WASHINGTON - Democratic leaders are unveiling what is expected to be their final health care bill Thursday, setting the stage for a Sunday vote on a plan that would affect most Americans and has become the defining issue in Barack Obama's presidency.
Leaving nothing to chance, the White House announced that Obama has put off his planned trip to Asia for a second time, delaying it until June. Obama was to have left Sunday.
Said House Speaker Nancy Pelosi: "He wants to be here for the history."
The plan would cost $940 billion over 10 years and extend coverage to 32 million Americans who are uninsured, while reducing the federal deficit by $138 billion over 10 years, the impartial Congressional Budget Office said, and continue to drive down red ink thereafter.
Democratic leaders said the deficit would be cut $1.2 trillion in the second decade.
The plan would restructure one-sixth of the U.S. economy in the biggest expansion of the social safety net since Medicare, a government-run health plan for the elderly, was created in 1965.
Though the vote is expected Sunday, passage is still not assured. With Republicans unanimous in opposition, Obama needs to win over moderate House Democrats, some of whom are wary about the plan's costs and abortion provisions.
Still, Obama appears on the verge of a victory on the signature issue of his presidency, just two months after it appeared all but dead. Democrats in January lost a Senate seat in a special election, denying them the 60-vote supermajority needed to overcome Republican blocking tactics. But Democrats are using a complicated legislative strategy, over strenuous Republican objections, to get the bill through both the House and Senate.
Obama called it the biggest deficit reduction since the 1990, when President Bill Clinton put the federal budget on a path to surplus.
"This is by one virtue of a reform that would bring accountability to the insurance industry and bring greater economic security to all Americans," Obama said. "So I urge every member of Congress to consider this as they prepare for their important vote this weekend."
But House Republican leader John Boehner said his party's lawmakers will "do everything that we can do to make sure this bill, never, ever, ever passes."
The Democrats' drive took on a growing sense of inevitability this week, picking up endorsements Wednesday from a longtime liberal holdout and from a retired Roman Catholic bishop and nuns who broke with church leaders over the bill's abortion provisions.
"This is a magnificent bill for the American people," said the Democrat's top vote-counter, Rep. Jim Clyburn. Leaders appeared increasingly confident of getting the 216 votes they need to pass the bill.
The health care issue is likely to shape the November congressional election, when Republicans try to capture control of both chambers. Democrats will campaign on having overhauled a system that has made both health care and insurance unaffordable for tens of millions of Americans. Republicans will say Democrats pushed through a bill that had little public support and will ultimately increase taxes and damage the quality of health care.
Once the legislation is fully phased in, most Americans would be required to carry coverage - and insurers would be forbidden from turning down people with health problems, or from charging them more.
The big expansion of coverage would not come until 2014, when new health insurance marketplaces open for business.
In the meantime, the legislation calls for a series of new consumer benefits. Insurers could not deny coverage to children because of an pre-existing health problem, nor could they place lifetime dollar caps on the amount of coverage. A new high-risk health insurance pool would provide coverage to uninsured people who can't get private coverage because of health problems.
Democrats are following a two-track legislative strategy for passing the bill. First, the House, despite the reservations of many Democrats, will have to endorse a bill that had been approved by the Senate last year. Then both chambers will quickly pass a package of fixes agreed to in negotiations with the White House. The Senate would use a procedure that requires only a simple majority, avoiding Republican delaying tactics.
Since they will vote first, House lawmakers are seeking assurances from their Senate counterparts that they have enough votes to pass the follow-up measure as well.
With Democrats promising 72 hours for lawmakers and the public to review the legislation once it is released, that would push a House vote on the bill until Sunday at the earliest - the same day Obama plans to leave for a trip to the Asia-Pacific region. Obama already has delayed the trip once so he can be present for the vote and help with the 11th-hour arm-twisting that inevitably will precede it.
The No. 2 House Democrat, Steny Hoyer, said Obama's travel plans would not interfere with Democrats' ability to pass the bill. "I think the president's presence helps, but is it needed?" said Hoyer. "You can dial a cell phone anywhere in the world."