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Will Stupak and the Catholic Bishops Kill Health-Care Reform?

The outcome of the battle for health-care reform may rest on the say-so of one man, Rep. Bart Stupak. But he's got an army of Catholic bishops pulling his strings.

UPDATE:Rachel Maddow reports that Stupak likely only has four or five members of Congress committed to voting with him against the Senate version of the health-care reform bill if he doesn't get new anti-abortion language added to the bill. Stupak claims he has at least twice as many. Maddow named her source as an aide to one of the House Democratic leaders.

With the congressional spring recess fast approaching, it's crunch time, once again, for health-care reform. And once again, one Democrat, Rep. Bart Stupak, is threatening to kill the bill -- with the help of 10 or so anti-choice compatriots he claims stand with him -- if the final deal does not include the draconian language on abortion contained in the health-care reform legislation passed by the House in November.

Stupak no doubt feels like the big man in this fight, the guy who can stop the clock and deprive some 30 million uninsured Americans a shot at having health-care coverage. In truth, however, the big men are the ones in mitres and vestments: the United States Conference of Catholic Bishops. It was they who demanded the Stupak amendment to the House bill, which bars any American who receives a government subsidy to purchase health insurance through a government-run insurance exchange from purchasing a plan that includes coverage for abortion.

The bishops lined up enough anti-choicers, who pledged to withhold their votes on the reform bill unless Stupak's demand was met, to force Speaker Nancy Pelosi to allow Stupak to bring his amendment to the House floor for a vote. There, aided by Republicans who went on to vote against the health-care bill, Stupak's amendment was attached to the House bill.

Now, Stupak and the bishops are back, ready to squelch any final deal unless their demands are met. Even if Democratic leaders are wiling -- and they may very well be -- it will be a tricky business to include language acceptable to Stupak and his pointy-hatted friends in any final package to be voted on in the House. It's all about process, and who can game it.

You'll recall that, before the new year, both the House and the Senate passed separate health-care reform bills, which everyone assumed would go to a conference committee where the differences would be hammered out before each chamber voted on a final package. Then Republican Scott Brown won the seat vacated by the death of Massachusetts Sen. Ted Kennedy, and a whole new strategy had to be arrived at, since the Democrats no longer had the nominal 60-vote super-majority required to break a filibuster.

The strategy is this: The House must now pass the Senate version of the bill -- which contains provisions that are problematic for many House members, and omits others, such as a limited public option, that are important to others -- and then do "fixes" to the Senate bill via a Senate process known as budget reconciliation, which can be won on a simple majority. In other words, a budget reconciliation bill is not subject to the filibuster, which requires a 60-vote majority to break.

But Bart Stupak and his bishop friends have a big problem with the Senate bill, and it's one that likely cannot be fixed via the budget reconciliation process: the Senate bill's harsh anti-abortion provision isn't draconian enough for them. Where the Stupak amendment to the House bill forbids the sale of abortion coverage in the insurance exchanges to people receiving subsidies, the Senate bill requires the consumer to write a separate check for abortion coverage in order to comply with existing law that forbids the use of federal funds to pay for abortion. And for this, they're willing to jettison health-care coverage for 30 million people, many of them children -- all ostensibly for the sake of fetal life.