneaking in funding for abortions but, on the other hand, that we're not restricting women's insurance choices."
Abortion-rights supporters in the House are furious. Forty representatives signed a letter Monday that is headed to House Speaker Nancy Pelosi stressing "we will not vote" for a final health care bill containing the Stupak language.
They say the Stupak language goes further than current federal law banning federal funds for abortions.
"The majority of private health insurance plans currently offer abortion coverage, and the (Stupak) amendment would result in the elimination of private abortion coverage in the 'exchange,' the new insurance market created under health care reform, as well as in the public option, if one is created," said Cecile Richards, president of Planned Parenthood.
Planned Parenthood said abortions at health centers cost $350 to $900 in the first trimester, while such procedures cost more at hospitals.
Supporters of the Stupak amendment say women who want an abortion could buy an insurance supplement that covers for such procedures.
But Richards counters that "a separate 'abortion rider' or 'single-service plan' is tantamount to banning abortion coverage since no insurance company would offer such a policy."
The overall health care bill passed the House by a vote of 220-215, meaning a flip of only three votes could later doom its final passage.
Meanwhile, the Stupak vote may energize abortion-rights foes in the Senate, where Sens. Orrin Hatch, R-Utah, and Ben Nelson, D-Neb., could lead the fight for Stupak-like provisions.
"Senator Nelson is strongly pro-life and was pleased the Stupak amendment passed with such strong support," said Nelson spokesman Jake Thompson, adding that it is "highly unlikely" the senator would support a bill that doesn't have a Stupak-like ban.
"He's evaluating options, including offering an amendment," said Thompson.
But spokesman Tait Sye of Planned Parenthood said they don't expect Stupak-like wording to be in the bill the Senate takes up, "and we will work to keep it out."
Stephen Hess, a politics expert at the left-leaning Brookings Institution, said House Democratic leaders "grossly underestimated" Stupak's skills.
"He ultimately rolled the Democratic leadership," Hess said.
"He showed very, very shrewd legislative maneuvering. It caught a lot of outsiders off guard who certainly didn't expect abortion would suddenly look like a potential deal breaker" on overhauling health care.
Douglas Johnson, the legislative director of the National Right to Life, called Stupak "fearless" and "heroic" for pushing to center stage how the health care bill deals with abortion.
"We expect this to be a big fight in the Senate, and in the (House-Senate) conference," said Johnson, adding his side will rely on Stupak. "Bart Stupak has been absolutely fearless in resisting every sort of pressure."
Johnson said the group will consider a vote for a final health care bill without Stupak-like language "a pro-abortion vote."
Stupak declined to say whether he would vote against a final health care bill if it doesn't include his or similar anti-abortion language.
But he said he wouldn't have voted for the health care bill Saturday without his wording.
Rep. Debbie Wasserman Schultz, D-Fla., a leading Democrat on the other side of the debate, said Monday she's working to strip Stupak's language from the bill.
As for whether the health care overhaul could be scuttled by the fight over abortion, Wasserman Schultz said she hopes lawmakers can figure out acceptable language to both sides to "make sure that doesn't happen."
House bill (Affordable Health Care for America Act)
Status: Democratic-controlled House narrowly passed this landmark health care legislation Saturday night, 220-215.
Who's covered: About 96 percent of legal residents under age 65. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.
Cost: The bill's cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion. Those figures leave out a variety of new costs, including increased prescription drug coverage for seniors under Medicare.
How it's paid for: $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million.
There are more than $400 billion in cuts to Medicare and Medicaid; a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; penalties paid by individuals and employers who don't obtain coverage; and a mix of other corporate taxes and fees.
Requirements for individuals: Must have insurance, enforced through a tax penalty of 2.5 percent of income. Can apply for hardship waivers.
Requirements for employers: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt; the penalty is phased in for companies with payrolls between $500,000 and $750,000.
Small businesses with 10 or fewer workers get tax credits to help them provide coverage.
Subsidies: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.
How you choose your health insurance: Beginning in 2013 through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges if they follow federal rules.
Benefits package: A committee would recommend a so-called essential benefits package including preventive services. Out-of pocket costs would be capped.
Insurance industry restrictions: No denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.
Government-run plan: A new public plan would be set up and run by the secretary of Health and Human Services. Would let the HHS secretary negotiate rates with providers.
Changes to Medicaid: Would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter, the federal government would pay 91 percent and states 9 percent.
Drugs: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Phases out gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.
Antitrust: Would strip the health insurance industry of exemption from antitrust laws covering market allocation, price fixing and bid rigging. Would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.
Senate Democratic bill
Status: Majority Leader Harry Reid, D-Nev., is finalizing legislation merging the work of two committees and making other changes. The bill has not yet been made public. Reid needs the votes of all 60 of his caucus members just to bring it before the Senate, and will also need those 60 votes to overcome a GOP filibuster.
Who's covered: The Senate Finance version covered an estimated 94 percent of Americans. Illegal immigrants would not receive government benefits.
Cost: Senate leaders aim to keep it under $900 billion over 10 years.
How it's paid for: Fees on insurance companies, drug makers, medical device manufacturers. Tax levied on insurance companies, equal to 40 percent of total premiums paid on insurance plans costing more than $8,000 annually for individuals and $21,000 for families. But that number may rise to $23,000. Retirees older than 55 and people in high-risk professions may be allowed to have more valuable plans before they're taxed. Cuts to Medicare and Medicaid. A fee on employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.
Requirements for individuals: Must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. The Senate Finance Committee version required individuals and families to buy coverage as long as it cost no more than 8 percent of their income. Those who refuse would face a fine of perhaps $100 in the first year, likely to increase over time.
Requirements for employers: Not required to offer coverage, but companies with more than 50 full-time workers would pay a fee as high as $750 multiplied by the total size of the workforce if the government ends up subsidizing employees' coverage.
Subsidies: Tax credits for individuals and families likely making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.
How you choose your health insurance: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Employees would be encouraged to keep their work-provided coverage.
Benefits package: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage: Under legislation passed by the Senate Finance Committee, the least generous would pay an estimated 65 percent of health care costs per year; the most generous would cover 90 percent.
Insurance industry restrictions: No denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size.
Government-run plan: Reid proposed a new federal insurance plan with payment rates to providers negotiated by the Health and Human Services secretary. States could opt out of the plan. It's not clear the proposal commands enough votes to survive, and it could be replaced by a standby system pushed by moderates that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies. The bill also would create nonprofit, member-owned co-ops to compete with private insurers.
Changes to Medicaid: Income eligibility levels likely to be standardized to 133 percent of poverty, or $29,327 a year for a family of four. States could negotiate with insurers to arrange coverage for people with incomes slightly higher.
Drugs : Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.
Antitrust: Amendment expected to be offered on the Senate floor to strip the health insurance industry of its antitrust exemption.
Associated Press contributed.