The Stupak-Pitts Amendment, barring private and public health insurance plans from offering abortions as part of basic coverage if they accept government subsidies, risks sinking the fragile health bill passed Saturday. President Obama and numerous Democrats say they will not support its passage with the amendment included.

House Democrats and advocates opposing the amendment fear it would put lower- and middle-income women, those most likely to use a public option and subsidized private plans, at risk for being uninsured at a critical time, as unintended pregnancies or medically complicated pregnancies that require abortion cannot be planned.

First introduced by Reps. Bart Stupak (D-Michigan) and Joe Pitts (R-Pennsylvania), the amendment would require women to buy separate "riders" to cover abortions, even if they otherwise paid for a full insurance plan. It passed with the support of 64 Democrats, a quarter of the party caucus, and the majority of Republicans - the health care bill itself, passed Saturday by a vote of 220 to 215, had only one Republican vote.

President Obama, in an interview with ABC News, voiced his opposition to the amendment, saying it needs "some more work before we get to the point where we're not changing the status quo." The existing legislation, in the form of the "Hyde amendment," prohibits federal dollars from being spent on abortion care. "And that's the goal," he said, voicing his opposition to the amendment.

Liberal House Democrats, led by Reps. Diana DeGette (D-Colorado) and Louise Slaughter (D-New York), are leading a group of more than 40 Democrats, enough to block the passage of a final bill, in writing a letter to House Speaker Nancy Pelosi (D-California) threatening to withhold their support if federal funding for abortion services is strictly prohibited in the final legislative bill.

Dated November 7, the letter laments the possibility that health care reform could be misused to hurt rather than heal, and goes on to say, "The Stupak-Pitts amendment to H.R. 3962, The Affordable Healthcare for America Act, represents an unprecedented and unacceptable restriction on women's ability to access the full range of reproductive health services to which they are lawfully entitled. We will not vote for a conference report that contains language that restricts women's right to choose any further than current law."

Slaughter, who is chairwoman of the Rules Committee, and DeGette, have also written to Obama, requesting a meeting to discuss the issue DeGette says will cause a firestorm.

"Women are going to realize that a Democratic-controlled House has passed legislation that would prohibit women paying for abortions with their own funds.... We're not going to let this into law," said DeGette, who predicts the amendment will be dropped as the underlying notion of the bill becomes clear to more moderate Democrats, who, she says, may have misunderstood that the amendment goes far beyond the existing ban on federal funding. "This would be the greatest restriction on a woman's right to get an abortion with her own money in our lifetime. The stakes could not be higher."

Rep. Deborah Wasserman-Schultz (D-Florida) also spoke out, saying Monday on "MSNBC," "I am confident that when it comes back from the conference committee that that language won't be there."

This legislative response comes on the heels of equally, if not more, vitriolic responses from advocacy groups. Planned Parenthood, one of the largest sexual and reproductive health care advocates and providers, said in a statement Saturday, "Planned Parenthood condemns the adoption of the Stupak/Pitts amendment in HR 3962 this evening ... This amendment reaches much further than the Hyde Amendment, which has prohibited public funding of abortion in most instances since 1977.

"It is extremely unfortunate that the United States Conference of Catholic Bishops and anti-choice opponents were able to hijack the health care reform bill in their dedicated attempt to ban all legal abortion In the United States. Most telling is the fact that the vast majority of members of the House who supported the Stupak/Pitts amendment in today's vote do not support HR 3962, revealing their true motive, which is to kill the health care reform bill. These single-issue advocates simply used health care reform to advance their extreme, ideological agenda at the expense of tens of millions of women."

President Obama campaigned heavily on a platform of comprehensive health care reform. "In my mind reproductive care is essential care. It is basic care. And so it is at the center and at the heart of the plan that I propose ... Essentially, what we're doing is to say that we're going to set up a public plan that all persons and all women can access if they don't have health insurance," he said in a speech to the Planned Parenthood Action Fund on July 17, 2007. "It'll be a plan that will provide all essential services, including reproductive services."

More recently, however, he moderated his position. "This is a healthcare bill, not an abortion bill. And we're not looking to change what is the principle that has been in place for a very long time, which is federal dollars are not used to subsidize abortions," Obama said. "I want to make sure ... 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."

Advocates say the limiting language of the amendment can only hurt those who are already most vulnerable. According to a 2003 Kaiser Family Foundation study, about half of people with private health insurance are in plans which include abortion coverage, which the amendment may limit if companies opt to receive government subsidies, and in places such as Washington State, where abortion is already covered by the state medical assistance, coverage runs the risk of being removed.

Planned Parenthood sees the issue of coverage of abortion services is more than one of simply accounting - for many women, it believes, it is a matter of life and death. "Together, women and their allies are going to make their voices heard, so that they do not become second-class citizens in a newly reformed health care system in the United States."