By DAVID CRARY
Associated Press

NEW YORK - For some abortion-rights activists, the debate over health-care reform has been frustrating, even disheartening, as they see their political allies on the defensive and their anti-abortion rivals on the attack.

The crux of the dispute is reflected in the slogan adopted by many anti-abortion activists, "Abortion is Not Health Care." The abortion-rights movement says the procedure should indeed be considered a valid health-care option, as worthy of public funding as any other form of care.

Abortion has been legal in the United States since a 1973 U.S. Supreme Court decision, but the procedure remains controversial.

The U.S. is the only major industrialized country without a comprehensive health-care plan, and one of President Barack Obama's goals is to bring coverage to most of the nearly 50 million Americans who lack health insurance. Congress has been trying to shape health-care reform for weeks, but has been finding sharp divides on how to go about it, both within the Capitol and among legislators' constituents.

Many abortion-rights advocates had hoped that the health-care debate would include a serious discussion of expanding access to abortion for low-income women, including the possible lifting of a 33-year-old ban on federal funding for the procedure except in cases of rape, incest and to save the mother's life.

Instead, under pressure from anti-abortion conservatives, the Obama administration and majority Democrats in Congress have generally focused their recent public comments about abortion on promises that their various reform proposals will conform with that ban, known as the Hyde Amendment.

"I'm profoundly disappointed," said Stephanie Poggi of the National Network of Abortion Funds, which helps low-income women pay for abortions. "We felt health-care reform is supposed to be about expanding care, not expanding inequality."

Terry O'Neill, the newly elected president of the National Organization for Women, said Democrats have been too willing to compromise, adding, "It makes me really angry."

"They're just wrong if they think compromise on abortion will bring more Republicans onboard," she said. "The voices insisting upon exclusion of abortion services will not vote for meaningful reform anyway."

In Congress, members who support abortion rights express empathy with such sentiment but say the time isn't right to push for repealing the Hyde Amendment.

"That's also my long-term goal, but practically speaking, we don't have the votes to do that right now," said Rep. Diana DeGette, a Democrat.

She said the immediate battle is to ensure that the status quo on abortion is maintained, so that women who have abortions covered through private insurance don't lose that coverage. According to the Guttmacher Institute, which studies reproductive-health issues, more than 80 percent of typical employer health plans cover abortion.

The National Right to Life Committee and its anti-abortion allies contend that the Democratic reform proposals would violate the Hyde Amendment because they would provide federal subsidies to private insurance plans that pay for elective abortions. Democratic leaders disagree, saying abortion coverage would be paid for by private premiums. Nonetheless, anti-abortion members of Congress from both parties will seek a ban on any type of federal subsidy for any insurance company covering elective abortions.

"Most insurance companies cover some form of abortion care, and we're seeing efforts to move away from that," said Dr. Willie Parker, an abortion provider in Washington, D.C., who serves on the board of Physicians for Reproductive Choice and Health.

"It's become necessary to be vigilant, even if we can't make any gains for abortion care, to make sure we don't lose any ground," he said.

Both sides in the debate cite polls saying a majority of Americans agree with them on the public-funding issue.

"If Congress does not explicitly exclude abortion from the health-care reform legislation, then Americans will be forced to pay for the taking of innocent human life," said Peggy Hartshorn of Heartbeat International, which runs a network of crisis-pregnancy centers. "Abortion does not improve anyone's health."

The White House reiterated Monday that no federal dollars will be used to fund abortions.

Obama "believes that Americans should be able to purchase health insurance coverage that reflects their values and needs," said spokesman Reid Cherlin. "Those seeking coverage for reproductive-health services will be able to sign up for plans that are right for them in an insurance market that will have more affordable choices than we have today."

The nation's leading abortion provider, the Planned Parenthood Federation of America, has not been pushing to make repeal of the Hyde Amendment part of the current debate. Rather, it wants to help ensure passage of a broad reform bill that will enable more low-income women to afford its non-abortion services - such as contraception, pregnancy testing, and screenings for breast cancer, cervical cancer and sexually transmitted diseases.

"We have to make some pragmatic choices about what we think is best overall to make sure these women have the best access to care," said Laurie Rubiner, Planned Parenthood's vice president for public policy.

NARAL Pro-Choice America, another major abortion-rights group, is taking a similar approach.

"It's not suitable or helpful to fight the abortion question in health-care reform," said NARAL's policy director, Donna Crane. "We're becoming increasingly perplexed and alarmed by the other side, which seems willing to take any legislative hostage to advance its agenda."

She said both sides in the abortion debate should be eager to promote comprehensive health-care reform that would benefit low-income women - on the premise that better access to contraceptives and more affordable pre- and postnatal care would lead to fewer abortions.

Poggi, of the National Network of Abortion Funds, said all wings of the abortion-rights movement agreed on the importance of improving overall health-care options.

"But what we're being offered is not enough," she said, contending that President Obama had "traded many women's futures away" when he assured Congress on Sept. 9 that the new health plan would provide no public funds for abortion.

"In the day-to-day world outside Congress, access to abortion is not a bargaining chip or a political football," Poggi said. "It's about whether women have the chance to live healthy lives.... It's about whether poor women and girls and women of color matter as much as other people."