With a fresh sense of urgency, President Barack Obama and congressional Democratic leaders pressed wavering rank-and-file lawmakers to back his health care overhaul, determined to give the party something to show voters in the midterm elections.
Obama was set to head to northeast Ohio on Monday with a final sales pitch for health care legislation that the top Democratic vote-counter in the House said still lacked the necessary votes to pass. Obama's top political adviser, David Axelrod, said he was "absolutely confident" the measure would pass during a make-or-break week that already saw the president delay his trip to Indonesia, Australia and Guam.
"This is the week where we will have this important vote," White House press secretary Robert Gibbs said. "I do think this is the climactic week for health care reform."
On Capitol Hill, the House Budget Committee was set to vote on legislation, one of the final steps in the Democrats' more than yearlong quest to get a bill to the president. The panel posted a placeholder bill on its Web site late Sunday that said the goal is "to provide affordable, quality health care for all Americans and reduce the growth in health care spending."
Lawmakers were expected to fill out the details, including the overall cost.
Clinching support for the bill might require Obama to back away from his insistence that senators purge the legislation of a number of lawmakers' special deals.
Taking a new position, Axelrod said the White House only objects to state-specific arrangements, such as an increase in Medicaid funding for Nebraska, ridiculed as the "Cornhusker Kickback." That's being cut, but provisions that could affect more than one state are OK, Axelrod said.
That means deals sought by senators from Montana and Connecticut would be fine — even though Gibbs last week singled them out as items Obama wanted removed. There was resistance, however, from two committee chairman, Democratic Sens. Max Baucus of Montana and Chris Dodd of Connecticut, and the White House has apparently backed down.
Axelrod said the principles the White House wants to apply include "Are these applicable to all states? Even if they do not qualify now, would they qualify under certain sets of circumstances?"
Meanwhile, the White House tried to increase public pressure on Congress to pass the legislation. Obama planned to visit Strongsville, Ohio, home of cancer patient Natoma Canfield, who wrote the president she gave up her health insurance after it rose to $8,500 a year. Obama repeatedly has cited that letter from a self-employed cleaning worker who lives in the Cleveland suburb to illustrate the urgency of the massive overhaul.
Canfield's sister, Connie Anderson, was scheduled to introduce Obama at that event.
Obama's efforts, though, face an uphill challenge for legislation that would provide health insurance to tens of millions who currently have none and would ban insurance companies from denying coverage on the basis of pre-existing conditions. It would require most people to obtain insurance and would subsidize premiums for poor and middle-income Americans.
The House GOP leader, Ohio Rep. John Boehner, acknowledged Republicans alone can't stop the measure but pledged to do "everything we can to make it difficult for them, if not impossible, to pass the bill." Republicans believe they may get help from Democrats facing tough re-election campaigns.
Axelrod said it will be a struggle, taking aim at insurance industry lobbyists who "have landed on Capitol Hill like locusts" and Republicans who see being on the losing side of the vote as a political victory.
"I am absolutely confident that we are going to be successful. I believe that there is a sense of urgency on the part of members of Congress," given recent news about insurance plan rate increases, Axelrod said.
Yet a dose of reality came from Rep. James Clyburn, the third-ranking House Democrat and main vote-counter. "No, we don't have them as of this morning, but we've been working this thing all weekend," the South Carolinian said Sunday.
Clyburn said he was confident the measure would pass, echoing comments from Speaker Nancy Pelosi, D-Calif., on Saturday.
Axelrod was on ABC's "This Week," NBC's "Meet the Press," and CNN's "State of the Union." Gibbs appeared on "Fox News Sunday" and CBS' "Face the Nation." Clyburn was on NBC and Boehner on CNN.
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