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   WASHINGTON — A restriction on abortion coverage, added late Saturday to the health care bill passed by the House, has energized abortion opponents with their biggest victory in years — emboldening them for a pitched battle in the Senate. 
   
   
   
   
   
   
   
   
   
   The provision would block the use of federal subsidies for insurance that covers elective abortions. Advocates on both sides are calling Saturday’s vote the biggest turning point in the battle over the procedure since the ban on so-called partial birth abortions six years ago. 
   
   Both sides credited a forceful lobbying effort by Roman Catholic bishops with the success of the provision, inserted in the bill under pressure from conservative Democrats. 
   
   The provision would apply only to insurance policies purchased with the federal subsidies that the health legislation would create to help low- and middle-income people, and to policies sold by a government-run insurance plan that would be created by the legislation. 
   
   Abortion rights advocates charged Sunday that the provision threatened to deprive women of abortion coverage because insurers would drop the procedure from their plans in order to sell them in the newly expanded market of people receiving subsidies. The subsidized market would be large because anyone earning less than $88,000 for a family of four — four times the poverty level — would be eligible for a subsidy under the House bill. Women who received subsidies or public insurance could still pay out of pocket for the procedure. Or they could buy separate insurance riders to cover abortion, though some evidence suggests few would, in part because unwanted pregnancies are by their nature unexpected. 
   
   Not many women who undergo abortions file private insurance claims, perhaps to avoid leaving a record. A 2003 study by the Alan Guttmacher Institute found that 13 percent of abortions were billed directly to insurance companies. Only about half of those who receive insurance coverage from their employers have coverage of abortion in any event, according to a study by the Kaiser Family Foundation. 
   
   Abortion rights advocates, however, are grappling with a series of incremental defeats in the courts and in Congress, and are now bracing for another struggle as the health care legislation goes to the Senate. 
   
   “This is going to make it that much more challenging on the Senate side,” said Nancy Keenan, president of Naral Pro-Choice America. 
   
   The president and Democratic leaders alike have long promised that their proposed health care overhaul would not direct taxpayer money to pay for elective abortions. But the president has never spelled out his answer to the contentious question of how to apply that standard to the novel program of offering insurance subsidies or a government-run plan to millions of poor and middle-class Americans. 
   
   House Democratic leaders had sought to resolve the issue by requiring insurers to segregate their federal subsidies into separate accounts. 
   
   Insurance plans would have been permitted to use only consumer premiums or co-payments to pay for abortions, even if individuals who received federal subsidies used them to buy health plans that covered abortion. But the House speaker, Nancy Pelosi, was unable to hold on to enough moderate and conservative Democratic votes to pass the health bill using that approach, forcing her to allow a vote Saturday night on the amendment containing the broader ban. 
   
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   Five states go further than the amendment to the health care overhaul. The five — Idaho, Kentucky, Missouri, North Dakota and Oklahoma — already bar private insurance plans from covering elective abortions. 
   
   The federal employees’ health insurance plan and most state Medicaid programs also ban coverage of abortion, complying with a three-decade old ban on federal abortion financing. Seventeen state Medicaid programs, however, do cover the procedure, by using only state money. 
   
   The bishops objected to the segregated funds proposal previously embraced by the House and Senate Democratic leaders in part because they argued that it amounted to nothing more than an accounting gimmick. 
   
   Advocates on both sides of the question weighed in, but the bishops’ role was especially pivotal in part because many Democrats had expected them to be an ally. They had pushed for decades for universal health insurance. 
   
   “We think that providing health care is itself a pro-life thing, and we think that, by and large, providing better health coverage to women could reduce abortions,” said Richard M. Doerflinger, a spokesman for the anti-abortion division of the United States Conference of Catholic Bishops. 
   
   “But we don’t make these decisions statistically, and to get to that good we cannot do something seriously evil.” 
   
   Beginning in late July, the bishops began issuing a series of increasingly stern letters to lawmakers making clear that they saw the abortion-financing issue as pre-eminent, a deal-breaker. 
   
   At the funeral of Senator Edward M. Kennedy in August, Cardinal Seán O’Malley, the archbishop of Boston, stole a private moment with Mr. Obama to deliver the same warning: The bishops very much wanted to support his health care overhaul but not if it provided for abortions. The president “listened intently,” the cardinal reported on his blog. 
   
