Slowly but steadily, support is building behind President Barack Obama's health care legislation in the House, the result of intense lobbying and politically targeted changes aimed at reassuring waverers and winning over critics.
Obama himself was to talk up the sweeping overhaul in a midday speech Friday in Virginia, his fourth outside-the-Beltway event in two weeks as he scrambles to rally the public ahead of a climactic vote this weekend. On Capitol Hill, congressional leaders were focusing on those rank-and-file Democrats, including moderates and opponents of abortion, who remained undecided after the release Thursday of a final package of changes to the massive 10-year, $940 billion legislation.
"Every vote around here is a heavy lift," House Speaker Nancy Pelosi, D-Calif., said. "We don't have a rubber-stamp Congress or a rubber-stamp (Democratic) caucus. So, we have our full airing of issues."
The White House and Democratic leaders trumpeted two new converts to their cause, as retiring Rep. Bart Gordon, D-Tenn., and first-term Rep. Betsy Markey, D-Colo., announced their support after opposing an earlier version of the legislation last year. Markey cited improved deficit cuts. Gordon said his backing was unrelated to a new provision sending higher Medicaid payments to Tennessee hospitals that treat large numbers of uninsured.
As rumors flew around the House chamber of more possible opponents-turned-supporters — and also of previous "yes" voters who might withdraw their support — Pelosi worked her members, seeking out lawmakers individually or in small groups on the House floor to try to win them over. With Republicans unanimously opposed after a year of corrosive debate, the vote set for Sunday was expected to be a cliffhanger, and Democratic leaders don't yet command the 216 commitments they need.
Obama postponed until June a planned Asia trip that was set to begin Sunday, allowing him to stay in town for the House vote and action next week in the Senate. Thursday afternoon, Obama played host to individual lawmakers seeking favors or reassurance. House Democrats were hoping to get a letter of support Friday signed by enough Senate Democrats to guarantee passage of the package of changes in that chamber, something leaders hope will reassure rank-and-file House members that they won't be left hanging out to dry.
With the addition of the 153 pages of revisions, the bill would expand health care to 32 million uninsured, bar the insurance industry from denying coverage on the basis of pre-existing medical conditions and trim federal deficits by an estimated $138 billion over the next decade.
Beginning in 2014, most Americans would be required for the first time to purchase insurance or face penalties if they refused. Large businesses would face fines if they did not offer good-quality coverage to their workers. Millions of families with incomes up to $88,000 a year would receive government help to defray their costs.
To address concerns of House Democrats, those subsidies were raised by an estimated $25 billion over a decade in the package of changes offered Thursday. Seniors who experience a gap in coverage in the Medicare prescription drug program would receive a $250 rebate this year — an election-year bragging point for Democrats as they look toward the fall campaign with control of Congress at stake. A special deal giving extra Medicaid money to Nebraska was struck in exchange for more Medicaid money for all states, though other special deals decried by Obama stayed in the bill.
The changes also included another of Obama's top priorities: Federally guaranteed student loans would now be made only by the government, ending a role for banks and other for-profit lenders who charge fees. The savings, an estimated $60 billion over a decade, would increase Pell grants for needy college students as well as support for programs such as aid to historically black colleges, a priority of the Congressional Black Caucus.
The package of changes would modify the sweeping health care legislation that cleared the Senate late last year. In a strategy designed to skirt Republicans' new ability to filibuster in the Senate, House Democrats on Sunday will move to pass both the Senate measure and the package of changes to it; the bill making changes could pass the Senate under rules allowing for a simple majority, not 60 votes.
In the Senate, Republicans plan to challenge select provisions by claiming they are not eligible to be included in a measure considered under non-filibuster rules.
Associated Press writers David Espo, Ricardo Alonso-Zaldivar, Charles Babington, Alan Fram, Laurie Kellman and Ann Sanner contributed to this report.
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