Decision Day For Us Health Care In The House

WASHINGTON (AP) The House of Representatives opened debate Saturday on a landmark health care overhaul as lawmakers moved toward a make-or-break vote certain to be seen as a test of Barack Obama's presidency.

The vote planned for late Saturday was expected to be tight. Democratic leaders hoped a late-morning visit by Obama to Capitol Hill would close the deal with some wavering lawmakers and ensure passage.

In the opening moments of debate, Democrats hailed the legislation as a moral and economic imperative. The legislation would extend coverage to nearly 50 million Americans now uninsured and ban insurance company practices such as denial of coverage based on pre-existing medical problems.

Republicans said the legislation would lead to a government takeover of the health care system that would damage the economy and erode the doctor-patient relationship.

Late Friday, House Democrats cleared an abortion-related impasse blocking a vote and officials expressed optimism they had finally lined up the support needed to pass Obama's signature issue.

Under the arrangement, abortion opponents were promised an opportunity to insert tougher restrictions into the legislation during debate on the House floor.

The leadership's hope is that no matter how that vote turns out, Democrats on both sides of the abortion divide will then unite to give the health care bill a majority over unanimous Republican opposition.

"We wish to maintain current law, which says no public funding for abortion," Democratic Rep. Bart Stupak of Michigan said. "We are not writing a new federal abortion policy."

Rep. Brad Ellsworth, an Indiana Democrat, added, "From day one, my goal has been to ensure federal tax dollars are not used to pay for abortions and to provide Americans with pro-life options on the exchange. And I am proud to be part of an effort to help make this goal a reality."

With Democrats' command of the necessary votes looking tenuous in the final hours, Obama threw the weight of his administration behind the effort to round up support. He and top administration officials worked the phones to pressure wavering lawmakers.

Democratic Rep. Jason Altmire of Pennsylvania said he heard Friday from Obama, White House Chief of Staff Rahm Emanuel, Health and Human Services Secretary Kathleen Sebelius and Education Secretary Arne Duncan.

Their message: "This is a historic moment. You don't want to end up with nothing," said Altmire, who remained undecided.

Democratic leaders hoped to hold the vote Saturday evening, but Majority Leader Steny Hoyer said it could slip.

Democrats hold 258 seats in the House and can afford 40 defections and still wind up with 218, a majority if all lawmakers vote. But all 177 Republicans were expected to vote "no," and Democratic leaders faced a series of complications trying to seal the needed votes for their complex and controversial legislation that would affect one-sixth of the economy and touch the lives of countless Americans.

Obama's push to reform the health care system has already moved further along the legislative process than a similar effort by President Bill Clinton in his first-term in the 1990s. Democrats are mindful that the party lost control of Congress in the 1994 mid-term elections in part because of their failure to enact health care reform legislation.

Even if the House passes a health care bill, it by no means guarantees that any reform measure will reach the president's desk to sign.

House rules make it easier for the large Democratic majority to advance legislation. But it will be tougher to get Senate approval because Democrats will need 60 out of 100 votes to end debate and bring legislation to a final vote, and several moderate Democratic senators still have reservations. If the Senate does pass a bill, it would have to be reconciled with the House version by a panel of lawmakers from both chambers before the legislation is put up for final approval.

In the Republican Party's weekly radio address, Mississippi Gov. Haley Barbour said Democrats should scrap their ambitious legislation and concentrate on modest health care changes that could find bipartisan support.

"The House Democrats' health care bill should be withdrawn and reworked," he said.

Tuesday's elections in which Democrats lost two governors' races sent a message that voters care about jobs, not growing the size of government, Barbour said.

The final hurdle for the Democrats was a controversy over federal funding for abortion, which simmered into Friday night with tensions running high as party leaders shuttled between meetings of anti-abortion and abortion rights lawmakers.

Federal law currently prohibits the use of federal funds to pay for abortions except in the case of rape, incest of situations in which the life of the mother is in danger. That left unresolved whether individuals would be permitted to use their own funds to buy insurance coverage for the procedure in the federally backed insurance exchange envisioned under the legislation.

Democrats have little room for error, with the prospect of the 2010 midterms looming large and a some of their own moderates already declaring their opposition.

The 10-year, $1.2 trillion House bill would create a new federally supervised insurance marketplace where the uninsured could purchase coverage.

Consumers would have the option of picking a government-run plan, the most hotly contested item in the legislation.

The United States is the only developed nation that does not have a comprehensive national health care plan for all its citizens. The government provides coverage for the poor, elderly and military veterans, but most Americans rely on private insurance, usually provided through their employers.

But with unemployment climbing above 10 percent, many Americans are losing their health insurance when they lose their jobs. At the same time, the deepening budget deficit have made it difficult for lawmakers to support costly new programs.

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Associated Press writers David Espo and Ricardo Alonso-Zaldivar contributed to this report.

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