Democrats on Monday began their climactic push to move health care legislation through the House by the end of the week, as President Barack Obama, House Speaker Nancy Pelosi and other senior leaders stepped up their efforts to win over the final votes needed to pass the historic bill.
In his third campaign-style health care rally in eight days, Obama on Monday traveled to Strongsville, Ohio, outside Cleveland, where he told the crowd of 1,450 that "we need courage" to quickly pass the overhaul. He also continued with his private effort to press House Democrats to support the bill.
At a closed-door meeting on Capitol Hill, Pelosi urged her Democratic colleagues to get behind the sweeping health care overhaul, even if they had problems with individual parts of the plan.
Consumer groups, labor unions, industry associations and business groups also intensified pressure on Democratic lawmakers who are on the fence. Many are facing a barrage of television ads in their districts, including a $10 million campaign by the U.S. Chamber of Commerce, a leading critic.
Meanwhile, the liberal grass-roots group MoveOn.org, which once targeted centrist Democrats who backed compromise legislation, is asking members for money to support primary challenges to Democrats who vote against it.
"In nearly 30 years of doing this, I can't remember a time when there has been as much focused and frenetic activity," said Ron Pollack, executive director of Families USA, an influential consumer group that is targeting 30 to 40 House Democrats to support the bill.
The behind-the-scenes pressure from Democratic leaders is focused primarily on conservative Democrats, because most liberals have already resigned themselves to supporting the legislation, even though it lacks a "public option" and other features they favor. Many conservatives, particularly so-called Blue Dogs, are concerned about cost and the bill's sweeping scope.
Many rank-and-file Democrats are deeply concerned about details of the legislation and the parliamentary moves being contemplated by party leaders.
Republican lawmakers remain steadfastly opposed to the Democratic legislation, which they have pledged to try to block first in the House and later in the Senate. As a result, Democrats are seeking to have the House approve the Senate-passed version - avoiding the need to return the bill to the Senate, where they have lost their filibuster-proof majority.
To address House Democrats' concerns, they plan to push through a package of changes in the Senate blueprint using a process known as budget reconciliation. That process requires only a simple majority, rather than the 60 votes necessary to squash a filibuster.
Pelosi effectively started the clock ticking Monday afternoon, as the House Budget Committee took the first steps to send legislation to the president's desk before Easter.
"When we bring the bill to the floor, we will have the votes," Pelosi said.
Obama also predicted victory. "I believe we are going to get the votes. We're going to make this happen," he told ABC News.
On Wednesday, the House Rules Committee is expected to take a bigger step by wrapping together the health care bill passed by the Senate last year and the package of changes sought by many House Democrats.
The package is expected to boost subsidies to help low- and moderate-income Americans buy health insurance, as well as provide additional coverage to seniors on Medicare by eliminating the gap in drug coverage known as the "doughnut hole."
Democrats also plan to use the package to scale back an unpopular new tax on high-end "Cadillac" health plans and eliminate a special deal that provides extra federal Medicaid funding to Nebraska.
The price tag of the changes will be as crucial as the details in the package. The original Senate health care bill is estimated to cost $875 billion over the next decade, which would be offset with a mix of new taxes and cuts in Medicare spending.
Any changes such as additional subsidies that push the cost over $950 billion in the next decade could drive away fiscally conservative Democrats.
Monday, two such Democrats - Reps. Allen Boyd of Florida and Chet Edwards of Texas - voted against advancing health care legislation out of the House Budget Committee. Both men opposed health care legislation last year.
A group of socially conservative Democrats, led by Rep. Bart Stupak of Michigan, also continues to threaten to vote against any legislation that would allow women who receive federal insurance subsidies to buy polices that cover abortions, even if they write a separate check to cover the procedure.