Democrats defend health strategy as vote nears

Representative Chris Van Hollen (D-MD), Chairman of the Democratic Congressional Campaign Committee, speaks during the 2009 Reuters Washington Summit in Washington in this October 20, 2009 file photo.

WASHINGTON (Reuters) - Democrats in the House of Representatives on Tuesday defended their plans to pass a broad healthcare overhaul without a direct vote as President Barack Obama's top domestic priority neared a make-or-break showdown.

Obama and House Democratic leaders lobbied undecided Democrats for support ahead of a potential weekend vote on the overhaul, which would constitute the biggest change in the $2.5 trillion healthcare system in four decades.

Democrats considered employing a complicated process that would declare the Senate's healthcare reform bill passed once the House approves a separate package including changes sought by Obama and House Democrats. That would avoid a direct tally on a Senate bill that is unpopular with some Democrats.

Republicans said the strategy was designed to protect Democrats in November's congressional election by camouflaging their vote. "There is no way to hide from this vote," House leader John Boehner said. "You can run but you can't hide."

Democrats noted Republicans had used the process when they controlled the House and said they were trying to change the subject.

"A lot of our colleagues on the other side of the aisle would prefer to talk about process because they don't want to talk about substance," said Democratic Representative Chris Van Hollen, head of the House Democratic campaign committee.

"They want to send a signal to the American people that the product that is going to come out of the House is the Senate bill. The fact of the matter is, we are amending the Senate bill," he said.

Democrats were still struggling to piece together changes to the overhaul and find a combination that would lead to favorable cost estimates from the Congressional Budget Office.

Once that is completed, the House Rules Committee will decide the process for passing the bill. Democrats said House leaders told members at an afternoon meeting to expect votes on either Saturday or Sunday.

House Democratic Whip James Clyburn, the top Democratic vote-counter in the House, told Fox News that Democrats still do not have the 216 votes needed for passage but he was confident of getting there.

'WE'LL GET THERE'

"I do not have 216 commitments yet, though I think we'll get there in time for the vote," Clyburn said.

The overhaul would extend coverage to more than 30 million uninsured Americans and ban insurance practices like refusing coverage to those with pre-existing medical conditions.

Health insurer shares were up on Tuesday slightly more than the broader market. The Morgan Stanley Healthcare Payor index was up 1.2 percent in midday trading and the S&P Managed Health Care index rose 1 percent. The Dow Jones index was up 0.2 percent.

As many as two dozen undeclared Democrats could decide the overhaul's fate, which has been the focus of a political brawl that has consumed the U.S. Congress for months.

Representative Jason Altmire, who voted against the overhaul in November but is undecided this time, said he has spoken to Obama three times in the last 10 days, including a 10-minute phone conversation on Monday.

"When the president takes the time to personally reach out, it makes an impact," he told reporters. He said he also heard from several Cabinet officers but is still undecided.

Altmire said the vote procedure being considered by House Democrats would be a negative factor in his evaluation, although other undecided Democrats said it did not matter.

"The media is really focused on process. Most of us are focused on substance," said Representative Jerry Connolly, another undecided Democrat.

Supporters argued House Democrats, who passed an initial version of the overhaul in November with three votes to spare, should go ahead and finish the job or they could face dire consequences in November's elections.

"If we pass this bill, we will be judged by the results," Democratic Representative Jerrold Nadler said. "If we don't pass this bill, we will be judged by the accusations."

Republicans have condemned the health bill as a costly government takeover that would lead to higher insurance premiums and less consumer choice.

Under the procedure planned for passing the reform overhaul, the House would approve the Senate's version of the bill. The changes sought by Obama and House Democrats would move through a separate measure.

The House changes would then be approved by the 100-member Senate under budget reconciliation rules that require only a simple majority, bypassing the need for 60 votes to overcome Republican procedural hurdles.

"I feel confident that once the House does its work, we will take care of things over here," Senate Democratic leader Harry Reid told reporters.

(Additional reporting by Thomas Ferraro; editing by David Alexander and Todd Eastham)