Health Care Endgame: Obama, Dems Duel Over Deadline

WASHINGTON, March 11, 2010— -- It's crunch time for health care reform. The White House wants to see the health care bill passed in the House next week, but the speaker of the House is making no promises.

Democratic lawmakers say they are close to a final deal on a health care bill, but serious questions remain as to whether the final legislation can be passed by President Obama's deadline of March 18, when he departs for Indonesia and Australia.

Behind closed doors today, White House health care advisor Nancy Ann DeParle gave a presentation to House Democrats on the president's health care proposal.

Afterward, House Speaker Nancy Pelosi, D-Calif., spoke briefly to reporters, calling DeParle's presentation "very productive" and saying, "We're another step closer to voting on quality, affordable health care for everybody."

But Pelosi made it clear she's not too keen on any deadlines set by the White House, even as White House officials insist that imposing a deadline is the only way to get Congress to act.

"March 18 is a very interesting date," Pelosi said. But, "we will take up the bill when we are ready to take up the bill."

She said the new bill, which will change aspects of the Senate bill that are unacceptable to the House, is not complete and won't be until the Congressional Budget Office has provided an official cost estimate. After that happens, Pelosi said, the House will need "at least one week" to consider the bill before a final vote.

Pelosi said in an interview with Charlie Rose that aired on Bloomberg News Wednesday that there are enough votes in the House to pass the health care bill "if we took it up today."

But senior House Democratic aides tell ABC News the speaker is not there yet, and she won't call for a vote on the bill unless she believes she has enough "yes" votes to pass it.

The intense focus and pressure tonight is on 37 House Democrats who voted "no" on the House health care bill in November and are now being pushed hard to vote "yes."

Pelosi and the White House may need to convince as many as a dozen lawmakers who previously voted "no" to switch.

Rep. Jason Altmire, D-Pa., is one of the 37.

"This is the finish line. We either pass this bill or we do nothing. That's a big choice to make," he told ABC News.

Altmire was called down to the White House twice last week to see the president. He has also heard from the president's sharp-elbowed Chief of Staff Rahm Emanuel.

"He doesn't hide his feelings -- he's not someone who holds back so I'm sure if I have to deliver that message it won't be well-received," said Altmire, about voting "no" again.

But Altmire now says he is willing to consider voting "yes" because he believes the bill has been improved.

Making the task more difficult is that several who voted "yes" in the fall have either left Congress, or changed their minds and now oppose the bill.

Obama: Congress Owes Americans Final Up or Down Health Care Reform Vote

Earlier today, CBO issued an updated cost estimate of the health care bill that passed the Senate Dec. 24, but that estimate didn't include the changes being negotiated with the White House. The updated estimate was up slightly, from $871 billion to $875 billion over 10 years. And the total deficit reduction went from $132 billion to $118 billion.

The CBO has not indicated when it may release a score on the health care bill now before the House, although it is expected to be any day.

Meanwhile, House and Senate Democrats continue to negotiate intensely on writing a compromise bill, the drafting of which in committee could happen as soon as Friday.

Late Wednesday, Democrats emerged from a closed door meeting and said they were close to an agreement on a compromise bill that could pass both the House and the Senate.

Outside Washington, a fired-up Obama took a campaign-like tone to urge Congress to vote "yes" on health care reform.

"I believe Congress owes the American people a final up or down vote on health care reform. The time for talk is over. It's time to vote," the president said in the battleground state of Missouri, where he was campaigning for Sen. Claire McCaskill, D-Mo. "We are not backing down, we are not quitting and we are going to get this done," he shouted.

As the fight for health care reform enters its final throes, the health care insurance industry is pledging up to $10 million to help defeat the proposal.

Health and Human Services Secretary Kathleen Sebelius went into the belly of the beast, speaking to insurance executives at their conference at the Ritz-Carlton in Washington, D.C., to propose a different path.

Rather than spend money attacking the parts of the legislation they oppose, Sebelius said they should come to the table and help in "strengthening the parts that are there that you talked about from the beginning are essential comprehensive reform."

Abortion, Special Deals Remain Final Sticking Points to Get House Democrats on Board

Away from the microphones and cameras, Democrats are strategizing about how to get a majority of House Democrats to support the bill that passed the Senate.

Obama has told Senate Majority Leader Harry Reid, D-Nev., to remove from the final compromise bill all the special deals that were cut to secure the support of individual lawmakers -- not just the ones for Sen. Ben Nelson, D-Neb., and Sen. Bill Nelson, D-Fla., that had been previously announced as on the chopping block.

One problem is that many anti-abortion Democrats do not like the somewhat less restrictive language on abortion in the Senate bill.

One solution would restore the more restrictive language, but some anti-abortion Republicans have said they would vote with abortion rights supporters to torpedo the whole deal, just to kill the health care bill.

Sen. Tom Coburn, R-Okla., said he would vote against the bill, regardless of which language is chosen.

"It won't happen because pro-life members like me, I won't vote for it. So you have large numbers of pro-life members who will never vote for it," Coburn, a doctor, said.

ABC News' Jake Tapper and Jonathan Karl contributed to this report.