The US House of Representatives drew close late Saturday to a vote on the broadest US health care overhaul in forty years, spurred on by President Barack Obama's call to "answer the call of history."
Obama's Democratic allies, seeking to fulfill his top domestic priority, said they were confident of having the 218 votes needed for passage after the president made a rare private visit to woo wavering lawmakers.
"This is our moment to deliver. I urge members of congress to rise to this moment, answer the call of history and vote yes for health insurance reform for America," he said later in a speech in the White House's Rose Garden.
Obama's efforts were part of an all-out Democratic campaign to hold enough of their 258-seat majority together to pass the 10-year, trillion-dollar bill in the face of seemingly united opposition from the chamber's 177 Republican.
"For generations, the American people have called for affordable, quality health care for their families. Today, the call will be answered," promised House Speaker Nancy Pelosi.
The bill aims to extend health coverage to 36 million Americans who lack it now, create a government-backed insurance plan to compete with private firms, and end denial of coverage based on preexisting medical problems.
By 2:00 pm (1900 GMT), Obama's allies had prevailed easily in a pair of procedural votes after several hours of often raucous debate, but the margin was expected to tighten considerably for the final vote many hours later.
Republicans appealed to swing-vote Democrats from battleground districts to reject what they warned would end up being a costly government takeover of health care, stoking traditionally American suspicions of the public sector.
"We are voting on Speaker Pelosi's one-trillion-dollar Washington takeover of health care. This bill bulldozes individual liberty and puts the government just where it doesn't belong," said Republican Representative Sam Johnson.
But Republican opposition was hardly the only hurdle: Democrats were wrestling with a bitterly divisive intra-party feud over whether government funds could go even indirectly to funding abortions.
Existing US law forbids federal money from going directly to abortion providers except in cases of rape or incest, or when pregnancy endangers the life of the mother, but a group of about 40 swing-vote Democrats successfully pushed for a vote on an amendment that would further tighten restrictions.
Reproductive rights groups and their Democratic supporters -- the party's majority -- opposed the new curbs.
Even if Democrats squeeze an overall health care bill through the House, it must still clear the Senate, where Democratic Majority Leader Harry Reid faces more daunting obstacles and has hinted any action could slip to 2010.
That would put the issue front-and-center in the 2010 mid-term elections, when one third of the Senate, the entire House of Representatives, and many US governorships are up for grabs.
The United States is the world's richest nation but the only industrialized democracy that does not ensure that all of its citizens have health care coverage, with an estimated 36 million Americans uninsured.
And Washington spends vastly more on health care -- both per person and as a share of national income as measured by Gross Domestic Product -- than other industrialized democracies, but with no meaningful edge in quality of care, according to the Organization for Economic Cooperation and Development.
Under the White House-backed bill, Americans would have to buy insurance and most employers would have to offer coverage to their workers -- though some small businesses would be exempt and the government would offer subsidies.
The measure includes a government-backed insurance plan, popularly known as a "public option," to compete with the private insurance industry.