Tea Party activists held a rally Tuesday on Capitol Hill to kill the health care measure House Democrats hope to pass this week. They called their rally Code Red for Health Care, and hoped their voices would help stall the bill.

Democrats are exploring a tricky procedure called "deeming" to speed up passage of health care legislation. The move would allow the House to pass the Senate health bill without a separate and distinct vote on it.

President Obama took a trip to the swing state of Ohio to push for an overhaul of the health care system. Although there is a multimillion dollar ad campaign for and against the measure, the strange coalition supporting the overhaul has stayed surprisingly intact.

A move by the agency that oversees Medicare to cut payments Jan. 1 for certain cardiac procedures has resulted in cardiologists suing the federal government. Their push back is an example of how difficult it is to make even small changes in the health care system.

Richard Doerflinger doesn't look the part of a high-powered political strategist. Bearded and bespectacled, he works in a small, cluttered office out of one of Washington’s less fashionable neighborhoods, far from the lobbying bastions of K Street.

Yet as the United States Conference of Catholic Bishops' point man on abortion, Doerflinger has emerged as a major player in the health care debate, one likely to play a pivotal role in the outcome.

It was Doerflinger who orchestrated the bishops’ successful campaign late last year to add a tough anti-abortion provision to the House legislation. The Senate adopted less stringent language.

Now, as President Barack Obama begins his last-ditch effort to pass final legislation, Doerflinger and his bosses are sending a clear message: If the Democrats want to succeed, they must include the House provision, or something equally restrictive, on abortion.

“The Senate may have to figure out whether it wants its abortion position or if it wants a health care bill," Doerflinger said in a recent interview. "That’s the difficult decision (House Speaker) Nancy Pelosi made, and she chose a health care bill. The Senate decided it could have its cake and eat it, too. That is no longer true. Something’s going to have to give.”

The bishops have supported universal health care coverage since the days of Woodrow Wilson. But that won't stop them from opposing any bill lacking a strict ban on using federal funds to pay for abortions, Doerflinger warns.

“We have a simple position,” he adds. “Everybody gets covered. Nobody gets deliberately killed.”

The bishops’ stand has encouraged abortion foes, outraged many women's groups and dismayed supporters - including some liberal Catholics - of the Democrats' health care legislation. They're worried an abortion impasse could derail the best chance in a generation to enact sweeping health legislation.

“We can’t lose sight of what’s at stake here,” says Chris Korzen, a former labor leader who heads Catholics United, founded to counter conservative Catholic groups. “We’re talking about extending health care coverage to millions of Americans who don’t have it. That’s highly consistent with pro-life values.”

Abortion rights groups have criticized Doerflinger and the bishops, saying they are holding the health care legislation hostage to their agenda. “No one else drew a line in the sand,” says Laurie Rubiner, vice president for public policy for Planned Parenthood Federation of America.

Working in "Little Rome"

The bishops' conference is headquartered in a neighborhood known as "Little Rome." Nearby is Catholic University and the largest Catholic church in the U.S., which has 65 million Catholics.

As associate director of the conference's Secretariat for Pro-Life Activities, Doerflinger cranks out reams of position papers, e-mails to congressional aides and letters from the bishops to lawmakers - not only on abortion, but also on euthanasia, embryonic stem cell research and physician-assisted suicide.

A self-described "policy wonk," Doerflinger leaves a lot of the schmoozing on Capitol Hill to colleagues, but doesn't miss crucial meetings, including one in House Speaker Nancy Pelosi’s office the night before the House passed the health bill last year. He and John Carr, who also works for the bishops, were the lone outsiders, prompting criticism from abortion-rights supporters that Pelosi, who is Catholic and supports abortion rights, was taking her cues from Rome.

The two men helped craft the final wording of the anti-abortion amendment offered by Rep. Bart Stupak, D-Mich., that cleared the way for House passage of the health care bill by five votes.

"He's a real smart guy," says Stupak, referring to Doerflinger. "Pretty detailed guy who does his homework ."

Among friends and foes, Doerflinger is known for his in-depth knowledge. Last year, he was honored as one of six of the “greatest heroes” of the anti-abortion movement and awarded a $100,000 prize by the Massachusetts-based Gerard Health Foundation, which opposes abortion.

