WASHINGTON — House Democratic leaders Thursday abandoned a long struggle to strike a compromise on abortion in their ranks, gambling that they can secure the support for President Barack Obama's sweeping health care legislation with showdown votes looming as early as next week.
In doing so, they are all but counting out a small but potentially decisive group whose views on abortion coverage have become the principal hang-up for Democrats fighting to achieve the biggest change in American health care in generations. Congressional leaders are hoping they can find enough support from other wavering Democrats to pass legislation that only cleared the House by five votes in an earlier incarnation.
The concession came as House Democrats attended a lengthy meeting with White House health adviser Nancy Ann DeParle, who tried to answer questions, resolve differences and calm nerves, especially for lawmakers expecting tough challenges in November. Participants said they generally embraced White House-brokered compromises on prescription drug benefits for the elderly and new taxes on generous insurance plans.
At stake is the president's call to expand health care to some 30 million people who lack insurance and to prohibit insurance company practices such as denying coverage to people who have been sick. Almost every American would be affected by the legislation, which would change the ways many people receive and pay for health care, from the most routine checkup to the most expensive, lifesaving treatment. And most Americans would be required by law to get health insurance.
Republicans continued their fierce criticisms of the president's efforts, vowing to make Democrats pay dearly in the fall elections if they don't back off from what they brand a government takeover of health care. But senior Democrats predicted they can convince their colleagues that doing nothing is the worst option of all, politically and substantively.
"The stars are aligning for victory on comprehensive health reform," said Sen. Tom Harkin, D-Iowa.
White House Chief of Staff Rahm Emanuel emerged from a meeting in the Capitol with top Democratic lawmakers Thursday night saying, "We made a lot of decisions. We're getting towards the end."
The end might be near, but the outcome remains uncertain. House Speaker Nancy Pelosi, D-Calif., must round up at least 216 votes when the real nose-counting and arm-twisting begin in a few days, after final cost estimates arrive from the Congressional Budget Office. All House and Senate Republicans have vowed to oppose the legislation.
With Senate Democrats no longer able to block Republican filibusters, the strategy calls for House Democrats to embrace a health bill the Senate passed in December, despite their numerous objections. Democratic senators in turn would promise to make a limited number of changes under "budget reconciliation" rules, which bar filibusters.
Republican and Democratic lawmakers quarreled Thursday over whether Obama must sign the Senate bill into law before Congress can make the changes, which Democrats see as crucial to making the overall package more politically palatable. Republicans plan to pounce on Democrats the instant the Senate bill becomes law, and House and Senate parliamentarians eventually may have to determine the allowable sequence of legislative actions.
Congressional Democrats appeared to agree with the White House on Thursday on a handful of issues. One would close a coverage gap in the Medicare prescription drug benefit, the so-called doughnut hole that has caused financial and emotional stress for numerous elderly Americans.
Another would impose a new excise tax, starting in 2018, on employer-provided health plans worth more than $10,200 for individuals and $27,500 for families. The Senate had wanted a stiffer tax on such "Cadillac plans," but the more labor-friendly House resisted.
Obama tried to soothe the feelings of two generally liberal constituencies – Congress's black and Hispanic caucuses – in separate White House meetings Thursday. Some black lawmakers say the health legislation doesn't do enough to help poor people. Many Hispanic members say it mistreats illegal immigrants trying to buy insurance with their own money.
One of the toughest hurdles facing Pelosi involves abortion. Some anti-abortion Democrats say the Senate language is not sufficiently airtight to prevent taxpayer dollars from mingling with money that might be used to subsidize abortions.
Others disagree, and party leaders acknowledged Thursday they can't resolve the dispute using budget reconciliation rules. Instead they hope that only a few House Democrats who voted for the health care package in November will now switch to "no" because of the abortion issue. Party leaders think they can offset those defections by persuading some of the 39 House Democrats who voted "no" last year to switch to "yes."
Many House Democrats who oppose legalized abortion "are either satisfied enough with the Senate provision, or they decide that that's as much as they're going to get and they don't want to defeat health care," said Rep. Henry Waxman, chairman of the House Energy and Commerce Committee.
House Majority Leader Steny Hoyer concurred with Waxman's comments.
Even if Pelosi and her allies can eke out a House victory, Senate Republicans are vowing to use almost every delaying tactic they can to slow final passage of the entire Democratic package, even if they're unable to kill it.
Sen. Judd Gregg, R-N.H., promised a sentence-by-sentence examination of the proposals, and scores of challenges. There will be "a lot of very tough votes on this bill," he said.
The White House seemed to back away from its earlier insistence that Congress act by March 18. "If it takes a couple extra days after a year" of struggles, presidential spokesman Robert Gibbs said Thursday, then "it takes a couple extra days."
Gibbs also said Obama was pushing the Senate to remove some of the special deals that remain in the legislation.
One, championed by Finance Committee Chairman Max Baucus, D-Mont., would provide Medicare benefits to residents of tiny Libby, Mont., who suffer from asbestos-related illnesses from a now-closed mining operation. The other, sought by Sen. Christopher Dodd, D-Conn., could spend $100 million to build a hospital at the University of Connecticut.
"We've made it clear to the Senate that the president's position in the final legislation should not contain provisions that favor a single state or a single district differently than others," Gibbs said.
The request drew a chilly response from senators. Jim Manley, spokesman for Reid, said the leader's office "appreciates the White House views, but no decisions have been made."
Democratic leaders must resolve several more issues before presenting a final package to their colleagues and the public. Lawmakers have not decided whether to attach an overhaul of the college student loan program to the health legislation. Nor have they settled on details for a higher Medicare tax on wealthy Americans, treatment of a dozen states that give their residents relatively generous Medicaid benefits and subsidies to help low-income people buy health insurance.
Associated Press writers Erica Werner, Alan Fram, Ricardo Alonso-Zaldivar, Laurie Kellman and Ann Sanner contributed to this report.