(WOMENSENEWS)–The words rang like gunshots in many women’s ears.

"Under our plan, no federal dollars will be used to fund abortions," President Obama told a joint session of Congress in a televised speech about health care reform on September 9.

His pledge is fueling the fight over women’s access to abortion under any form of government insurance that might survive lawmakers’ protracted and intense battles over health care reform.

Three days after Obama’s speech, tens of thousands of protestors swarmed the U.S. capital in a rally that organizers touted as the largest-ever outpouring of political conservatives. Many carried anti-choice placards and chanted slogans that blasted the inclusion of abortion services in the public plan.

Pro-choice activism is also revved up.

Last weekend, the New-York based Physicians for Reproductive Choice and Health sent 26 doctors to Capitol Hill to talk to lawmakers about the importance of including women’s reproductive health care, including contraception, prenatal care, and abortion, within health reform.

One million U.S. women need abortions each year, and one-third require this procedure at some point in their lives, according to the New York-based Guttmacher Institute.

Via their Web sites, Planned Parenthood and NARAL Pro-Choice America, both with large presences in Washington D.C., are enabling supporters to circulate petitions; to pen letters to the editors of local newspapers; and to lobby their Congressional representatives.

Eliminating Field of Battle

Sen. Max Baucus (D-Mont.) threatened to short-circuit the skirmish by eliminating the entire field of battle. On September 16, he introduced a spinoff of the Obama-favored plan that excludes a government program and the abortion politics that go along with it.

Pro-choice supporters argue that covering abortion is necessary to maintain women’s health and women’s rights and is already part of current government policy.

Many point to a July opinion poll by the Washington-based National Women’s Law Center, which indicated that 71 percent of voters favor including reproductive services in health care reform.

Abortion is permitted by law as a result of the U.S. Supreme Court’s 1973 Roe v. Wade decision and is a standard part of insurance coverage in 80 percent of employer-sponsored health plans, according to the Web site Polifact.com.

Under the 1985 Consolidated Omnibus Budget Reconciliation Act, laid-off workers can remain on their former employer’s group health plans for 18 months. Federal funding supports COBRA coverage, including abortion services.

"When the President made this announcement, he traded many women’s futures away," said Stephanie Poggi, executive director of the Boston-based National Network of Abortion Funds. "The poorest women must scrape and skimp–forgoing food, electricity and even risking eviction by delaying rent–to afford abortion services. And now, the President is recommending that we expand this inequality to millions more women."

Under the 1976 Hyde Amendment, Medicaid (the government’s health plan for low-income Americans) does not pay for elective abortions, but does pay for them in the cases of rape, incest and medical concerns that threaten the mother’s life.

Changing the Hyde Amendment

"We would love it if all poor women were able to get abortions, which would require repealing or changing the Hyde Amendment," said Dr. Suzanne Poppema, chair of the board for Physicians for Reproductive Choice and Health. "That’s one of pro-choice advocates’ longer-term goals. But right now, we’re fighting to ensure that the reform bill provides access for women’s health care and that it does not roll back coverage for the reproductive health services that many women already have."

 Stephanie Poggi

In his speech, Obama noted that private insurance is three times as expensive as employer-sponsored insurance; that premiums have gone up three times faster than wages; and that 14,000 Americans lose the coverage they need every day due to unemployment and rising health care costs.

To address these problems, Obama recommends creating a public insurance plan that would coexist and compete with private insurers, in the same way that public colleges and universities share their market with private schools.

Americans who could not afford his plan would get need-based tax credits so they could buy coverage.

Obama’s proposal is outlined in H.R. 3200 (America’s Affordable Health Choices Act of 2009)–one of a dozen health-reform proposals now before Congress, and the one with the most support. Legislators may vote on the bill this month.

Though Obama appeared in his speech to soften a long-held pro-choice position, reproductive rights activists are encouraged by the August amendment proposed by Rep. Lois Capps (D-Calif.). This legislation, absorbed into the official text of H.R. 3200, protects public-option abortion services by cordoning them off from federal funding.

Instead of coming from tax dollars, the money would come from the premiums that individuals pay to join the public plan.

Striking Common Ground

In another pro-choice feature, the amendment says that elective abortion in the public plan could be funded at the discretion of the secretary of the U.S. Department of Health and Human Services. Current Secretary of Health and Human Services Kathleen Sebelius has a long-standing pro-choice record.

But the amendment strikes common ground by requiring every state to offer two types of public plans: one that provides abortion coverage and one that does not.

Since Capps introduced her amendment, anti-choice groups have ramped up their media activism.

The Family Research Council, a conservative Christian group based in Washington, D.C., ran ads in five states. The ad showed a couple sitting at a kitchen table and grimly commiserating over the man’s inability to get needed surgery through his public Medicare plan while "Planned Parenthood is included in the government-run health plan and spending tax dollars on abortions."

The Susan B. Anthony List, which supports anti-choice female candidates and is headquartered in Arlington, Va., launched ads in Nevada, home of Democratic Senate Majority Leader Harry Reid, attacking him for "pushing a massive government-run health care system requiring taxpayer funding for abortions."

Students for Life of America, also in Arlington, asked high school students to wear white T-shirts with the slogan "Abortion is not health care," while Priests for Life, based in New York, asked people to "pray that the current health care reform bills being debated in Congress do not result in an expansion of abortion."

Taking effect in 2013 and costing $900 billion over 10 years, H.R. 3200 would necessitate that every citizen carry health insurance and would require companies to cover their employees. The bill would prevent insurance companies from denying coverage because of preexisting conditions and prohibit them from dropping policyholders when they became ill.

The bill would also create an insurance exchange in which individuals and businesses can shop for coverage at competitive prices.

"The exchange would work much like Orbitz or other travel Web sites," said Tait Sye, a spokesperson for the Planned Parenthood Federation of America, which is the largest provider of abortion services in the United States. "People shopping for insurance would be able to review the listings in the exchange and then approach representatives from private insurers or the public plan to get details about signing up."

Molly M. Ginty is a freelance writer based in New York City.