The decades-long battle over abortion has emerged as a mini-drama in the larger debate on a health care overhaul, and Central Valley lawmakers are divided.

U.S. Rep. Doris Matsui, D-Sacramento, has joined at least 40 other House Democrats in vowing to oppose health care legislation if the abortion limits included in an amendment to the bill passed by the House survive, said spokeswoman Mara Lee.

The amendment, inserted to win needed votes from reluctant Democrats, would extend the current ban on using federal money to pay for abortions. It could also restrict abortion coverage for those who buy coverage through a proposed government-run insurance exchange, regardless of whether they receive a government subsidy.

This exchange would be one of the main ways for the uninsured to obtain coverage, choosing from a government-run public option and competing commercial plans. The government would provide subsidies to help those too poor to purchase insurance on their own.

Matsui voted against the abortion amendment, but gave her support to the overall bill. The Senate is working on its own version of health care legislation, and the abortion issue could pose another hurdle for Democrats' hope to implement the Obama administration's top domestic priority.

"If we're going to have an abortion debate, let's have a separate abortion debate," not a "back-door" one, Lee said. "We are undoing years of work to protect a woman's right" to make reproductive decisions.

Rep. Dan Lungren, a Republican from Gold River, voted in favor of the abortion limits and opposed the broader health care bill.

"This is not a question of Roe v. Wade. It's about forcing taxpayers to pay for abortions," Lungren said, referring to the landmark Supreme Court case that legalized abortion.

"It's obvious the Democrats wouldn't have had enough votes to adopt the (health care) bill if they hadn't adopted the amendment."

Republicans point out that the amendment would not outlaw abortions.

"It just says it prohibits federal money to be used for abortions," said Rep. Tom McClintock, R-Elk Grove, adding that anyone who wants abortion coverage could purchase that coverage on their own – outside the government-run exchange.

Republicans could have exploited Democratic tensions by keeping the House bill intact, McClintock said. With little room for error – the bill's margin of victory was a mere five votes – House leaders might have then seen a major defeat of the broader health bill.

"You could have seen Republicans abstain (from the amendment vote) to make it more difficult for the measure to pass," McClintock said. "It sets up an interesting voting dynamic in the unlikely event it comes back to the House."

McClintock said health care legislation faces "a very steep hill to climb in the Senate."

The abortion amendment passed with support from 64 Democrats, including Democratic Reps. Jim Costa of Fresno and Dennis Cardoza of Merced.

Costa and Cardoza, both so-called Blue Dog Democrats who represent conservative-leaning districts and whose support for health care legislation has sometimes wavered, ultimately voted for the final overhaul package, including the abortion amendment.

Planned Parenthood's Mar Monte office, which covers 27 California counties and parts of Northern Nevada, sent a letter Monday expressing dismay to the pair of Central Valley congressmen.

The letter was signed by Deborah Ortiz, now vice president of public affairs for Planned Parenthood's Mar Monte region. Ortiz served with both Cardoza and Costa in the state Legislature.

"Given our long friendship and history of working on behalf of those who have little to no access to health care, I welcome an explanation of your vote," her letter said. "Absent an explanation, I can only assume that the decision was a political rather than a policy decision."

Neither Cardoza nor Costa returned phone calls requesting interviews.

Costa's spokesman, Bret Rumbeck, said the congressman's office received the strongly worded letter. "We get lots of tough letters," he said.

Abortion rights advocates argued that that the amendment would have a disproportionate effect on poor women, because they are more likely to lack insurance, and to seek coverage through the exchange.

In 2005, 1.2 million abortions were performed in the United States, including 208,000 in California, according to the Guttmacher Institute, which tracks abortion rates.

The rate of abortion among women living in poverty is more than four times greater than for women making 300 percent of the federal poverty level, according to the institute.

"I understand there are people in this country who feel very strongly about abortion – that women shouldn't have them, that the government shouldn't pay for them – but we should not be on a road that takes away a woman's right to reproductive freedom," said Shauna Hecker, executive director for Women's Health Specialists.

Hecker's group serves 50,000 women and performs about 4,000 abortions annually at family planning clinics in Sacramento and three other Northern California cities.

Call The Bee's Bobby Caina Calvan, (916) 321-1067.