House Democratic leaders are predicting victory for President Barack Obama’s bill to overhaul the US health care system.
Passage of a landmark bill would be one of the most significant legislative triumphs in the US in decades.
The House of Representatives convened in a rare Sunday afternoon session for a series of votes to determine the fate the bill.
Mr Obama has made health care reform the defining issue of his first year in office, setting off a tumultuous debate that has left the country deeply divided.
If passed, the reform is likely to be judged alongside the boldest acts of presidents and Congress in domestic affairs.
While national health care has long been a goal of presidents stretching back decades, it has proved elusive, in part because self-reliance and suspicion of a strong central government remain strong in the US
In the hours before the vote, House Democratic leaders were still trying to nail down commitments from a handful of members, some of whom remained concerned about the abortion issue.
Mr Obama, who cancelled a trip to Asia to be on hand for the vote, was spending the day in the White House West Wing for some last-minute lobbying, making and taking calls with politicians.
“There are still members looking at it and trying to make up their minds,” House Democratic leader Steny Hoyer said on NBC television’s Meet The Press in the hours before the vote. He added that the number of those still undecided were in “the low single digits”.
“We think there are going to be 216-plus votes when we call the roll,” Mr Hoyer said, enough to ensure the measure’s passage.
Republicans attributed the caution to public controversy over the plan, which played out in angry protests at the doorstep of the Capitol during the House of Representatives’ rare weekend session.
The last-minute decision making of politicians gave the House vote a measure of suspense, despite the Democrats’ optimism. House Democratic Caucus Chairman John Larson stopped just short of declaring victory.
“We have the votes now – as we speak,” Mr Larson said on ABC’s This Week.
Republicans remain resolutely opposed to the legislation and warned they will make Democrats pay dearly in the autumn elections when control of Congress is at stake if the fiercely debated measure becomes law. Republicans contend the plan amounts to a government takeover of health care that will lead to higher deficits and taxes.
“The American people don’t want this to pass. The Republicans don’t want this to pass. There will be no Republican votes for this bill,” Eric Cantor, the House’s second-ranking Republican, told ABC.
With Mr Obama’s emotional appeal yesterday ringing in their ears, House Democratic leaders are preparing for three showdown votes today – on a “rule” to establish debate guidelines; on a package of changes to a Senate-passed health care bill; and on the Senate bill itself, the focus of intense national debate for months.
Democrats need 216 votes to pass each one. With all 178 Republicans and at least two dozen Democrats vowing to vote ’no’, the legislation’s fate lay in the hands of the few Democrats who remained uncommitted ahead of today’s vote.
The Democrats’ vote-counting whip in the House, James Clyburn of South Carolina, said some in his caucus remained concerned about what the bill would mean for elective abortions.
Democrat Bart Stupak said he was one of about a half-dozen anti-abortion Democrats who were working out language for a presidential executive order that would provide more assurances that no public money would be used for elective abortions.
“Until we get matters signed, sealed and delivered ... our votes are still ’no’,” Mr Stupak said on MSNBC. “If we get this thing resolved, then they’ll have more than enough votes.”
It was unclear whether Mr Obama would agree to issue an executive order along those lines, but Mr Clyburn said more would be known by this afternoon.
Long-standing federal policy bars US aid for abortions except in cases of rape, incest or when the mother’s life is in danger.
Another snag involved widespread distrust among House members that the Senate would be able to pass the “fixes” to the bill. Mr Clyburn’s Senate counterpart, Senator Dick Durbin of Illinois, said on CBS’ Face The Nation that he has commitments of support from at least a majority of the 100-member chamber, but Democratic leaders have not released a list of supporters.
However, Democratic leaders appeared confident they would prevail in the House of Representatives. They pointed to the President’s emotional speech to the caucus at the Capitol yesterday, and they cited a sense of momentum from the handful of rank-and-file Democrats who have announced their support over the past several days.
If Democratic leaders prevail on all three House votes, Obama could sign the Senate version of the bill into law. The bill of “fixes” would go to the Senate, which hopes to pass it within a week under a procedure called reconciliation that requires only 50 votes in the 100-member body.
The parliamentary manoeuvres became necessary after January’s special election in Massachusetts when a Republican won the seat held for decades by the late Senator Edward Kennedy, a champion of health care reform. That deprived the Democrats of their 60-vote Senate supermajority required to block Republican legislative delaying tactics.
The US is alone among developed nations in not offering its citizens comprehensive health care, with nearly 50 million Americans uninsured.
Although the bill before Congress does not provide universal health care, it should expand coverage to about 95% of Americans.
It would require most Americans to carry insurance with subsidies for those who can’t afford it, expand the government-run Medicaid programme for the poor, and create new marketplaces where self-employed people and small businesses can pool together to buy health care.
The 10-year, $940bn (€694bn) measure represents the biggest expansion of the social safety net since Medicare and Medicaid were enacted in the 1960s to provide government-funded health care coverage to the elderly and poor.
The sweeping legislation, affecting virtually every American and impacting one-sixth of the US economy, would extend coverage to an estimated 32 million uninsured, bar insurers from denying coverage on the basis of pre-existing medical conditions and cut federal deficits by an estimated $138bn dollars (€101bn) over a decade.