Sunday's vote on health care still a cliffhanger

WASHINGTON — House leaders decided Saturday to vote directly on the Senate's health-care bill, dropping a much-criticized strategy of allowing lawmakers to "deem" the landmark legislation into law. But the outcome of that potentially historic vote remained in doubt as a pivotal bloc continued to withhold its support over the bill's abortion language.

House leaders hoped to sway them with an executive order affirming President Obama's commitment to a long-standing ban on public abortion funding. But Rep. Marcy Kaptur, D-Ohio, a key anti-abortion vote, said she thought the document would be insufficient to bring all 10 anti-abortion Democrats onboard.

The Senate bill currently requires women who buy government-subsidized insurance plans that cover abortion services to send their insurer a separate check to cover the abortion benefit. The holdouts want to place tougher restrictions on federal funding for abortion services.

Senior Democrats said they would need those 10 votes to get the 216 necessary to pass the bill. They predicted a cliffhanger when the House gathers Sunday to vote.

The last-minute decision to vote on the Senate bill undercut a Republican argument that Democrats were abusing House rules and procedures in their eagerness to pass a health-care overhaul. It also appeared to swing several key lawmakers behind the legislation Saturday, including Rep. Dennis Cardoza, D-Calif., a member of the fiscally conservative House Blue Dog Coalition.

Obama went to the Capitol to exhort wavering lawmakers to rise to the aid of millions of uninsured Americans, calling it "the single most important step that we have taken on health care since Medicare" in 1965. Outside, thousands of boisterous protesters jeered the health-care bill.

House Speaker Nancy Pelosi's decision to have the House hold two votes, one on the Senate bill and one on a separate package of revisions, reversed her position from last week, when she said she preferred to use a legislative procedure called "deem and pass." Republicans had accused Pelosi, D-Calif., of trying to dodge responsibility for a health-care overhaul, and even some Democrats complained about the move.

House Minority Leader John Boehner, R-Ohio, hailed the change as "a victory for the American people," and he vowed to force Democrats to stand up, one by one, to announce their vote for the $940 billion bill.

"Now House Democrats will face two crucial votes tomorrow," Boehner said. "They will have to vote on the Senate-passed bill, stuffed with tax hikes, Medicare cuts, and infamous backroom deals — and they will vote on something worse: their 'fix' with more taxes, more Medicare cuts, and new special deals."

Later, Boehner said: "This is not over. They do not have the votes yet. We've got to keep working to make sure that they never, ever, ever, ever get the votes to pass this bill."

House passage would immediately send the slightly narrower Senate version of the health bill to the White House for Obama's signature, allowing the president to claim victory on his most important domestic initiative. The package of revisions would go to the Senate for action next week under special rules that protect it from a GOP filibuster. On Saturday, Senate Majority Leader Harry Reid, D-Nev., publicly assured House Democrats that he has the 51 votes to approve their changes, making "a good law even better."

If the Senate passes the amendments package without any changes, they too would go to Obama for his signature, although Democratic officials conceded the Senate may alter the package, which would require another House vote on the changes but not on the overall health-care overhaul as defined in the Senate bill.

The compromise package would extend coverage to 32 million Americans over the next decade, leaving only about 5 percent of nonelderly citizens without coverage, according to projections by the nonpartisan Congressional Budget Office (CBO).

Millions of people would be added to the rolls of Medicaid, the government health program for the poor, while millions more who lack access to affordable coverage through the workplace would receive federal tax credits to buy insurance.

Every American would be required for the first time to obtain coverage or face a penalty of at least $695 a year. Employers, too, would have a new responsibility, to offer coverage or face penalties of $2,000 per worker.

By cutting more than $500 billion from Medicare over the next decade and raising taxes on the well-insured and high-earners, the package would trim deficits by $138 billion over the next decade and by around $1.2 trillion in the decade thereafter, the CBO said.

Republicans questioned assertions of deficit reduction, predicting that Democrats would abandon the measure's primary funding mechanisms when seniors begin to feel the pinch of Medicare cuts and union families fall victim to a new 40 percent tax on the most generous insurance policies, provisions that would take effect in 2018. If those and other politically painful provisions were removed, the CBO said, the measure would increase deficits.

"This is going to be a program that will rival the size and liability of Medicare for sure, in my opinion," said Rep. Paul Ryan, D-Wis.

But the numbers swayed several wavering Democrats, and Obama assured lawmakers that voters would soon see through the Republican exaggerations about the package. Listing a number of popular provisions that would take effect this year — including tax credits to help small businesses buy insurance and key insurance-industry reforms — Obama predicted that if he signs "this legislation into law, it's going to be a little bit harder to mischaracterize what that legislation is all about."

Democratic lawmakers and top aides have been working around the clock trying to address flare-ups over elements of the bill. They said that they had worked out an agreement to resolve one of the last remaining issues: a dispute over geographic disparities in Medicare payments.

The agreement could lead to higher payments to doctors and hospitals in states such as Iowa, Minnesota, Oregon, Washington and Wisconsin, where Medicare rates are relatively low but studies suggest the quality of care is high.

Kathleen Sebelius, the secretary of health and human services, sent a letter to Congress saying she would commission studies by the National Academy of Sciences to investigate the issue and recommend solutions.

"The current geographic variation in Medicare reimbursement rates is inequitable," Sebelius said.

"You can't do much better than that," said Rep. Peter DeFazio, D-Ore., who spoke with the president Saturday to help seal the agreement. DeFazio said he would back the bill. Other holdouts who declared their support Saturday included Reps. Jim Costa of California, Chris Carney of Pennsylvania and Gerry Connelly of Virginia.

The Republican message was being received loud and clear outside the Capitol, however, where hundreds of angry protesters gathered and waved placards that said "Defeat Obamacare" and "Born in the USA not the USSR."

Republicans were treated as heroes as they walked through the crowds, who patted them on the back and thanked them for their opposition. Democrats were greeted with jeers and the pointed message: "We'll Remember in November," as one sign said.

Post reporters Ben Pershing

and Perry Bacon Jr. contributed to this report.

Material from the Tribune Washington bureau and The New York Times is included in this report.