Critics say that Doerflinger can be bombastic and unyielding. “He doesn’t subscribe to the theory that you can catch more flies with honey than you can with vinegar,” says Sean Tipton, director of public affairs for the American Society for Reproductive Medicine.

In the late 1990s, Tipton recalls, then-Senate Majority Leader Trent Lott, a Republican, held a meeting to try work out a compromise on the contentious issue of federal funding for embryonic stem cell research. "It became apparent that Doerflinger and I could not do that,” Tipton says. “When you’re coming at the issue where a fertilized egg is a sacred human being with full constitutional rights, there’s not a lot of room for compromise."

Doerflinger admits he's blunt, but adds, "I don’t see a point in avoiding plain facts.”

Wrenching Tragedy

A wrenching family tragedy helped propel Doerflinger toward his life’s work. When he was a teenager growing up on Long Island, his older brother, Eugene, was injured in a car accident and lapsed into a "vegetative state,” Doerflinger says. One physician advised his mother to put Eugene in an institution and "forget you ever had a son,” he says. Instead, she took Eugene home. Four months later, he woke up. Eugene lived near his family, although with severe mental and physical disabilities, until his death in 2008.

The experience of how a family can come together and care for a loved one who had a life that other people think is over affected my attitudes,” Doerflinger says.

Culture Wars

He has spent 30 years on the front lines of the culture wars, with the ultimate goal of overturning Roe v. Wade, the 1973 Supreme Court decision that legalized abortion. He sees the battle being won through incremental change.

But critics say it would be a colossal mistake to kill universal health care for an incremental victory on abortion. “The difference between the two bills is pretty thin,” says Michael Sean Winters, a liberal Catholic author. “Doerflinger is so dug in, he’s missing the point on the Senate bill, which is also pro-life."

The House health bill bars insurance companies from selling policies that cover abortion to anyone who receives federal subsidies to buy insurance. The Senate’s less restrictive amendment permits insurers to offer abortion coverage, but requires customers to buy it with a separate check drawn on personal funds.

The Democrats’ best shot at succeeding on health care is to have the House pass the Senate bill. Then both chambers would make some changes in that legislation by passing a second bill under complex budget rules.

But some anti-abortion House lawmakers say they won't vote for the Senate bill. And it could be difficult for the Senate to adopt the House abortion language because of political and procedural reasons.

Amid the wrangling, Doerflinger stays focused on what he says is the bottom line. “If the bill attacks life itself, in our view, it’s not health care reform,��� he says. “You’ve undermined the foundation of the right to health care if you’re weakening the right to life. We can’t get over that. We can’t walk away and say this is good enough. That’s our moral position. We don’t trade the two off."

This story was produced through collaboration between NPR and Kaiser Health News (KHN), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

Since the Senate passed its version of a health overhaul on Christmas Eve, most of the debate has focused on the politics of the effort. By now, many people have forgotten — if they ever knew — what the bill would actually do.

So here's a short refresher.

According to the Congressional Budget Office, the Senate-passed bill would expand coverage to roughly 30 million of the 46 million people in the U.S. who lack health insurance. Most of the remaining uninsured would be undocumented immigrants, who would be ineligible for benefits under the bill.

Insurance Mandates

One of the most popular things the bill would do is ban insurance companies from excluding people or raising their rates, because they have what's known as a pre-existing medical condition.

What's that? Here's how California Democratic Rep. George Miller described his: "I sit here with two artificial hips, a little bit of arthritis, and I have a kidney stone. I'm dead in that insurance market if I have to switch policies or switch companies."

But in exchange for getting insurance companies to agree to accept everyone, the insurance companies need more healthy people to be covered to help spread the risk. So the bill does something that's a lot more controversial: It requires everyone to have insurance.

That's something many Republicans used to support, but don't now. "Never has the federal government said any American had to buy anything. Now, [you] have to buy insurance. If you don't buy insurance, pay the IRS more money," said Sen. Charles Grassley (R-IA) during the Senate's floor debate in November.

Grassley is correct in that the mandate would be enforced at tax time. If you can't prove you're covered, you'll pay a penalty.

Helping Hand

But help will be available. If you're poor, you'll get health insurance for free through the Medicaid program. For the first time, able-bodied adults who are simply low-income would become eligible for Medicaid.

Middle-class people who have to buy their own policies would get government subsidies. And small businesses would get tax credits to encourage them to help pay for insurance for their workers.

