WASHINGTON — As a historic vote on sweeping health care legislation nears, Democratic moderates in the House of Representatives face relentless pressure as they juggle personal pleas from President Barack Obama, a multi-million-dollar ad barrage and constituents who are fed up with the convoluted congressional process.
In the spotlight are 39 Democrats who voted against the House's original health care measure Nov. 7. Democrats hold 253 of the House's 431 currently filled seats, and 216 votes are needed for passage. The bill won't pass unless some of those 39 switch their positions.
Democratic leaders hope to vote by this weekend, but they're finding it difficult to push wavering members off the fence.
"I'll vote the way my district wants me to vote," said Rep. Jason Altmire, D-Pa., after hearing from Obama this week.
Rep. Adam Smith, D-Wash., emerged from an Obama meeting saying that he remained undecided.
Rep. Walt Minnick, D-Idaho, a freshman who was elected in an overwhelmingly Republican district, says he won't vote for the bill.
The White House won't say which lawmakers the president is pressing, despite Obama's campaign calls for transparency in government.
Altmire, a second-term congressman, said Obama's pitch Tuesday was that "the economy will turn around and people will judge the effects of the health care bill in that context."
Sometimes colleagues apply the heat. Minnick said pressure to fall in line with other Democrats usually came at House caucus meetings, but mostly he was listening to his Idaho constituents.
"That is more the pressure that I tend to pay attention to," he said. "I try pretty hard to be more responsive to that than I do to arm-twisting from colleagues or leadership here."
The pressure will only grow before the final vote. Interest groups on both sides plan to spend at least $10 million on ads.
The National Republican Congressional Committee vowed Tuesday that "any Democrats who might think they can get away with a 'yes' vote for the Obama-Pelosi health care bill should brace themselves for an all-out blitz courtesy of the NRCC."
Also raising concerns about the bill are Employers for a Healthy Economy, a U.S. Chamber of Commerce-led coalition of business groups that plans to spend $4 million to $10 million on a TV ad in 17 states and on national cable. The ad, which began running last Wednesday and will continue through this Saturday, charges that the bill would mean "billions in new taxes ... more mandates on businesses."
America's Health Insurance Plans, the industry trade group, is spending a seven-figure amount for a cable TV ad that's running nationwide.
Pressure is also strong from the other side. Health Care for America Now, a coalition of liberal groups and labor unions, launched a $1.4 million ad buy Tuesday that runs through Friday in 11 swing districts, including Altmire's. The coalition and like-minded groups plan to spend $11 million overall.
MoveOn.org, another liberal group, plans to spend $300,000 on ads in swing districts in Pennsylvania, North Dakota and New York.
Obama has met recently with blocs of liberals and members of the Congressional Black and Hispanic caucuses, and had one-on-ones with lawmakers. House Democratic Caucus Chairman John Larson of Connecticut said the president was prepared to help swing members with their campaigns and fundraising.
Altmire had three conversations in the last 10 days with Obama; the most recent came Monday.
"We talked policy," he said.
Altmire had voted against the House bill. Among his concerns were its income tax surcharge on the wealthy and a mandate that employers offer health insurance. Obama noted that the surcharge is gone and the mandate has been eased in the measure's final version.
Altmire said he remained unsure whether the legislation would curb costs, and that this week's furor over the complicated process that congressional leaders were planning to use to pass it was troubling his constituents.
House leaders are leaning toward not voting directly on the Senate-passed measure. Instead, they plan to have the House vote on a rule governing debate on a "sidecar" bill intended to modify the Senate legislation's most controversial terms. The rule would "deem" that the rule's passage meant that the House has approved the Senate-passed measure, and the House next would vote on the "sidecar" bill to modify the Senate legislation. House leaders of both parties have used this obscure process many times to expedite bills, but never for such sweeping legislation.
This way, House members never would vote directly on the Senate measure, which includes controversial terms such as big Medicaid subsidies for Nebraska, which other states wouldn't get. That might insulate House members against attack ads before November's elections charging that they'd voted for the Nebraska giveaway.
However, Altmire and a lot of other members say the public often sees such maneuvers as sneaky ways to avoid tough choices.
"It taints the process for my constituents," he said, "and so it weighs on my view of the process."
Obama is scrambling to push the bill through the House in time to salvage his trip to Guam, Indonesia and Australia, which he's postponed by three days. He's now set to leave Sunday.
White House Chief of Staff Rahm Emanuel, a key enforcer on health care votes, will stay behind, as will Vice President Joe Biden, should his vote be needed to break a Senate tie.
(David Goldstein, Erika Bolstad, Les Blumenthal and Margaret Talev contributed to this story.)
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