Pat Dollard

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WASHINGTON — Amid intense lobbying by the Obama administration, House Democratic leaders struggled Friday for the final votes needed to pass sweeping health care legislation, working to ease concerns among Hispanic holdouts and abortion foes.

“We’re very close” to having enough votes to prevail, said Majority Leader Steny Hoyer of Maryland, although he added a scheduled Saturday vote could slip by a day or two and sought to pin the blame on possible Republican delaying tactics.

“Nice try, Rep. Hoyer, but you can’t blame Republicans when the fact is you just don’t have the votes,” shot back Antonia Ferrier, spokeswoman for the GOP leader, Rep. John Boehner of Ohio.

In a struggle that combined the fate of President Barack Obama’s top domestic priority and a 2010 campaign issue, bipartisanship was not an option.

GOP leaders boasted that all 177 House Republicans stood ready to oppose the $1.2 trillion bill, which would create a new federally supervised insurance marketplace where the uninsured could purchase coverage.

Consumers would have the option of picking a government-run plan, the most hotly contested item in the legislation and the basis for the Republican claim that Democrats were planning a government takeover of the insurance industry.

Democrats said their bill was designed to spread coverage to millions who lack it, ban insurance industry practices such as denying coverage on the basis of pre-existing medical conditions and restrain the growth of health care spending nationally. The Congressional Budget Office said that if enacted, the measure would extend coverage to 96 percent of all eligible Americans within 10 years.

Obama and his administration lobbied furiously for its passage.

Rep. Jason Altmire, a second-term Democrat from western Pennsylvania, said he received calls during the day from the president, White House Chief of Staff Rahm Emanuel, Health and Human Services Secretary Kathleen Sebelius and Education Secretary Arne Duncan. Their message was “this is a historic moment. You don’t want to end up with nothing,” he said.

Altmire added his callers emphasized the legislation would change once it left the House, “but if you kill it now it’s over” for the foreseeable future. He said he remained undecided on his vote.

Several Democrats have already announced their opposition, most of them moderate to conservative members of the so-called Blue Dog Coalition.

Democrats hold 258 seats in the House and can afford 40 defections and still wind up with 218, a majority if all lawmakers vote.

The White House issued a statement of support for the measure, saying it “meets the president’s criteria for health insurance reform: It assures that all Americans have access to quality, affordable health care that is there when they need it and does so without adding a dime to the deficit.”

Months after Obama urged lawmakers to remake the health care system, House Speaker Nancy Pelosi and the leadership struggled to resolve controversies over the bill’s treatment of illegal immigrants and insurance coverage for abortion, issues that transcend health care and have long divided the Democratic cacus as they do the nation.

Abortion blended politics and religion.

Federal law currently prohibits the use of federal funds to pay for abortions except in the case of rape, incest of situations in which the life of the mother is in danger. That left unresolved whether individuals would be permitted to use their own funds to buy insurance coverage for the procedure in the federally backed insurance exchange envisioned under the legislation.

A compromise proposal backed by Rep. Brad Ellsworth, D-Ind., would allow it, so long as abortions weren’t paid for from federal funds used to subsidize insurance policies bought by lower-income individuals and families.

While that was enough to satisfy some, other abortion foes objected, backed by the U.S. Conference of Catholic Bishops, and Democrats weighed possible concessions that could satisfy them without losing votes from abortion rights Democrats.

The controversy surrounding illegal immigrants remains “a work in progress,” Rep. Nydia Velazquez, a New Yorker and chairwoman of the Hispanic Caucus, said after a mid-day meeting in Pelosi’s office.

As drafted, the legislation permits illegal immigrants to purchase coverage with their own money inside the insurance exchange that would be created — a provision that the 23-member Hispanic Caucus wants retained in any final compromise that reaches Obama’s desk.

One lawmaker who attended the sesssion, speaking on condition of anonymity to discuss the private talks, said members of the Hispanic Caucus sought and received assurances from Pelosi that she and the leadership would support them as the bill made its way through the House and ultimately to the president’s desk. But this lawmaker said the speaker was not able to get a pledge in return that the Hispanics would all vote for the bill regardless of how their issue was ultimately settled.

Despite the uncertainty, Hispanic lawmakers generally have a strong incentive to support the legislation. According to the Census Bureau, nearly 31 percent of Hispanics are uninsured, roughly double the rate of 15 percent for the U.S. population as a whole.

The bill provides federal subsidies for consumers at lower incomes to to defray the cost of insurance. Most individuals would be required to buy coverage and large businesses would have to provide it to their employees.

The bill would be paid for by cuts in future payments to Medicare providers as well as a surcharge of 5.4 percent on income tax filers with income of $500,000 for individuals and $1 million for couples.

The bill also would provide for a large expansion of Medicaid, the federal-state program for the poor, and eliminate a gap in drug coverage under Medicare.