WASHINGTON - Victory within reach, President Barack Obama rallied House Democrats on Saturday for a final health care push ahead of a critical make-or-break vote for his presidency, capping off a long, turbulent debate that has left the country deeply divided.
Democratic leaders appeared confident they had overcome a flare-up within their ranks over abortion funding restrictions in the legislation that was the last big hurdle to securing the few votes needed to pass the landmark legislation.
Building on Democrats' momentum, House leaders decided on a straight up-or-down vote on Obama's top priority and the defining issue of his first year in office, backing off a much-challenged plan to vote on the bill indirectly. With the vote scheduled for Sunday, the battle tilted in Obama's direction as more Democrats disclosed how they would vote.
The president decided to make a final personal appeal with a Saturday afternoon visit to the Capitol. He spoke after Senate Majority Leader Harry Reid reassured House rank-and-file Democrats that the Senate will complete the legislation. More than 50 Democratic senators have signed a pledge to do so, Reid's spokesman said.
"Is this the single most important step that we have taken on health care since Medicare?" Obama asked lawmakers. "Absolutely." He was referring to the 1965 legislation passed during President Lyndon B. Johnson's administration that provided government-funded health care coverage to the elderly.
Obama can rely only on Democrats to gain passage of his top domestic priority in the face of unanimous opposition from Republicans who say the plan amounts to a government takeover of health care that will lead to higher deficits and taxes.
The sweeping legislation, affecting virtually every American and more than a year in the making, would extend coverage to an estimated 32 million uninsured Americans, forbid insurers to deny coverage on the basis of pre-existing medical conditions and cut federal deficits by an estimated $138 billion over a decade.
For the first time, most Americans would be required to purchase insurance, and they would face penalties if they refused. Billions of dollars would be set aside for subsidies to help families at incomes of up to $88,000 a year afford the cost. And the legislation also provides for an expansion of Medicaid that would give government-paid health care to millions more low-income Americans.
Congressional analysts estimate the cost of the two bills combined would be $940 billion over a decade. The bill would remake one-sixth of the U.S. economy. The United States is the only major industrialized country that does not have a comprehensive national health care plan.
Scrambling to gather the 216 votes needed for passage in the House, Democratic leaders and Obama focused last-minute lobbying efforts on two groups of Democrats: 37 who voted against an earlier bill in the House and 40 who voted for it only after first making sure it would include strict abortion limits that now have been modified.
One option on abortion emerged Saturday — an executive order from Obama — that would reflect long-standing law barring federal funding for abortions except for cases of rape, incest or when the mother's life is in danger. Party leaders saw that approach as crucial to winning the support of anti-abortion Democrats for the health care bill.
House Speaker Nancy Pelosi, asked if they were working on an executive order, said simply: "Ask the president."
It was unclear whether the strategy would win support from conservative Rep. Bart Stupak, leader of abortion foes who are opposing the health bill unless tight restrictions are included.
Leaders worked into Friday night attempting to resolve the dispute over abortion, and Saturday morning they were increasingly confident it would not scuttle the bill.
Stupak, who succeeded last November in inserting strict anti-abortion language into the House bill, had hoped to do so again. Eight Democrats joined Stupak Friday cosponsoring a resolution that would insert his abortion restrictions as a "correction" to the underlying bill.
That would add new complications to the already complex strategy Democrats are pursuing to pass the bill, requiring additional votes on a highly charged issue. Abortion opponents are divided over whether restrictions on taxpayer funding for abortion already in the bill go far enough.
Asked by reporters if she would allow a separate vote on abortion restrictions, Pelosi seemed to rule it out. Pelosi met Saturday with three anti-abortion Democrats who are part of Stupak's group and was later seen on the House floor talking intently with Stupak.
The House Rules Committee worked through the day Saturday to set the terms for the vote. Democratic leaders dropped plans to employ a controversial procedure known as "deem and pass." Under that procedure, a single vote would have been held in the House to endorse the health reform bill approved by the Senate last year as well as a package of fixes to it.
That procedure has been used in the past by both parties but its use has been widely criticized for legislation as massive as a health care overhaul.
Rep. Steny Hoyer, the No. 2 House Democrat, said the House would vote separately on the fix-it companion bill and then the Senate bill. Hoyer said the latter would go to Obama for his signature while the companion bill heads to the Senate. Hoyer said he has seen the letter from Reid indicating he has the necessary votes to pass the fix-it measure under a procedure called reconciliation that requires only a simple majority of 51 in the 100-member body, avoiding Republican delaying tactics.
The vote count in the House seemed to be breaking in Obama's favor.
An abortion foe, Rep. Baron Hill announced Saturday that he would support the bill. In addition, four Democrats said Friday they would vote "yes" after voting against an earlier version that passed the House last year, bringing the number of switches in favor of the bill to seven.
On the other side of the ledger, two Democratic former supporters announced their intention to oppose the bill. Massachusetts Rep. Stephen Lynch said he did so despite a telephoned appeal from Vicki Kennedy, whose late husband, Sen. Edward M. Kennedy, championed health care for decades.
Rep. Anh Cao, the only Republican to support the earlier measure, has also announced his opposition.
Republican leaders vowed to make Democrats who support the legislation pay a political price in November's national election when control of Congress will be at stake.
Republicans said, as they have from the outset, that Democrats were angling for a government takeover of health care. They also said the cost of the bill would be covered by $900 billion in higher taxes and cuts in future Medicare payments. Medicare is the government-run program to provide health care to the elderly.
"This bill requires 10 years of tax increases and 10 years of Medicare cuts just to pay for six years of supposed benefits, many of which don't even go into effect until 2014," House Republican leader John Boehner said in the Republican's weekly radio and Internet address. "That's not reform."
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