WASHINGTON — As Democratic leaders in Congress and the White House decide how to pursue a likely final push for enactment of a national health-care overhaul this spring, Catholic and pro-life leaders see signs that the latest approach could expand public funding for abortion even beyond previous versions of health reform.

The U.S. Conference of Catholic Bishops (USCCB) and pro-life groups are carefully tracking developments on the federal health-care overhaul that was upended by a special election in January in Massachusetts. Sen. Scott Brown, R-Mass., shocked the Washington establishment when he was elected to the Senate seat long held by Democratic Sen. Edward “Ted” Kennedy, after explicitly running as the crucial vote against the health-care bill.

The result was that prospects for a final negotiated health-care bill between House and Senate Democratic leaders fell apart as moderate Democrats feared for the impact of the bill on their own chances for re-election. This fear was reinforced by polls that indicated the legislation had fallen into disfavor with the majority of Americans.

“There are a number of rank–and-file Democrats worried that they could lose their seats if they vote for this bill,” said Richard Doerflinger, associate director of pro-life activities at the USCCB.

In the weeks since the Massachusetts election, President Obama has sought to restart the drive for a comprehensive health-care law by introducing his own $950 billion proposal and holding a Feb. 25 bipartisan summit to discuss various health-reform proposals.

The Obama proposal closely mirrors the Senate-passed bill, which Catholic and pro-life groups roundly criticized for allowing federal tax dollars to subsidize insurance plans that cover elective abortions and allowing federal agencies to require that all private insurance plans cover abortion as “preventive care.”

Additionally, the Obama approach could go even further than the permissive Senate bill by providing $11 billion for community health centers, some of which could use that funding to directly cover abortions they provide, according to pro-life critics.

“The president’s proposal is the most pro-abortion of the health-care proposals to date,” said Matthew Faraci, a spokesman for Americans United for Life.

The bill also lacks many of the conscience protections that would keep Catholic health-care workers from having to participate in abortion or other unethical procedures, noted Doerflinger.

Democratic Defections

It was notable that Obama chose the abortion- and conscience-language approach of the Senate-passed health bill over the House-passed bill language, which included strong pro-life protections sponsored by Rep. Bart Stupak, D-Mich.

The pro-abortion language could undermine the legislative chances of the final health bill because Stupak and up to 12 other pro-life Democrats who supported the House-passed bill would oppose a final bill without abortion-funding restrictions. They could be joined by liberal Democrats who are upset that the final bill does not offer a so-called public option, according to health-care lobbyists.

Such Democratic defections would doom the health-care bill in the face of unified Republican opposition because the earlier version passed the House by only a five-vote margin.

A third group of Democrats that may move en masse against the bill are members of the fiscally conservative Blue Dog Caucus, according to lobbyists. Many of these Democrats are from conservative districts and particularly sensitive to the decrease in public support for any health-care bill.

Democratic leaders and other supporters of the health-care bill have focused on swinging public sentiment back in favor of the overhaul, in order to bolster nervous moderate Democrats in the House.

“No legislative procedure is going to work until the public is shown that this is not the horrible bill that they have been led to believe,” said David Kendall, senior fellow for health policy at Third Way, a group that has supported the Democratic health-care bills.

There is also a strong possibility that Democrats may use a controversial tactic known as reconciliation, in which they would pass the bill in the Senate with a simple majority of 51 votes, rather than the 60 votes needed to break a filibuster. House Speaker Nancy Pelosi on Friday revealed that Democratic leaders are asking the Senate to pass the legislation with a “simple majority.”

Supporters of the health bills may have a large task in re-winning the public to their side.  A February CNN poll echoed many others when it reported that only 25% of Americans supported enactment of a health-care bill similar to the one already passed by the House and Senate. Abortion opponents also point out to swing district Democrats that there is wide public opposition to public funding of elective abortion. A December Quinnipiac University poll found 72% oppose the use of taxpayer funds to pay for abortions under any health-care reform effort.

“We’re focusing on reaching out to members of the House and encouraging them to continue to stand for life,” Faraci said.

‘Difficult Bind’

If Democratic leaders are unable to garner enough support for the Obama measure, then a piecemeal approach that advances individual pieces of a health-care overhaul separately is also possible, according to health-care experts. However, a limited approach will not come until Obama and congressional Democrats have exhausted all efforts to enact a comprehensive package, if only because they have already invested so much time and prestige on the effort.

“The polling is rather against doing anything on this scale right now,” Doerflinger said. Democratic leaders “are in a difficult bind.”

Rich Daly writes from Washington.