No issue was more pivotal in the health care reform debate than abortion.

In fact, one of the only reasons Democrats were able to pass the bill was because they forged a controversial agreement with numerous moderate, pro-life Democrats who now face tough re-election bids.

That's why anti-abortion activists are using the health care vote to as campaign fodder against these Democrats. In many cases, pro-life groups assert that these lawmakers sold out their principles on abortion to pass the health care law.

Take a TV commercial crafted by the anti-abortion Susan B. Anthony List that targets Democrats which the group claims "flipped" on abortion. One such lawmaker is freshman Rep. Kathy Dahlkemper (D-PA), a pro-life Democrat whose vote for health care hinged on an abortion agreement.

"Kathy Dahlkemper had a choice to make: protect life or side with President Obama and Speaker Pelosi," intones the ad's narrator. "She chose them. Kathy Dahlkemper betrayed you."

The spot ends with a warning to to the Congresswoman: "Votes have consequences."

"Consequences" can mean lots of things in politics.

Rep. Bart Stupak (D-MI) authored the amendment. In fact Stupak received death threats for crafting the anti-abortion language. Now he's retiring. Rep. Alan Mollohan (D-WV) lost his primary. That's left anti-abortion forces to target a litany of other Democrats who only supported the health care bill because of the final abortion text. That includes Reps. Steve Driehaus (D-OH), Baron Hill (D-IN), Chris Carney (D-PA), Tom Perriello (D-VA), Paul Kanjorski (D-PA), Kathy Dahlkemper (D-PA), Joe Donnelly (D-IN), Charlie Wilson (D-OH), Marcy Kaptur (D-OH) and Nick Rahall (D-WV). Most face tough contests.

The Susan B. Anthony List proposed erecting four billboards to go after Driehaus. The freshman Democrat is locked in a pitched re-election battle in heavily-Catholic Cincinnati with former Rep. Steve Chabot (R-OH). Driehaus edged out Chabot two years ago.

"Shame on Steve Driehaus," the signs read. "Driehaus Voted for Taxpayer-funded abortion."

Driehaus argues the health law does anything but. He points to an executive order President Obama signed in March that specifically prohibits the use of taxpayer dollars from paying for abortions in the newly-created health care exchanges. For years, Congress annually approved the "Hyde Amendment," a similar measure which banned the use of taxpayer dollars for abortions except in cases of rape, incest or when the life of the prospective mother is at risk.

Pro-life groups including National Right to Life, Americans United for Life, Focus on the Family, and the United States Conference of Catholic Bishops strongly disagree that the executive order codifies the Hyde Amendment into law.

And Mr. Obama and pro-life Democrats took heat from their most-loyal supporters.

National Organization for Women head Terry O'Neill said the president broke his trust with women by signing the executive order.

"The National Organization for Women is incensed that President Barack Obama agreed today to issue an executive order designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women's access to abortion," said O'Neill in March.

Meantime, Driehaus filed a complaint with the Ohio Elections Commission over the Susan B. Anthony billboards. The Congressman said that the ad was patently false and that the executive order does not permit federal funding for abortion services. A three-member panel ruled in favor of Driehaus and ordered another hearing to determine whether the Susan B. Anthony List broke the law.

The Susan B. Anthony List said it was appalled the elections commission truncated its First Amendment Rights and contested the finding.