Washington – Pelosi Predicts a Health Bill Within 10 Days

Washington – Speaker Nancy Pelosi mobilized House Democrats on Friday for a final effort to pass an overhaul of health care, predicting approval in the next 10 days with help from President Obama, who delayed a trip abroad to try to win over wavering Democrats.

The White House said Mr. Obama would begin his trip to Indonesia and Australia a week from Sunday, three days later than scheduled, allowing him to be on hand for what is shaping up as the pivotal period for his top domestic initiative. Mr. Obama will travel to Ohio on Monday to push for passage.

But even as the yearlong battle hurtled toward a conclusion, approval of the bill was hardly certain, so lawmakers were preparing for a week of arm-twisting and high drama. Although they have been debating the issue for a year, some House Democrats said Friday that they could not say how they would vote because they had not seen the final text of the legislation or an official estimate of its cost.

Some issues that could swing blocs of votes, like insurance coverage for abortions, remain unresolved. House Democratic leaders said they had suspended their efforts to reach a compromise with party members who oppose abortion and the use of federal money to subsidize insurance that includes coverage of the procedure. That could cost them the votes of some House Democrats who supported the health care bill in the fall after it was amended to impose tight restrictions on abortion coverage.

The Capitol, normally quiet on a Friday, was abuzz as Democrats and Republicans readied for what is likely to be a frenetic push, leading to a series of climactic votes.

At the same time, members of both parties struggled to decipher a ruling by the Senate parliamentarian about how they would have to navigate through the complex rules governing the legislative technique being used by Democrats to win final approval of the bill. While their interpretations differed, Democrats said they believed they could meet its requirements with this sequence of events:

As soon as Thursday or Friday, the House would pass the health care bill approved by the Senate in December. The House would immediately approve a package of changes in a separate bill, using a procedure known as budget reconciliation, to avoid the threat of a Republican filibuster in the Senate.

Mr. Obama would sign the Senate health care bill, making it the law of the land. The budget reconciliation bill would go to the Senate, where Republicans intend to offer dozens of amendments and points of order in an effort to alter or stop it. Assuming they are able to fend off the Republican blocking efforts, Democrats could pass the reconciliation package with a simple majority vote, amending the health bill in a way that makes it acceptable to Democrats in the House and the Senate and to Mr. Obama. The president would then sign the reconciliation bill, completing the process.

The Senate Republican leader, Mitch McConnell of Kentucky, said Democrats were “twisting themselves into pretzels trying to figure some way to get this health care bill passed.”

“The reason all of this arm-twisting and deal-making and parliamentary maneuvering is going on is that people hate this bill,” Mr. McConnell said. “They are trying to convince their members, within eight months of an election, to ignore their constituents and do something that the public is opposed to.”

Ms. Pelosi said a proposed overhaul of the student loan program would be included in the reconciliation bill, a decision that cheered many Democrats. The education bill is popular in the House, and some Democrats said it could help win support for the overall package, in part because it cuts off subsidies to big banks at a time of populist anger against Wall Street.

“This is a controversial, difficult vote for a lot of people, me included,” said Representative Robert E. Andrews, Democrat of New Jersey. “The more things that you can go home and say are in the bill that are sort of universally popular, yeah, it helps.”

He noted, for example, that the bill would provide additional money for community colleges and Pell grant scholarships.

But another New Jersey Democrat, Representative Bill Pascrell Jr., criticized packaging the health care and education bills together. “We will be confusing the American people more than we already have,” said Mr. Pascrell, who supports both bills.

Ms. Pelosi welcomed Mr. Obama’s decision to delay his trip.

“I’m delighted that the president will be here for passage of the bill,” she said. “It’s going to be historic. And it would not be possible without his tremendous, tremendous leadership, his persistence, his concern for the American people, always guided by his statement that we will measure our success by the progress being made by America’s working families.”

The bill would provide coverage to more than 30 million people who are uninsured, would require most Americans to carry insurance and would prohibit insurers from denying coverage to people who are sick. In both houses, Republicans strenuously oppose the legislation, saying it would raise taxes, cut Medicare and lead to higher premiums for many people who are relatively young and healthy.

Though Democrats said the bill could come to a vote by the end of the week, they have missed many self-imposed deadlines on health care, and when pressed on the schedule, Ms. Pelosi said she could not guarantee final House action by March 21, when Mr. Obama is to leave on his trip.

“I’m hoping that it will be in that time frame,” she said, adding, “We stand ready to stay as long as it takes to pass the bill.”

Representative Anthony D. Weiner, Democrat of New York, expressed the optimism of many in his party after the House Democratic Caucus met Friday.

“There’s been a tidal change, I think, in the last 72 hours or so,” Mr. Weiner said. “People have become more confident that we’re going to get this done.”

Abortion is perhaps the most contentious outstanding issue. Representative Steny H. Hoyer of Maryland, the Democratic leader, said he had discussed the issue with Representative Bart Stupak of Michigan, a leader of the anti-abortion Democrats. But Mr. Hoyer said, “I made it clear I was not negotiating.”

House Democrats dislike the Senate health bill and do not want to vote for it without an assurance that the Senate will pass the budget reconciliation bill to eliminate politically unpopular provisions, like one giving Nebraska extra Medicaid money.