Those who have to buy their own health insurance get another leg up — a new marketplace called an exchange. There they could pool their buying power and compare their options.

At the same time, said Senate Finance Committee Chairman Max Baucus (D-MT), "exchanges will make it easier for consumers to choose the most efficient plans. And that will reduce their costs and put pressure on insurance companies to offer lower-cost, higher-quality plans."

Another cost-cutting aspect of the bill is a new focus on paying doctors, hospitals and other health care professionals.

"We ... believe that there should be incentives to provide care based upon best practices, not based upon simply procedures being reimbursed," House Majority Leader Steny Hoyer (D-MD) said at the White House health meeting last month. In other words, the new payment system would be based on how health care professionals do their jobs, rather than just how many tests they order or exams they perform.

Political Deal-Making

But politics has had a lot to do with getting the bill this far. Now House Democrats are being asked to cast a vote for the bill the Senate passed Christmas Eve. And, at least initially, they'll have to approve that Senate bill with no changes.

That means, as Sen. Lamar Alexander (R-TN) reminded everyone at last month's meeting, "It still has the sweetheart deals in it. ... I mean, what's fair about taxpayers in Louisiana paying less than taxpayers in Tennessee? And what's fair about protecting seniors in Florida and not protecting seniors in California and Illinois and Wyoming?"

Alexander was referring to several deals cut by Senate Majority Leader Harry Reid to win the 60 Democratic votes needed to get the bill passed by the Senate.

Of course, here's where this process gets even more complicated. Those so-called sweetheart deals are expected to be cancelled in a second bill. That so-called fix bill will carry the compromises now being made between the Senate and the House. That bill is also likely to alter the way the health care program is paid for.

But that second bill is still being drafted, and House Democrats are skittish about its ultimate prospects. Don't expect a House vote on the Senate bill until they get some assurances about what that second bill will do — and that the Senate can actually pass it.

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Rep. Bart Stupak (D-MI) says he is concerned the health care bill could contain what he deems lax language on abortion. But he says he's waiting to see the final language in the bill before he decides on his vote. Stupak says he won't support a measure that changes current law on federal funding of abortions.

Sen. Debbie Stabenow (D-MI) says the Senate reconciliation process on the health care bill will deal with dollars not policy. The comments come amid opposition from House Democrats over the measure's language on abortion. Stabenow says there aren't enough votes in the Senate for the measure to include what the opponents want.

Where to go next on health care legislation has been foggy at best, but Friday the mists began to clear. After Thursday's bipartisan summit at the White House, Democratic leaders have decided to press forward — dropping any hope of Republican support for the overhaul.

Now the leaders have to figure out what new health care policy can pass both chambers of Congress — with the votes of Democrats alone.

Can It Pass The Senate?

For almost an entire year, the big question about health care has been, "What can pass the Senate?" Because in that chamber, one usually needs 60 votes to win.

But now that Senate Democrats have decided to swerve and bring up the health care bill under what are called "budget reconciliation rules," they only need 51 votes — a simple majority — to pass the bill.

So suddenly, the big question has changed. Now what everyone wants to know is, "What can pass the House?" Republican House Whip Eric Cantor of Virginia says not much.

"They can't pass this bill," he says.

Cantor has widely circulated a memo that says the House has changed a lot since the first health care bill passed — by a vote of 220 to 215. Since then, the Senate loosened abortion language, seats have shifted, and now — says Cantor — there's no way to pass health care in the House with only Democratic votes.

"There is a scenario where you can see [House Speaker] Nancy Pelosi doesn't have any more than 200, maybe 200 and a couple more votes," Cantor says.

Democrats Say There's Still Hope

But Cantor is the Republicans' whip, not the Democrats'. And though many admit it will be tricky, it's not impossible, says Rep. Raul Grijalva, a Democrat from Arizona.

"We have to get something that gets us 217 votes in the House and 51 in the Senate," Grijalva says. "I think it's doable, but because we're going it alone, we can make it as strong as possible."

Grijalva is co-chair of the House Progressive caucus. For him, a stronger bill is a more liberal bill.

"Many of us continue to push for the public option," Grijalva says. "Many of us continue to say national health exchange instead of state by state. And I think if the needle's going to be thread, you already know within our caucus who the 'no' votes are going to be."

