The lone Republican who voted for the Democrats’ health care reform bill in November won’t support the final bill if it doesn’t have the same abortion restrictions that passed in the House.

A spokeswoman for Rep. Anh “Joseph” Cao, Louisiana Republican, said Tuesday that the lawmaker is concerned the language in the final bill is going to be closer to what passed the Senate, which he doesn’t support.

“He would rather see some form of health reform done than not done,” said spokeswoman Princella Smith. “But he’s just not budging on the life issue.”

Mr. Cao, who represents a New Orleans-area district with a 21 percent uninsured population, said in November that he broke ranks with Republicans to support the House bill because of the last-minute abortion restrictions, which had the backing of the U.S. Conference of Catholic Bishops. If those change, he’s going to have a “very hard time” supporting the bill again, his spokeswoman said.

“Congressman Cao has always been an ardent defender of life,” Ms. Smith said. “He would not have voted for the [House] bill if it didn’t have sufficient language to protect the lives of the unborn.”

Mr. Cao at one time studied to be a Catholic priest, is a member of the National Advisory Council of the U.S. Conference of Catholic Bishops and has voted with National Right to Life 100 percent of the time since he won his seat in 2008.

A “no” vote from Mr. Cao would eliminate any appearance of bipartisanship in the health legislation, an issue that has already proven to be controversial with voters. It became the defining issue in today’s special election to fill Sen. Edward M. Kennedy’s long-time seat in Massachusetts.

It would also slice Democrats’ vote margin even further. The health bill passed 220-215, just two more than the 218 required for passage. House and Senate Democrats are still hammering out differences in the two pieces of legislation, a list that includes abortion as well as taxes and whether to establish state or national exchanges.

The House’s legislation would ban anyone who receives federal tax subsidies from buying an insurance plan that includes abortion coverage — if women want it, they would have to buy an additional side plan that includes it. A group of House Democrats who oppose abortion, headed by Michigan Rep. Bart Stupak, said it was the only way to ensure their tax dollars don’t cover the controversial procedure and the only way they’d support the bill.

The Senate’s plan would require women with insurance plans that cover abortion to pay entirely for their own abortion coverage, keeping any federal tax subsidies separate. The insurance exchanges would have to have at least one plan that doesn’t cover the procedure. And states would be allowed to pass a law prohibiting any plan in the exchange from providing abortion coverage.

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