   Bishops implored their priests and parishioners to call lawmakers. Conservative Democrats negotiating over the issue with party leaders often expressed their desire to meet the bishops’ criteria, according to many people involved in the talks. On Oct. 8 three members of the bishops conference wrote on its behalf to lawmakers, “If the final legislation does not meet our principles, we will have no choice but to oppose the bill.” 
   
   On Sunday, some abortion rights advocates lashed out at the bishops. “It was an unconscionable power play,” said Cecile Richards, president of Planned Parenthood Federation of America, accusing the bishops of “interceding to put their own ideology in the national health care plan.” 
   
   Now some Senate Democrats, including Bob Casey of Pennsylvania and Ben Nelson of Nebraska, are pushing to incorporate the same restrictions in their own bill. Senior Senate Democratic aides said the outcome was too close to call. ||||| President Obama and Senate Democrats sought on Sunday to generate momentum from the House's passage of health-care legislation, even as a new hurdle emerged: profound dismay among abortion-rights supporters over antiabortion provisions inserted into the House bill. 
   
   The House passed its version of health-care legislation Saturday night by a vote of 220 to 215 after the approval of an amendment that would sharply restrict the availability of coverage for abortions, which many insurance plans now offer. The amendment goes beyond long-standing prohibitions against public funding for abortions, limiting abortion coverage even for women paying for it without government subsidies. 
   
   The abortion issue had been rumbling within the House Democratic caucus for weeks, but Saturday's votes revealed the depths of the fault lines. The amendment passed with the support of 64 Democrats, roughly a quarter of the party caucus. 
   
   But abortion-rights supporters are vowing to strip the amendment out, as the focus turns to the Senate and the conference committee that would resolve differences between the two bills. 
   
   Although House liberals voted for the bill with the amendment to keep the process moving forward, Rep. Diana DeGette (Colo.) said she has collected more than 40 signatures from House Democrats vowing to oppose any final bill that includes the amendment -- enough to block passage. 
   
   "There's going to be a firestorm here," DeGette said. "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." 
   
   Senate Majority Leader Harry M. Reid (D-Nev.) is waiting for cost estimates of provisions of the bill he is cobbling together, and he hopes to bring it to the Senate floor before Thanksgiving. The battle over abortion has been more muted in the Senate, but Jim Manley, Reid's spokesman, predicted that would change. 
   
   "The debate in the House highlighted some of these issues that we're going to have to face here in the Senate, and on this issue in particular, it's something [Reid] is going to have to talk with his caucus about," Manley said. 
   
   Obama left the abortion issue unmentioned Sunday when he appeared in the White House Rose Garden to give brief remarks congratulating the House on its "courageous" passage of the bill. "Now it falls on the United States Senate to take the baton and bring this effort to the finish line on behalf of the American people," he said. "And I'm absolutely confident that they will." 
   
   Other issues remain unresolved. The House bill's primary new revenue source to pay for the bill is an income tax surcharge on families earning more than $1 million; the Senate bill will probably rely on a proposed new excise tax on costly insurance plans. The House and Senate also differ on a government-run insurance plan to be offered on the new marketplace where small businesses and people without employer-provided coverage -- about 30 million in all -- would buy coverage. 
   
   The Senate version would limit this "public option" by allowing states to opt out of it, but even in that form, the bill's prospects are unclear. Sen. Joseph I. Lieberman (I-Conn.), whose vote Democrats will probably need to break a filibuster, warned again Sunday on Fox News that he will withhold his support if the bill includes a public option. 
   
   The bills also differ in their requirements for employers to provide coverage -- the House's language is tougher -- and in the subsidies for those who cannot afford coverage, which are larger in the House version. Both bills deny subsidies to illegal immigrants, but the Senate version goes further by also barring them from buying coverage on the new marketplace with their own money.
target: – The abortion funding ban included in the health-care bill passed by the House Saturday could doom it down the road, as abortion supporters in the Senate threaten revolt, and those who voted for it in the House vow they won't back the final bill if it's still included, the Washington Post reports. The 11th-hour provision, which was pushed through with the help of the Roman Catholic bishops, "is going to make it that much more challenging on the Senate side," the president of NARAL-Pro Choice America tells the New York Times. And even if the bill somehow manages to squeak by in the Senate, a group of House liberals who voted for the amendment just to keep the bill moving has vowed to block its final passage. "We're not going to let this into law," said Rep. Diana DeGette. For those on both sides of the abortion debate, the stakes are high. "This would be the greatest restriction on a woman's right to get an abortion with her own money in our lifetime," the pro-choice activist said.