How big will abortion become in the final House vote on ObamaCare?  Even NPR now reports that it has arguably become the biggest issue in adopting the Senate version of the health-care overhaul.  The House version passed with the public option and with the Stupak amendment, giving progressives and moderates an uneasy draw in November.  Neither exist in the Senate version, and while both factions in the Democratic caucus are unhappy about that, the abortion problem may be too difficult to surmount:

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,” said House Majority Leader Steny Hoyer, (D-MD), 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.

Last year, I wrote about the difference between the Senate and House versions of the language barring federal funding of abortions.  The Stupak amendment explicitly barred federal funding for abortion services in any form in plain language.  The Senate version instead relies on the mechanism of the Hyde amendment, which only applies if Congress renews it annually as part of the appropriations process.  Once Congress fails to renew the Hyde Amendment (which bars HHS funds from being used for abortion services), the Senate language actually creates a mandate for the federal government to provide those funds.  The key language comes in Section 1303:

The Secretary shall assure that with respect to qualified health plans offered in any Exchange established pursuant to this title—(I) there is at least one such plan that provides coverage of services described in clauses (i) and (ii) of subparagraph (B); and (II) there is at least one such plan that does not provide coverage of services described in subparagraph (B)(i).

Clauses (i) and (ii) relate to abortion services that would normally be barred from federal funding.  Instead of barring the use of federal funds for abortions, the government would mandate abortion insurance once the Hyde amendment disappears, and would have to provide it by law if no private insurers offered it.  It’s a carte blanche for subsidized abortions.

The National Right to Life Campaign agrees, and plans on making this a critical vote:

But while abortion-rights groups may not like the Senate bill, pro-life 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. …

National Right to Life’s opinion on the bill counts, because it scores votes as being pro-life 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 useo the so-called budget reconciliation process that only requires 51 Senate votes.

That process won’t include changes to the Senate version of the abortion language.  While the Stupak amendment would easily pass the House again with bipartisan support, the Senate won’t offer it.  Ben Nelson (D-NE) insisted that any version of the bill would have to have it, but then retreated once he received his Cornhusker Kickback.

The question will be whether Stupak and other pro-life Democrats will vote for an abortion mandate mechanism in the end just to appease Pelosi and Obama.  NRLC bets that they won’t — but if they do, NRLC wants to make sure that it sticks to them in the midterm elections.