WASHINGTON - House Democratic leaders are pushing to finish far-reaching health legislation and hold a climactic vote in the next three weeks, aiming to overcome reluctance from rank-and-file lawmakers. But they conceded Thursday they may not meet President Barack Obama's challenge for swift action.
House Majority Leader Steny Hoyer said the Democrats would like to get a final vote by Congress' Easter break, which begins March 29. But he also said "the world doesn't fall apart" if that timeline isn't met - a nod to the many missed deadlines that have characterized the health overhaul effort so far.
Democratic leaders are contending with a host of undecided lawmakers who want to see the fine print before making a decision. Hoyer said final language and a cost estimate should come back from the Congressional Budget Office by the end of next week.
"At this point in time we don't have a bill," Hoyer said. "It's a little difficult to count votes if you don't have a bill."
Separately, more than a dozen House Democrats were meeting with Obama at the White House Thursday afternoon. Among the group were lawmakers who voted against the legislation last year. Obama is leaving for an Asia trip March 18, and the White House would like to see action before then, something Hoyer said was "doable," even as he noted the bill still hadn't been completed.
House Speaker Nancy Pelosi, D-Calif., said, "I feel very confident about how we go forward."
"Every legislative lift is a heavy lift around here," Pelosi said.
At its core, the legislation still is largely along the lines Obama has long sought. It would extend coverage to tens of millions of uninsured Americans while cracking down on insurance company practices such as denying policies on the basis of pre-existing medical conditions. An insurance exchange would be created in which private companies could sell policies to consumers.
Much of the cost of the legislation, nearly $1 trillion over a decade, would be financed by cuts in future Medicare payments and higher payroll taxes on individuals earning more than $200,000 and couples more than $250,000.
In his latest changes Obama added some Republican ideas raised at last week's bipartisan summit, including renewed efforts on changes in medical malpractice and rooting out waste and fraud from the system.
The House passed health overhaul legislation by a narrow 220-215 vote in November, but since then several Democrats have defected or left the House. To avoid a filibuster in the Senate that Democrats can't defeat, Obama is now pushing the House to approve the Senate's version of the bill, along with a package of changes to fix elements of the Senate bill that House Democrats don't like, including a special Medicaid deal for Nebraska and a tax on high-value insurance plans that is opposed by organized labor.
Obama made a closing argument for action Wednesday, saying, "I believe the United States Congress owes the American people a final vote."
The legislative maneuvering ahead is tricky and Democratic leaders are facing discontent from lawmakers who've taken a political beating over the past year of corrosive debate. Also, as many as a dozen anti-abortion Democrats are threatening to defect because of the Senate bill's more permissive language on federal funding of the procedure.
The outcome will depend on lawmakers like Rep. Dina Titus, D-Nev., a first-term congresswoman in a divided district who overcame initial qualms to vote for the legislation in November, only to come under attack from Republicans over the decision. Titus said Thursday she's undecided.
"I think what's happened in my district is, there's a great deal of uncertainty," Titus said. "Some people still think there's death panels."
Titus said she's trying to make the decision based on what's best for her district, leaving political considerations aside, but lawmakers who switch from voting "yes" to "no" - or vice versa - risk being labeled flip-floppers.
"I think it'll be very hard to explain back home why people who voted for the House bill are voting against this legislation, especially if you sit in the center to right of the caucus. The Senate bill has only moved to the middle," said Rep. Chris Murphy, D-Conn.
In his speech Wednesday, Obama called for an "up-or-down vote" within weeks under rules denying Republicans the ability to block the bill with a filibuster.
Lawmakers were almost finished merging House and Senate versions of sweeping overhaul legislation when a special election in January cost Democrats their filibuster-proof Senate majority, throwing the effort into disarray.
Thirty-nine Democrats voted "no" on the House bill, and Pelosi will probably need some of those to switch to make up for votes lost from anti-abortion Democrats and others.
"We're not going to vote for the bill with that language in there," Rep. Bart Stupak, D-Mich., leader of the anti-abortion Democrats in the House, said on ABC's "Good Morning America."
"I want to see health care, but we're not going to bypass some principles that we believe strongly about," Stupak said.
Health and Human Services Secretary Kathleen Sebelius, appearing on the same show, said she hoped that "when the bill is in its final form and people have a chance to look at it, I think they will understand that this bill does not change the status quo on abortion."
"There will be no federal financing of abortion," she said.
Sen. Lamar Alexander, R-Tenn., said Obama and House Democratic leaders are asking their members to "hold hands, jump off a cliff and hope Harry Reid catches them." Reid is the Senate Democratic leader. Alexander said there is no guarantee the Senate would pass the reconciliation bill, with Republicans figuring out how to derail it.
Alexander told reporters Thursday that if the bill passed there would be an instant effort to repeal it and it would define every political race in the country this fall.