Like it or not, the healthcare debate has turned into a fracas over abortion rights.

pelosifingerU.S. House Democratic leaders had hoped to avoid just that in their push to expand healthcare coverage and reform the health insurance market.

But getting the votes to pass the historic legislation on Saturday boiled down to settling a dispute between pro-choice and pro-life forces over abortion.

Abortion foes won. The House passed an amendment restricting the availability of insurance policies that include elective abortion services even though many medical plans currently offer such coverage.

The debate over abortion highlights broader questions surrounding the government's reach in healthcare.  Once the government starts subsidizing insurance premiums, it will dictate what can and cannot be included in that coverage.