WASHINGTON — Love her or hate her, House Speaker Nancy Pelosi is at the peak of her political power, and she seems to be reveling in the high drama of the moment.
Last week, as she searched for the 218 votes required to pass a mammoth health care bill, the San Francisco Democrat made her view of the stakes clear: "We have an historic opportunity. . . . It is something that many of us have worked our whole political lifetimes on."
On Saturday night, after the House of Representatives passed Pelosi's bill with two votes to spare, no one was smiling more broadly than the 69-year-old Pelosi.
It won't be known for weeks whether Pelosi can help get a bill through the Senate and to the president's desk and whether the compromises the House made on abortion and other issues will help or hurt that effort, but she had much to celebrate with her preliminary victory, including her own political survival.
For starters, she'd withstood withering attacks and TV impersonations and had overcome many doubters, laying her reputation on the line as she guaranteed that the House would pass a health care bill.
She stood firm, predicting from the beginning that the House would include a public option as part of its bill, even when the prospects appeared to be fading fast in August.
Leading one of the hottest domestic debates to hit Washington in years hasn't come without a price, though.
Pelosi's job approval ratings have sunk dramatically this year, even in her home state of California, as she gets much of the blame for public dissatisfaction with Congress and the gridlock on Capitol Hill.
The latest Field Poll, released last month, found that only 34 percent of Californians gave her good marks, compared with 44 percent who disapproved of her performance. The poll found that her approval rating had declined by 14 percentage points in a seven-month period.
Always the lightning rod, Pelosi is hearing from both sides of the aisle.
While many Democrats are offering their praise after watching Pelosi's high-wire performance, Republicans are calling the health care bill "PelosiCare," warning that it will lead to higher taxes and job losses.
Mayor David Cicilline of Providence, R.I., the chairman of the U.S. Conference of Mayors health committee, said Pelosi showed "extraordinary leadership and fierce determination" in getting the bill through the House.
The Communication Workers of America, a labor union, commended the speaker, saying that her bill "will provide enormous benefits to our nation."
On the Republican side, Michael Steele, the chairman of the Republican National Committee, said Pelosi had finally got her wish — "a government-run health care experiment" that will increase the deficit and hurt Medicare.
And Chris Chocola, a former Indiana Republican congressman and the president of the conservative Club For Growth, said the bill's price tag is "shocking, but not surprising to anyone familiar with the liberal extremism of the House Democrats."
"PelosiCare is a disaster," he said.
As Congress heads to a possible finish line on health care this year, Pelosi is hoping to deliver the largest expansion of health care since Congress created Medicare in 1965.
She has much work to do before she can claim success, however, and there will be plenty of opportunities for opponents to derail the House bill.
First the Senate, where there are great ideological differences, must pass a bill, and then a conference committee must meld the House and Senate bills. Depending on what emerges, it may be difficult for Pelosi to get her troops to sign off on a final version, particularly given the Democratic resistance on the first vote.
Pelosi's big moment arrived at 11:06 p.m. in Washington Saturday, when she stood before her colleagues to announce the margin of victory: 220-215. Thirty-nine Democrats, or 15 percent of the majority party, had voted against their leader. She still managed to eke out the win, however — and even picked up one Republican vote.
"The bill is passed," said Pelosi, who then pounded her gavel.
Shortly before midnight, Pelosi got a congratulatory call from one of her biggest fans, President Barack Obama. At a Democratic fundraiser in San Francisco last month, Obama called Pelosi "one of the best speakers imaginable," joking that she "is subjected to constant criticism and griping — and then there's the other party." He said that Pelosi had "steely determination" and that her toughness was the main reason Congress would pass a health care bill this year.
"Let me talk to you — Nancy Pelosi is tough," Obama said at the fundraiser. "I want everybody to know that."
Pelosi prevailed in July, keeping her delicate Democratic coalition intact when members of the Blue Dog coalition rebelled against the public option. One of the biggest ironies: Pelosi had produced a winning strategy by helping recruit many of the conservative Democrats to run in Republican-leaning districts in 2006 and 2008.
Before the House voted to approve her bill, Pelosi had angered many of her fellow Democratic abortion-rights supporters by allowing a vote to ban public insurance plans from offering abortion coverage. Pelosi made the call after it became clear that allowing the abortion vote was the only way to get the broader bill passed.
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