The US House of Representatives opened a historic debate Saturday on remaking US health care, with President Barack Obama set to make a rare in-person appeal for his top domestic priority.
Obama hoped to bring the full persuasive power of the US presidency to bear in an 11th-hour push to secure the 218 votes needed to pass what would be the most ambitious overhaul of its kind in nearly a half-century.
Shortly before the formal debate began, Democratic House Majority Leader Steny Hoyer predicted passage of the 10-year, one-trillion-dollar legislation cobbled together in months of public talks and backroom negotiations.
"We think we'll have 218 by the time we vote on this bill later on this afternoon or early this evening," Hoyer told MSNBC television, describing himself as "confident" in the outcome.
Related article: Hoyer predicts bill will pass
All 177 House Republicans are expected to oppose the measure, meaning Democrats can afford just 40 defections from their 258-seat majority and still pass the bill in a vote expected as early as Saturday.
But the White House and its allies were leaving nothing to chance, bringing in Obama to urge wavering lawmaker to "do this for the country, do this for your constituents," according to the president's spokesman, Robert Gibbs.
Republican delaying tactics could stall the bill, a 10-year plan, estimated at about one trillion dollars, to extend health coverage some 36 million Americans who currently lack it.
But Republican opposition was hardly the only hurdle: Democrats were wrestling with a bitterly divisive intra-party feud over whether government funds could go even indirectly to funding abortions.
Existing US law forbids federal money from going directly to abortion providers except in cases of rape, incest, or when pregnancy endangers the life of the mother, but a group of about 40 swing-vote Democrats successfully pushed for a vote on an amendment that would further tighten restrictions.
Reproductive rights groups and their Democratic supporters -- the party's majority -- opposed the new curbs.
Even if Democrats squeeze overall health care bill through the House, it must still clear the Senate, where Democratic Majority Leader Harry Reid faces more daunting obstacles and has hinted any action could slip to 2010.
That would put the issue front-and-center in the 2010 mid-term elections, when one-third of the Senate, the entire House of Representatives, and many US governorships are up for grabs.
Key facts: US health care bill
The United States is the world's richest state but the only industrialized democracy that does not ensure that all of its citizens have health care coverage, with an estimated 36 million Americans uninsured.
And Washington spends vastly more on health care -- both per person and as a share of national income as measured by Gross Domestic Product -- than other industrialized democracies, according to the Organization for Economic Cooperation and Development.
The United States spent about 7,290 dollars per person in 2007, more than double what Britain, France, and Germany spent, with no meaningful edge in the quality of care, and lags behind OECD averages in key indicators like life expectancy and infant mortality.
Under the White House-backed bill, Americans would have to buy insurance and most employers would have to offer coverage to their workers -- though some small businesses would be exempt and the government would offer subsidies.
The measure includes a government-backed insurance plan, popularly known as a "public option," to compete with the private insurance industry.
The non-partisan Congressional Budget Office says the bill, as written, would cut the budget deficit by about 100 billion dollars over 10 years while extending health care coverage to 96 percent of all Americans.
