WASHINGTON (AP) — House Democrats are pushing to the brink of passage a landmark, $940 billion health care overhaul bill that would simultaneously deliver on President Barack Obama’s promise to expand coverage while slashing the deficit, a strategy aimed at winning over the party’s fiscal conservatives.

The 10-year plan would provide coverage to 32 million people now uninsured through a combination of tax credits for middle class households and an expansion of the Medicaid program for low-income people. Release of the legislation on Thursday, March 18 set the stage for a House vote on Sunday, March 21, and Democrats have already signaled they plan to go it alone, without Republican support. The GOP has steadfastly opposed Obama’s plan from the outset.
The plan would restructure one-sixth of the economy, covering 95 percent of eligible Americans, in the biggest expansion of the social safety net since Medicare was created in 1965. It would also impose new obligations on individuals and businesses, requiring for the first time that most Americans carry health insurance and penalizing medium-sized and large companies that don’t provide coverage for their workers.

Hospitals and doctors, drug companies and insurers would gain millions of new paying customers, but they would also have to adjust to major changes. Medicare cuts would force hospitals to operate more efficiently or risk going out of business. Insurance companies would face unprecedented federal regulation. Health care industries would be hit with new federal taxes. Upper-income households would face a new tax on investment earnings.

The Congressional Budget Office estimated the legislation would reduce the federal deficit by $138 billion over its first 10 years, and continue to drive down the red ink thereafter. Democratic leaders said the deficit would be cut $1.2 trillion in the second decade – and Obama called it the biggest reduction since the 1990s, when President Bill Clinton put the federal budget on a path to surplus.

“This is but one virtue of a reform that would bring accountability to the insurance industry and bring greater economic security to all Americans,” Obama said. “So I urge every member of Congress to consider this as they prepare for their important vote this weekend.”

House Speaker Nancy Pelosi was already pleased.

“We loved their number,” said the California Democrat, referring to the budget estimate.

The Democrats’ drive took on a growing sense of inevitability, picking up endorsements Wednesday, March 17 from a longtime liberal holdout and from a retired Roman Catholic bishop and nuns who broke with church leaders over the bill’s abortion provisions. Leaders appeared increasingly confident of getting the 216 votes they need to pass the bill.

But House Republican Leader John Boehner of Ohio said his party’s lawmakers will “do everything that we can do to make sure this bill never, ever, ever passes.”

The legislation would be vulnerable to attack after it passes, since the biggest changes would be phased in slowly. The major expansion of coverage would not come until 2014, when new health insurance marketplaces open for business.

In the meantime, the legislation calls for a series of new consumer benefits. Starting this year, insurers could not deny coverage to children because of a pre-existing health problem, nor could they place lifetime dollar caps on the amount of coverage. A high-risk health insurance pool would provide coverage to uninsured people who can’t get private coverage because of health problems.

Democrats are following a complicated, two-track legislative strategy for passing the bill. First, the House will have to approve a Senate bill that many of its Democratic members object to. Then, both chambers will quickly pass a package of fixes agreed to in negotiations with the White House.

Since the House will vote first, Democratic leaders are seeking assurances from their Senate counterparts that they have enough votes to pass the follow-up measure as well.

Democrats are promising 72 hours for lawmakers and the public to review the legislation once it’s released, so that would push a House vote on the bill until Sunday at the earliest – “during daylight hours,” said Rep. Henry Waxman, D-Calif.

Sunday is also the day Obama plans to leave for an overseas trip. Obama already has delayed the trip once so he can be present for the vote and help with the 11th-hour arm-twisting that inevitably will precede it.

The Number 2 House Democrat, Maryland Rep. Steny Hoyer, said Obama’s travel plans would not interfere with Democrats’ ability to pass the bill.

“I think the president’s presence helps, but is it needed?” Hoyer asked. “You can dial a cell phone anywhere in the world.”

The budget office said much of the legislation’s long-term deficit reduction came from two key changes Democrats made in recent days. Starting in 2019, the bill would slow annual inflation increases in new federal tax credits available to help people pay health insurance premiums. Beginning in 2020, it would accelerate the impact of a tax on high-cost insurance plans by indexing it to the general rate of inflation.

Labor unions earlier succeeded in easing other features of the insurance, and Thursday the AFL-CIO’s executive council was deliberating over the latest changes.

The long-anticipated measure is actually the second of two bills that Obama hopes lawmakers will send him in coming days, more than a year after he urged Congress to remake the U.S. health care system. The first cleared the Senate late last year but went no further because House Democrats demanded significant changes – the very types of revisions now being packaged into the second bill.

After heavy lobbying from Obama, liberal Rep. Dennis Kucinich, D-Ohio, announced his support Wednesday, becoming the first Democrat to declare he would vote in favor of the legislation after opposing an earlier version. Shortly after Kucinich’s announcement, a letter was released from 60 leaders of religious orders urging lawmakers to vote for the legislation.

The endorsement reflected a division within the Catholic Church. The U.S. Conference of Catholic Bishops opposes the Senate-passed legislation, contending it would permit the use of federal funds for elective abortions.

Late Wednesday, however, retired Bishop John E. McCarthy of Austin, Texas, told The Associated Press he was urging approval of the legislation.

Reflecting growing opposition among states to the health care bill, Idaho Gov. C.L. “Butch” Otter, a Republican, signed a measure Wednesday requiring the state attorney general to sue the federal government if residents are forced to buy health insurance. Similar legislation is pending in 37 other states.

Associated Press writers David Espo, Ricardo Alonso-Zaldivar, Charles Babington, Alan Fram, Sam Hananel and C.J. Jackson contributed to this report.