House Speaker Nancy Pelosi, a liberal lawmaker from San Francisco, faced some wrenching political choices going into Saturday's vote on a health care reform bill.

Centrist "Blue Dog" Democrats were seeking concessions for their votes. The biggest one, sought by Roman Catholic bishops, would have blocked use of federal subsidies for health insurance that covers elective abortions.

You could argue that a more skilled politician might have seen this play coming and deflected it. Yet at the moment of truth, Pelosi made the right call. Had she not acceded to the demands of the Blue Dogs, the House probably would have rejected a potential expansion of health care coverage to 36 million Americans.

Now the attention turns to the Senate, where Majority Leader Harry Reid will confront other tough trade-offs.

Part of Reid's challenge is the barrage of propaganda that Republicans continue to spew. Before Saturday's vote, House Minority Leader John Boehner labeled the Democratic measure "the greatest threat to freedom that I've seen in the 19 years I've been in Washington."

Contrary to Boehner's fear-mongering, the House bill poses no threat to anyone's current health care or freedom. If anything, Congress has been tepid in pushing to quickly expand health access, and do so with reliable financing.

In the Senate, as in the House, the big issue is a so-called public option, a government-backed health insurance plan that would compete with private plans. Reid wants to give states the right to opt out of the public option.

Some conservative Democrats want the public option stripped from the bill. Others want it added at a future date if a reform plan based on private insurance fails to meet certain goals.

California's senators, particularly moderate Dianne Feinstein, could be instrumental in helping Reid bridge these differences. Although Feinstein has been hammered by liberals for raising concerns about new health care entitlements, she has an obligation as a member of the Senate Appropriations Committee to look out for the bottom line.

Interestingly, Feinstein has recently shown an inclination to speed up – instead of slow down – the race toward expanded health care. Last week, she was asked if the benefits contained in congressional health care plans will take too long to take effect.

"Is it a problem? Yes, it's a problem," Feinstein told The Hill. "People expect something will happen, and then nothing happens. We're going to look at that."

Without a doubt, the House-approved restriction on abortion funding will complicate the Senate's deliberations. If included in a final bill, it would likely prompt many private insurance companies to drop abortion as a covered procedure. Otherwise, such companies would be unable to compete for low- and middle-income customers who would be eligible for subsidized insurance under the legislation.

For pro-choice advocates, this is a rallying cry, but it's one they must keep in perspective. A 2003 study found that only 13 percent of abortions were directly billed to insurance companies. In other words, the House abortion restrictions contained in the House bill may have far less effect than some fear – or some hope for.

Health care reform, by contrast, has a chance of expanding coverage to millions who, for now, can only dream of it.