The bill also prevents affordability credits from being used to pay for abortion coverage; the credits would help middle-class and working-class Americans purchase insurance coverage on the private market. Eighty-seven percent of existing private insurance plans cover abortion, which is significantly cheaper and less medically risky than pregnancy and childbirth. After reform, if insurers want to continue to provide such care, the House bill would require them to segregate all government funding from the co-pays individuals pay into the plans. Abortions could only be paid for out of the “private” side of the ledger.

In addition, in each state, the health-insurance market must include one plan that does cover abortion, and one plan that does not. But because the vast majority of insurers currently do cover the procedure, pro-choicers view the provision as a step forward for the opposition. “That kind of leans toward the pro-life position,” Waxman said.

Pro-life Democrats have been especially influential in the health reform process because so many of them are considered swing voters on the overall package. Rep. Bart Stupak, a Michigan Democrat with strong ties to the religious right, has emerged as a spokesman for antiabortion sentiments in both parties. He continues to push forward in an attempt to amend the Pelosi bill to restrict abortion even further. Stupak’s goal is to outlaw all abortion coverage within the health-insurance exchanges, requiring women to purchase a special “rider” for abortion services. But according to health-care experts, few women anticipate needing an abortion and thus would be unlikely to pay extra for the coverage—even though about half of American women experience an unintended pregnancy in their lifetimes, and one-third of American women have had an abortion.

Adam Sonfield, senior public policy associate at the Guttmacher Institute, which researches reproductive health issues, told The Daily Beast, “Currently, it’s not that we can’t pay for coverage that includes abortions. It’s that we can’t cover abortions. The [Stupak] standard is stricter than the standard in Hyde.”

Abortion-rights activists regard Stupak as “obsessed,” motivated by religious beliefs, and unwilling to compromise. They allege that he may not truly support the president’s effort to overhaul the health-care system, pointing out his ties to groups like Focus on the Family and the National Right to Life Committee, which opposed the expansion of S-CHIP, the state program that provides health care to poor children.

Pro-choice leaders disagree about whether more support from the White House could have strengthened their hand in the health-reform battle. In addition to the failed efforts to include comprehensive abortion coverage in the public plan, efforts to require private health insurance coverage of birth control also fell flat. In 1993, Hillary Clinton explicitly told Congress that she expected pregnancy and abortion to be treated in health reform like any other medical service. This year, though, Obama sent a different message, telling Katie Couric in July, “I think we also have a tradition of, in this town, historically, of not financing abortions as part of government-funded health care. Rather than wade into that issue at this point, I think that it’s appropriate for us to figure out how to just deliver on the cost savings, and not get distracted by the abortion debate at this station.”

A different tone from the White House might have helped pro-choice groups, Waxman said. “We would like significant support from the administration on women exercising their constitutional rights,” she said.