And then there are the conservative Democrats who want strong, clear language banning the use of federal money for abortions.

"I want to see it totally prohibited, airtight, lock-solid: You can't spend federal money — or any taxpayer money — on abortion," says Rep. Jason Altmire, a Democrat from Pennsylvania.

In fact, Altmire is one of the Democrats who voted against his party's bill in the House — not because of abortion, but because it didn't do enough to control medical costs and it didn't put enough emphasis on quantity of care.

"If they add some stronger language than the House had on cost containment, I think you're moving in the right direction — but, again, I need to see language," Altmire says.

That's the kind of "give" that Democratic leaders are hoping for. It appears that some conservative Democrats — even those who voted against health care the first time — are open to a new version of the bill.

New Motivation?

What changed? One conservative Democrat, Rep. Allen Boyd of Florida, cited the announcements by insurance companies that premiums will shoot up this year.

And then one liberal Democrat, Rep. Jim McDermott of Washington, says there's a big question all members are asking themselves in this election year: After spending months struggling with health care and taking gut-wrenching votes, is it better to take a stand and get nothing done, or to accomplish something that's imperfect?

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One of the components of President Obama's health plan is a feature that was in the Senate overhaul bill but not the House version — the so-called Cadillac tax, an excise tax on high-cost health insurance policies. But even proponents of the excise tax say it may be too weak to do much.

The Cadillac tax isn't intended as a way to generate a lot of income for the government. Instead, it's designed to hold down health costs by making people more aware of the costs of medical care. It taxes high-cost insurance policies provided by employers, with the idea that employers will instead buy lower-cost, nontaxed plans.

Many of the high-cost Cadillac plans have no copayments and no deductibles — that is, no $10 or $20 for each doctor visit, no $300 or $600 for each hospital visit. Lower-cost plans do have deductibles and premiums, and the idea is that paying that will make people more price-conscious: Doctors will think twice before ordering tests that may not be really necessary; and patients will ask their doctors if they really need this procedure or that hospitalization.

"Health care is expensive, and you want to have people think about how much they're spending on health care compared to the other necessities and luxuries of life," says economist Gail Wilensky. And she says people don't do that if they're not paying something for it out of pocket.

Last November, two dozen of the nation's top economists signed a letter in support of the excise tax. In December, the Senate included the tax in its overhaul bill. The tax would go into effect in 2013. Employer-purchased individual policies that cost more than $8,500 a year would be taxed, as would family policies priced higher than $23,000.

Among those who don't like the plan is Lawrence Mishel of the Economic Policy Institute. "When you tax plans which cost a lot of money, you tax plans that are rich with people who are sick and elderly, or in occupations which are risky, or people who live in high-cost areas." It's not fair, he says, to tax these plans just because of their price tag. And there's always the question of whether sick people will really want to question their doctors about cost.

Unions fought mightily against the plan, because many unions opt for untaxed health benefits over taxed wages — the untaxed benefits are a higher value.

Obama included a scaled-down version of the tax in his health overhaul plan. In his proposal, the tax would go into effect in 2018. Dental and vision plans would not be included in the total. Individual plans that cost more than $10,200, and family plans over $27,500 would be taxed.

That has some supporters of the excise tax unhappy. Wilensky says it's way too watered down. And physician-economist Alan Garber of Stanford University, who signed the letter in support of an excise tax back in November, said it may simply be a response to political reality. "Many of my colleagues and I are concerned that the long delay means that it will be too easy to find reasons not to implement it, so it may never be adopted. We'd like to see more done sooner."

In the past, unions fought hard against excise taxes, saying that their members have bargained away wages in exchange for health benefits, and that if employers cut back on insurance premiums to avoid the tax, there's no guarantee that the employers would turn around and give the money they've saved to their workers. Unions lobbied the White House hard, and were a big part of the reason that the president's health proposal delayed the implementation for five years.

Representatives of some of the big unions say they support the new plan as a good compromise. "This is a vast improvement over the Senate version," says Steve Kreisberg of the American Federation of State, County and Municipal Employees (AFSCME). "We don't think it's the best way to fund health care, but in the context of what the bill is and the compromises the president has had to make, we're supportive."

Meanwhile, the final fate of an excise tax will be clearer after Obama hosts what's slated to be a bipartisan discussion of his plan on Thursday.

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