By Lori Montgomery
Washington Post Staff Writer
Thursday, November 5, 2009

House leaders put in motion the machinery to hold a rare Saturday vote on the most far-reaching expansion of the health-care system in more than 40 years.

Even so, they were still locking down support Wednesday among a handful of holdouts, with the biggest bloc dissatisfied with the measure's handling of abortion.

Many Democrats said passing the measure has become even more crucial politically after Republicans won governor's races in Virginia and New Jersey this week. So Democratic whips worked their rank and file, while House leaders tried to secure a momentum-building endorsement from the AARP, the nation's largest association of people over 50. President Obama, meanwhile, laid plans to visit Capitol Hill on Thursday or Friday to address House Democrats in a final push for his signature domestic initiative.

Late Wednesday, a bill that Republicans expect to offer as an alternative to the Democratic package received its assessment from congressional budget analysts, who concluded that the proposal would barely dent the ranks of the uninsured.

The measure would cover 3 million additional people at a cost of $60 billion through 2019, according to an analysis by the nonpartisan Congressional Budget Office. The Democrats' bill, by comparison, would cover far more -- 36 million additional Americans -- at a much higher cost -- $1.055 trillion through 2019, the CBO has said.

House Republicans are united in opposition to the majority's health bill, so to pass the measure, Democrats will need at least 218 votes from their 258-member caucus. That group grew by two in Tuesday's elections: While some Democrats bemoaned the loss of the governor's mansions, House Speaker Nancy Pelosi (Calif.) cheerfully prepared to swear in newly elected Democrats from New York and California, both of whom have pledged to support the health bill.

"From our standpoint, we picked up votes," Pelosi said.

House leaders said that they were confident of reaching their goal in time for a Saturday debate on the most significant changes to the nation's health-care system since the creation of Medicare in 1965. They released 42 pages of amendments to the 1,990-page health package unveiled last week, a move that started the clock ticking on their pledge to make the legislation publicly available for 72 hours before lawmakers are asked to pass judgment.

"We are now in the final stage of moving this critical bill through the House," Majority Leader Steny H. Hoyer (D-Md.) said in a statement. "Our members have worked very hard on this legislation, and I believe that as a result, we have a strong product that will lower costs and provide greater health care stability for all Americans."

Further amendments are likely Friday, when the House Rules Committee will meet to determine the parameters of the floor debate. Lawmakers from both parties are expected to offer a series of adjustments, and Rules Committee Chairman Louise M. Slaughter (D-N.Y.) said she would accept at least one of them: a compromise crafted to soothe the bitter divide over abortion that holds as many as 40 votes in the balance.

The dispute centers on whether the package would, for the first time in more than 30 years, broadly permit federal funds to be spent on abortion. Under the House measure, insurance plans offered through federally subsidized exchanges could cover abortion services, but the insurance companies would be asked to segregate the subsidies from private premiums and co-pays, using only the latter to cover the cost of abortion. The package also would create a government-run insurance plan, which would operate under similar rules.

Antiabortion Democrats, led by Rep. Bart Stupak of Michigan, have criticized that approach as an accounting distinction, arguing that even private premiums paid to a public insurance program amount to federal funds. The compromise offered by Rep. Brad Ellsworth (D-Ind.) would require federal health officials to hire a private contractor to handle payments to abortion providers, an idea that appeared to leave some antiabortion lawmakers cold.

Stupak, who was back home for a funeral Wednesday, said in a statement that he would keep trying to block the health bill "until there is satisfactory language to prevent public funding for abortion," ideally by banning abortion services from both the public plan and subsidized private plans.