WASHINGTON — For weeks, the Catholic Church has asked its U.S. parishioners to work toward ensuring that tough language restricting federal funding of abortion is included in healthcare overhaul legislation.
It has gone so far as to insert a prayer into the weekly bulletins of dioceses across the country, imploring Congress to "act to ensure that needed healthcare reform will truly protect the life, dignity and healthcare of all."
But as the U.S. Conference of Catholic Bishops, the church's governing body in America, tries to rally its forces outside Congress, it is also using its leverage within.
A number of groups oppose abortion rights, but the church is one of the few to also support Democratic efforts to overhaul healthcare. That has given the church a seat at the negotiating table.
It used that influence this month as the House of Representatives prepared to vote on the healthcare legislation. Negotiators for the church worked with lawmakers to add an amendment to ensure that federal insurance subsidies do not wind up funding elective abortion.
Supporters of abortion rights said that the amendment would in effect block coverage for abortion even when individuals paid for policies themselves. But the House adopted the amendment, and the bill passed.
The Catholic Church came to play a role in the legislation partly because it has long supported wider healthcare access for low-income Americans.
"Healthcare has been one of their basic goals out there for years," said Rep. Bart Stupak of Michigan, the Democratic sponsor of the abortion amendment and himself a Catholic.
The church also had amassed goodwill during years of working with Democrats on such issues as tax credits for the working poor, immigration, climate change and nutrition programs. It had built a level of trust that other antiabortion groups could not.
The church "played a critical role in a number of initiatives over many years that affect our most vulnerable people," said Ellen Nissenbaum, legislative director of the Center on Budget and Policy Priorities, which focuses on issues involving low- and moderate-income people. "Their work has made a tremendous difference on fundamental issues of poverty and economic justice."
As House floor action on the healthcare bill drew near, church leaders talked to Speaker Nancy Pelosi (D-San Francisco) and Minority Leader John A. Boehner (R-Ohio).
Pelosi, also a Catholic, let the House vote on Stupak's amendment despite the strong objections of abortion-rights supporters in her caucus.
It was natural for Stupak to consult with the bishops conference in order to draft the amendment. But the church's role in the process has drawn criticism.
"They came to the Hill, locked themselves in a room with leadership and threatened to take the bill down in the 11th hour," said Laurie Rubiner, vice president of public policy for Planned Parenthood, which supports abortion rights.
The Stupak amendment applies to people who use federal subsidies to buy insurance on a new "exchange," or insurance marketplace.
But Rubiner and other abortion-rights supporters say the amendment will affect people who buy policies in the exchange even without subsidies. They say the amendment will prompt insurers to drop abortion coverage from all health policies offered in the exchange, subsidized by the government or not.
The church had rejected compromise language on abortion.
"I guess I'm very surprised that an entity that purports to be a supporter of healthcare reform and an advocate for poor and low-income women would take such a hard line and refuse to compromise," Rubiner said.
More liberal Catholic organizations say the bishops don't speak for the mainstream. In a recent poll commissioned by Catholics for Choice, 68% of Catholic voters surveyed disapproved of the bishops' unyielding stance on insurance coverage for abortion.
"Catholic voters clearly have a different mind-set than the bishops do," said Jon O'Brien, president of the abortion-rights group.
The leader of the U.S. Conference of Catholic Bishops, Cardinal Francis George, of President Obama's hometown of Chicago, has been a foil for the president at times.
When the University of Notre Dame invited Obama to speak earlier this year, the cardinal called the occasion "an extreme embarrassment" to Catholics.
"Some of his policies we think are simply wrong," George said in an interview in Rome last month.
"At those moments, we have to do what you always have to do in a free country. You can criticize the politics of the government."
Last week, the bishop of Providence, R.I., blasted Rep. Patrick J. Kennedy (D-R.I.) for voting against the Stupak amendment. Bishop Thomas J. Tobin accused Kennedy, son of the late Sen. Edward M. Kennedy (D-Mass.), of "false advertising" for describing himself as a Catholic, and said Kennedy should not receive Holy Communion.
"It's not too late for you to repair your relationship with the Church," Tobin wrote in a letter to Kennedy.
The church's attitude led Rep. Lynn Woolsey (D-Petaluma), the leader of the House Progressive Caucus, to ask last week whether the conference's federal tax exemption as a religious organization should be revoked.
The bishops have pledged to be just as active in the Senate healthcare debate as they have been in the House.
They will probably have the help of one or more Democrats who oppose abortion, such as Sen. Bob Casey of Pennsylvania.
"The conference will remain vigilant and involved throughout this entire process," Cardinal George vowed last week.
Janet Hook of the Washington bureau contributed to this report.