House Leaders Move to Ensure Passage of Health Bill

House Democratic leaders prepared to begin the year's first floor debate on health care overhaul with some uncertainty about the outcome, but having struck a compromise with the largest group of holdouts in their caucus.

Late Friday, apparently still short of the votes needed to ensure the bill's passage, the leaders signaled the Rules Committee to permit a vote on an amendment from anti-abortion Democrats that would put additional restrictions on federal funding of abortions through insurance plans. Unless Democratic supporters of abortion rights revolt -- or Republicans withhold their support for tactical reasons -- adoption of that amendment could well produce the needed additional votes for passage of the legislation.

The amendment will be one of only two permitted after the House conducts four hours of general debate and after House Democrats caucus with President Obama.The other amendment will be a GOP substitute. Republicans will also have the opportunity to try to attract Democratic votes and change the bill through a recommital motion.

As of late Friday, at least 20 House Democrats had indicated in interviews and public statements that they plan to vote against the legislation (HR 3962). Twenty "no" votes would leave the Democrats with a pool of 238 potential votes for the measure, or just 20 more than the 218 needed to guarantee passage. No Republican support for the legislation is expected.

Twenty other Democrats said Friday they remained undecided. Many of their votes were considered likely to hinge on how the bill addresses the issue of abortion and whether the government-run "public option" plan would pay for abortions and in what circumstances. Abortion opponents want to make sure that the public plan does not in effect authorize federal funding of abortion.

After a long meeting Friday night with a half-dozen lawmakers who are abortion rights backers, House Speaker Nancy Pelosi, D-Calif., and her leadership team asked the Rules panel to make in order an amendment to be offered Saturday by anti-abortion Reps. Bart Stupak, D-Mich., and Brad Ellsworth, D-Ind. Rules Chairman Louise M. Slaughter of New York was among those in the session.

"I am more optimistic than I've been at any point in this process that we'll be successful tomorrow," Robert E. Andrews of New Jersey said after the Friday evening meeting. "People are trying to find a way to get to yes," Andrews said, referring to concerns about abortion and immigration-related language.

"The pro-life members want to be sure the principle of the [late Rep. Henry] Hyde amendment, which is to stop public subsidy of abortions, is completely vindicated here," Andrews said. "The pro-choice members want to make sure it is not expanded beyond its present scope. There is agreement that that's the goal. It's a very difficult needle thread. And they're in there threading needles right now."

The Democratic leaders' struggle to round up support for the bill is a consequence of their election strategies in 2006 and 2008. Under Rahm Emanuel, the former House Democratic Caucus and Democratic Congressional Campaign Committee chairman who is now White House chief of staff, the party sought out moderate Democrats to run for seats in districts with many independent and Republican voters.

The strategy has resulted in a 258-seat Democratic majority. But many junior Democrats are now balking at supporting the health bill for fear that it reflects liberal ideology, especially regarding abortion.

"It doesn't appear they have the votes at this point," one such moderate, Jason Altmire, D-Pa., said early Friday. He estimated that the leaders faced a "decent-sized" shortage. Altmire said he remained uncommitted, in part because of the abortion issue.

Hours in Rules The Rules Committee conducted a nearly nine-hour debate on the health bill that ended early Saturday morning with adoption of a resolution that, as expected, limits Republicans to offering a single substitute amendment. The committee made changes in the legislation through a manager's amendment, in addition to making the abortion amendment in order.

To shore up support earlier in the week, Democratic leaders accepted an intial changes in abortion language from Ellsworth. The additional amendment Stupak and Ellsworth will offer would essentially make permanent law of the restrictions on federal funding of abortion provided by what is known as the Hyde Amendment -- language in annual appropriations bills that prohibits federal funding of abortion in programs such as Medicaid unless the pregnancy is the result of rape or incest or threatens the mother's life. The amendment would apply permanent Hyde restrictions to insurance policies sold through a new government-run "exchange" receiving federal subsidies. That would include a new government-run plan known as the public option.

Ellsworth said he asked Democratic leaders to write language prohibiting the public option from covering what opponents call "elective" abortions. The change, Ellsworth said, would help draw support for the legislation -- or at least acquiescence -- from the U.S. Conference of Catholic Bishops, the most respected anti-abortion group among like-minded Democrats. "A lot of folks would like the bishops' endorsement of this," he said.

The language Ellsworth proposed earlier in the week would have allowed the public option to cover elective abortion, something the bishops called unacceptable in a Nov. 4 memo Wednesday to House members.

Abortion rights supporters grudgingly accepted the earlier Ellsworth language. But Diana DeGette, D-Colo, said Thursday that the Pro-Choice Caucus, which counts 190 Democrats in its membership, would not accept more restrictive language. DeGette is co-chairwoman of the Pro-Choice Caucus.

Supporters of the health overhaul bill needed to win the votes of at least a handful of abortion opponents. Stupak, co-chairman of the congressional Pro-Life Caucus, has said that as many as 40 Democrats might vote against the bill without the restrictive abortion language. If all 40 voted against the bill, along with all 177 Republicans, Democrats would be left with no margin for other defections.

Obama was scheduled to address the Democratic caucus in the morning, before votes on the measure. One senior Democrat said that Pelosi rescheduled Obama's address -- originally planned for Friday -- because she "made the determination that we need him to close and prevent any last-minute wrinkles."

Alan Ota, Ed Epstein, Keith Perine and Seth Stern contributed to this story.