In November, U.S. Rep. Ahn “Joseph” Cao, who represents most of New Orleans, bucked his party and was the lone Republican vote for the House of Representatives version of the healthcare bill, after aligning himself with anti-abortion Democrats. Negotiated by Rep. Bart Stupak, D-Mich., the “Stupak amendment” was restrictive enough to allay the concerns of the small bloc of legislators.

The House now is preparing to vote on a final package, a composite of the Senate version with some modifications sought by the House of Representatives and the White House. The Stupak bloc again is threatening to vote no because of their belief that the abortion restriction it too weak.

Negotiations between the Democratic leadership and Stupak broke down late last week, forcing members of his small but important coalition to act on their own.

Congressman Cao, as of today, is instructing staff to say that he will not vote for healthcare reform, unless the abortion language is stronger.

Cao’s office did not return calls for comment.

Last week, staffers indicated that Cao is following the interpretation U.S. Conference of Catholic Bishops, who Monday reiterated their opposition to the bill.

“The bishops were left disappointed and puzzled to learn that the basis for any vote on health care will be the Senate bill passed on Christmas Eve… It expands federal funding and the role of the federal government in the provision of abortion procedures. In so doing, it forces all of us to become involved in an act that profoundly violates the conscience of many, the deliberate destruction of unwanted members of the human family still waiting to be born.”

But other Catholic groups dispute that reading of the bill.

For instance, the National Catholic Reporter published a letter this weekend sent to Congress from 25 evangelical and Catholic leaders, an anti-abortion group called Catholics in Alliance for the Common Good. In it, they detail a series of safeguards against the federal funding in the bill.

After citing the specific provisions in the bill, they conclude:

We are now at a critical moment in the history of our country. More than 30 million Americans may finally gain access to a health care system that is affordable — providing families, children and seniors with fundamental care that is essential to human dignity. We respectfully ask that you make an informed decision about this legislation based on careful deliberation guided by facts.

Similarly, the Catholic Health Association split with the bishops to urge passage of the  healthcare legislation.

Many Democrats have insisted that the Hyde amendment, which has barred the federal funding of abortion since it was passed in 1976, would apply to the healthcare bill. Still, Congressional leaders have worked to add language, including the Stupak amendment, to apply restrictions more explicitly.

Both the House bill, now by the wayside, and the Senate bill under consideration  seek to maintain the ban on federally funded abortions.

The difference, then, is one of semantics. According to Washington and Lee law professor Timothy S. Jost, the House and Senate bills are “essentially equivalent,” but he points to four areas where the two versions seem to be at odds.

The first is that in the House bill, people who accept tax subsidies to help purchase insurance would have to buy a supplemental policy without any public assistance to add abortion coverage. Under the Senate version, individuals would only have to pay a separate premium to add abortion coverage to the policy they purchase using subsidies. In the other three areas, Jost argues that the Senate version of the healthcare bill is more restrictive on abortion than the House bill. The Senate bill lets states bar any policies that cover abortions from being sold in insurance exchanges, regardless of whether or not federal subsidies are used. The Senate bill also prohibits plans from advertising abortion coverage, which  the House bill does not, and provides $250 million in teen pregnancy counseling, which the House bill does not.

Many other anti-abortion Democrats have found the language in the Senate bill to be adequate. Today, Virginia Democrat Tom Perriello, who is still on the fence on the final bill, released a statement with his conclusion that there can be no federally funded abortions under the legislation being considered

“I have plenty of serious problems with the Senate bill and, until I see the final language, I cannot take a position on final passage. But the existing language on abortion in the current Senate bill meets the pledge I made to ensure no federal funding for abortion in this health care bill.”

Cao’s deference to the U.S. Conference of Catholic Bishops for their interpretation is troubling. It both undermines his claim of independent-mindedness and raises questions over whether Cao would split with the Catholic church on any issue, including hard-line views against the rights of homosexuals and the use of contraception.

To his credit, Cao has been consistent in his rhetoric as he’s considered the merits of healthcare legislation – he’s always pointed to the abortion issue as foremost on his mind – but now, because of his deference to the U.S. Conference of Bishops, he has painted himself into a corner. If he votes for the healthcare bill after having not received any additional concessions on his pet issue, the ultimatum he has put forth over the last several weeks will have been a lie. If he votes against healthcare reform, he’ll have flip-flopped on the coverage expansion he supported just a few months ago – and his defiance the majority of his district will have sealed the coffin on his political career.

While many political observers can compellingly argue that there is no path to re-election for Cao, his opposition to the Obama administration’s signature issue definitively slams the door on much of the liberal crossover support that secured Cao’s unlikely election in the first place.

Politics aside, it seems indefensible to this non-Catholic to base such an important vote on what seems to me to be a very minor discrepancy between two bills that both seek to prevent the funding of abortion. Given a recent estimate that a lack of insurance contributes to 45,000 American deaths annually, voting for a healthcare reform bill that will expand coverage to tens of millions of Americans is the only pro-life position to take.