House leaders decided Saturday to stage a vote on the Senate's health-care bill, dropping a much-criticized strategy of allowing lawmakers to "deem" the landmark legislation into law. But the outcome of that vote remained in doubt as a pivotal bloc of Democrats continued to withhold its support over fears that the bill would open the door to the federal funding of abortion.
House leaders were working to secure their votes late Saturday with the promise of an executive order affirming President Obama's commitment to a longstanding ban on public abortion funding except in cases of rape or incest, or to save the life of the mother. Rep. Marcy Kaptur (D-Ohio), a key antiabortion vote, said she thought the document would be insufficient to bring the entire group of about 10 antiabortion Democrats onboard.
Senior Democrats predicted a cliffhanger when the House is expected to vote Sunday night, saying they are likely to clear the 216-vote threshold for final passage by the narrowest of margins. Democratic leaders huddled in the office of House Speaker Nancy Pelosi (D-Calif.) late into the evening, reviewing the final list of commitments.
Throughout the day, thousands of angry protesters milled outside the Capitol; some hurled insults at black and gay lawmakers and shouted at Democrats to "kill the bill!" Meanwhile, Obama made a final pitch for reform, exhorting wavering lawmakers to rise to the aid of millions of uninsured Americans by taking "the single most important step that we have taken on health care since Medicare" was created in 1965.
Pelosi's decision to have the House hold two votes, one on the Senate bill and one on a separate package of revisions, reversed an apparent plan laid earlier in the week, when Pelosi said she preferred not to force rank-and-file Democrats to cast a separate vote on the unpopular Senate bill. Republicans had accused her of trying to dodge responsibility for health reform, and even some Democrats complained about the move.
On Saturday, House Minority Leader John A. Boehner (R-Ohio) hailed Pelosi's decision as "a victory for the American people." He vowed to force Democrats to stand up, one by one, to announce their vote for the Senate bill, which contains a number of politically fraught provisions, including a special deal for Sen. Ben Nelson (D-Neb.) that would require taxpayers nationally to pay for an expansion of Medicaid in his state.
"Now House Democrats will face two crucial votes tomorrow," Boehner said in a statement. "They will have to vote on the Senate-passed bill, stuffed with tax hikes, Medicare cuts, and infamous backroom deals -- and they will vote on something worse: their 'fix' with more taxes, more Medicare cuts, and new special deals."
For the first time since Wednesday, Democrats lost a vote. Rep. Zack Space, a second-term lawmaker from a swing district in eastern Ohio, said he would vote "no" Sunday, a switch from his vote for health care in November.
"This is not over," Boehner told reporters. "They do not have the votes yet. We've got to keep working to make sure that they never, ever, ever, ever get the votes to pass this bill."
House passage would immediately send the slightly narrower Senate version of the health bill to the White House for Obama's signature, allowing the president to claim victory on his most important domestic initiative. The package of revisions would go to the Senate for action next week under special rules that protect it from a GOP filibuster. On Saturday, Senate Majority Leader Harry M. Reid (D-Nev.) publicly assured House Democrats that he has the votes to approve their changes, making "a good law even better."
In a fiery closing argument for health reform, Obama urged lawmakers to focus not on the impact to his presidency or even the impact to their own political fortunes when they cast what he acknowledged will be a "tough vote." Instead, Obama reminded them of the nation's 100-year quest for universal health coverage, and told them to vote against the bill only if "you honestly believe in your heart of hearts" that it is not a "vast improvement over the status quo."
"This is a middle-of-the-road bill that is designed to help the American people in an area of their lives where they urgently need help," Obama told Democrats in the underground Capitol Visitor Center. "We have been debating health care for decades. . . . It is in your hands. It is time to pass health care, and I am confident you are going to do it tomorrow."
The compromise package would spend $940 billion to extend coverage to 32 million Americans over the next decade, leaving only about 5 percent of non-elderly citizens without coverage, according to projections by the nonpartisan Congressional Budget Office. Millions of people would be added to the rolls of Medicaid, the government health program for the poor, while millions more who lack access to affordable coverage through the workplace would receive federal tax credits to buy insurance.
For the first time, every American would be required to obtain coverage or face a penalty of at least $695 a year. Employers, too, would have a new responsibility: to offer coverage or face penalties of $2,000 per worker. By cutting more than $500 billion from Medicare over the next decade and raising taxes on the well-insured and high-earners, the package would trim deficits by $138 billion over the next decade and by around $1.2 trillion in the decade thereafter, the CBO said.
Republicans questioned assertions of deficit-reduction, predicting that Democrats would abandon the measure's primary funding mechanisms when seniors begin to feel the pinch of Medicare cuts, or when union families fall victim to a new 40 percent tax on the most generous insurance policies set to take effect in 2018. If those and other politically painful provisions were removed, the CBO said, the measure would increase deficits.
"This is going to be a program that will rival the size and liability of Medicare for sure, in my opinion," said Rep. Paul Ryan (R-Wis.).
The Republican message was being received loud and clear outside the Capitol, where angry protesters gathered and waved placards that said "Defeat Obamacare" and "Born in the USA not the USSR." Republicans were treated as heroes as they walked through the crowds, who patted them on the back and thanked them for their opposition. Democrats were greeted with jeers.
Black lawmakers said some protesters hurled racial epithets at them, and in one instance, spit upon them.
Rep. Emanuel Cleaver (D-Mo.) said that he was walking into the Capitol to vote when a protester spat on him. Police quickly responded and detained the protester, Cleaver said in a statement, but the lawmaker declined to press charges.
Others hurled epithets at Rep. John Lewis (D-Ga.), a former civil rights leader, and Rep. Andre Carson (D-Ind.) as they left the Capitol after Obama's speech.
"They were shouting the N-word," Carson told reporters. "It was like a page out of a time machine."
Observers also said that Rep. Barney Frank (D-Mass.) was heckled with anti-gay epithets inside the Longworth House Office Building.
"I have heard things today that I have not heard since March 15, 1960, when I was marching to get off the back of the bus," said House Majority Whip James E. Clyburn (D-S.C.), the highest-ranking black official in Congress.
Staff writers Ben Pershing and Perry Bacon Jr. contributed to this report.