Stage is set for historic healthcare vote

Reporting from Washington —  After a frenzied push to nail down final commitments and resolve lingering disputes in their ranks, House Democrats are poised Sunday to pass the most sweeping change to the nation’s healthcare system since the creation of Medicare nearly half a century ago.

Democrats will now proceed with a straight up-or-down vote on the healthcare bill that passed the Senate last year. Party leaders, facing the possibility of failure, decided Saturday to scrap plans to use a controversial procedural maneuver to approve Senate legislation.

The House plans to begin voting on the Senate bill Sunday afternoon. It will also hold a second vote Sunday on a package of amendments to modify some provisions of the Senate legislation and expand its scope to satisfy demands from House Democrats.

Barring a last-minute breakdown over abortion, House Democrats are expected to have the 216 votes they need.

Democrats rallied around the plan after an emotion-filled day on Capitol Hill during which President Obama delivered a fiery speech that brought lawmakers to their feet in support of the overhaul. Outside, thousands of angry protesters gathered, calling on lawmakers to “kill the bill.”

The last-minute decision Saturday to vote directly on the Senate bill undercut a Republican argument that Democrats were abusing House rules and procedures in their eagerness to pass the healthcare overhaul. The decision also appeared to swing several key lawmakers behind the legislation Saturday, including Rep. Dennis Cardoza (D-Atwater), a member of the fiscally conservative House Blue Dog Coalition.

“We are on the verge of making great history for the American people,” House Speaker Nancy Pelosi (D-San Francisco) told her Democratic colleagues at the meeting with Obama that turned into a spirited rally.

During his speech, Obama reminded lawmakers of the historic opportunity at hand.

“Don’t do it for me. Don’t do it for the Democratic Party,” the president said. “Do it for the American people. They’re the ones looking for action right now.

“I know it is a tough vote,” Obama said. “And I am actually confident . . . it will end up being the smart thing to do politically, because I believe that good policy is good politics.”

Senate Majority Leader Harry Reid (D-Nev.) also promised that he had the 51 votes needed to pass the amendments package, which will be presented in the form of a filibuster-proof budget reconciliation measure as soon as Monday.

As Democrats worked inside the Capitol, tensions continued to mount outside, and protesters flooded into the buildings where lawmakers have their offices.

Rep. Andre Carson (D-Ind.) said he and Rep. John Lewis (D-Ga.), both of whom are black, were accosted outside the Capitol by one group of protesters who shouted racial epithets at them.

“It was like a page out of a time machine,” Carson said outside the House chamber Saturday afternoon.

The demonstrators, many with conservative “tea party” groups, carried signs reading: “Government is the problem, not the solution.”

The 10-year, $940-billion healthcare package is expected to extend medical insurance coverage to about 32 million people by 2019, while also using a series of tax hikes and cuts in Medicare spending to reduce the overall federal deficit by $138 billion over the next decade, according to a preliminary estimate by the nonpartisan Congressional Budget Office.

The House plans to begin voting Sunday afternoon, unless Republicans try to use parliamentary rules to delay the vote. GOP lawmakers pledged Saturday to continue fighting the legislation, which they say will drive up government spending and healthcare costs.

“This weekend, House Republicans will stand with the American people and do everything in our power to defend their freedom and bring about healthcare reform that gives them more freedom and not more government,” said Rep. Mike Pence of Indiana, the No. 3 House Republican.

If passed, the Senate bill would go to Obama for his signature and the package of amendments would go to the Senate for its approval.

If the Senate passes the amendments package without any changes, it too would go to Obama for his signature. Democratic officials concede, however, that the Senate may alter the package, which would require yet another House vote on the changes -- but not on the healthcare overhaul as defined in the Senate bill.

The legislative endgame came into focus Saturday after a flurry of last-minute negotiating and cajoling. Pelosi and her lieutenants rushed between their offices and the House floor to settle lingering disputes among rank-and-file Democrats.

The leaders intensely worked with administration officials to satisfy demands from a small group of antiabortion lawmakers who wanted to place tough restrictions on federal funding for abortion services.

Senior Democrats were exploring whether the president could issue an executive order to clarify that the healthcare legislation would not allow any taxpayer money to be used for abortions and to further protect doctors and other medical providers who choose not to provide abortion services.

“It may be all that’s left,” said Rep. Marcy Kaptur (D-Ohio), a socially conservative lawmaker among the group of holdouts led by Rep. Bart Stupak (D-Mich.) who said they could not support the legislation without more abortion restrictions.

Other social conservatives say they are satisfied that the bill’s language is sufficiently restrictive to ensure that women who receive federal insurance subsidies would not be able to use them to pay for abortion services.

The Senate bill currently requires women who buy subsidized insurance plans that cover abortion services to send their insurer a separate check to cover the abortion benefit.

Working with administration officials, a group of lawmakers from rural districts also hammered out an agreement to boost how much Medicare pays rural doctors and hospitals, a key issue for many legislators. Under the terms of the agreement fleshed out in the early hours of the morning, the Department of Health and Human Services would develop a permanent fix over the next two years.

“You can’t do much better than that,” said Rep. Peter A. DeFazio (D-Ore.), who spoke with the president Saturday to help seal the agreement. DeFazio said he would back the bill.

Other Democratic holdouts who declared their support Saturday included Reps. Jim Costa of Fresno, Christopher Carney of Pennsylvania and Gerald E. Connolly of Virginia.

noam.levey@latimes.com

kim.geiger@latimes.com

Times staff writers Michael Muskal in Los Angeles and Janet Hook in the Washington bureau contributed to this report.