WASHINGTON (AP) A crucial first Senate vote on President Barack Obama's health care overhaul in a rare Saturday night session looms as a test of Democratic unity and the president's prestige.

Democratic leaders are optimistic of success, but they need every Democrat and both independents to vote ``yes,'' and two moderates remained uncommitted ahead of the roll call, which is expected around 8 p.m. The vote will determine whether debate can go forward on Majority Leader Harry Reid's 2,074-page bill to dramatically remake the U.S. health care system over the next decade.

Most everyone would be required to purchase insurance under Reid's legislation, and billions in new taxes would be levied on insurers and high-income Americans to help extend coverage to 30 million uninsured. Insurance companies would no longer be allowed to deny coverage to people with medical conditions or drop coverage when someone gets sick.

The two holdouts are Sens. Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana. A third centrist, Ben Nelson of Nebraska, announced Friday that he'd be supporting his party on the test vote, while cautioning that it didn't mean he'd be with them on the final vote.

``It is not for or against the new Senate health care bill,'' Nelson said. ``It is only to begin debate and an opportunity to make improvements. If you don't like a bill, why block your own opportunity to amend it?''

If that same reasoning holds with Lincoln and Landrieu, Reid, D-Nev., will have the 60 votes he needs to prevail in the 100-seat Senate. The 40 Republicans are unanimously opposed.

Landrieu has made comments suggesting she'll support the move to debate, but Lincoln, who faces a difficult re-election next year, carefully avoided taking any public position Friday.

Republicans took to the Senate floor to slam the bill as a government takeover that would increase taxes and lead to rationing of health care.

``Washington will tell you what is good enough coverage,'' said Sen. Mike Enzi, R-Wyo. ``These insurance changes will increase costs for millions of Americans.''

Democrats said their legislation could make historic and necessary improvements in the country's social safety net.

``Prices of health care are marching relentlessly upwards, and so too many people don't have coverage,'' said Sen. Byron Dorgan, D-N.D. ``The purpose of all of this is to try to get a handle on it somehow.''

The White House issued a statement late Friday praising the Senate measure.

``This bill provides the necessary health reforms that the administration seeks affordable, quality care within reach for the tens of millions of Americans who do not have it today, and stability and security for the hundreds of millions who do,'' the statement said.

The action in the Senate comes two weeks after the House approved a health overhaul bill of its own on a 220-215 vote. After the vote Saturday night, senators will leave for a Thanksgiving recess. Upon their return, assuming Democrats prevail on the vote, they will launch into weeks or more of unpredictable debate on the health care bill, with numerous amendments expected from both sides of the aisle and more 60-vote hurdles along the way.

Senate leaders hope to pass their bill by the end of the year. If that happens, January would bring work to reconcile the House and Senate versions before a final package could land on Obama's desk.

The bills have many similarities, including the new requirements on insurers and the creation of new purchasing marketplaces called exchanges where self-employed individuals and small businesses could go to shop for and compare coverage plans. One option in the exchanges would be a new government-offered plan, something that's opposed by private insurers and business groups.

Differences include requirements for employers. The House bill would require medium and large businesses to cover their employees, while the Senate bill would not require them to offer coverage but would make them pay a fee if the government ends up subsidizing employees' coverage.

Another difference is in how they're paid for. The Senate bill includes a tax on high-value insurance policies that's not part of the House bill, while the House would levy a new income tax on upper-income Americans that's not in the Senate measure. The Senate measure also raises the Medicare payroll tax on income above $200,000 annually for individuals and $250,000 for couples. Both bills rely on more than $400 billion in cuts to Medicare.

The Senate bill was written by Reid in private negotiations with White House officials, combining elements of two committee-passed bills and making additional changes with an eye to getting the necessary 60 votes.

Along the way, Reid sweetened the pot for individual senators, adding federal funds for Louisiana and agreeing to support an amendment written by Sen. Ron Wyden, D-Ore., that would expand eligibility for the purchasing exchanges.

(Copyright 2009 by The Associated Press. All Rights Reserved.)

WASHINGTON (AP) Most women in their 20s can have a Pap smear every two years instead of annually, say new guidelines that conclude that's enough to catch slow-growing cervical cancer.

The change by the American College of Obstetricians and Gynecologists comes amid a completely separate debate over when regular mammograms to detect breast cancer should begin. The timing of the Pap guidelines is coincidence, said ACOG, which began reviewing its recommendations in late 2007 and published the update Friday in the journal Obstetrics Gynecology.

The guidelines also say:

Routine Paps should start at age 21. Previously, ACOG had urged a first Pap either within three years of first sexual intercourse or at age 21.

Women 30 and older should wait three years between Paps once they've had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait.

Women with HIV, other immune-weakening conditions or previous cervical abnormalities may need more frequent screening.

Paps can spot pre-cancerous changes in the cervix in time to prevent invasive cancer, and widespread use has halved cervical cancer rates in the U.S. in recent decades. About 11,270 new cases will be diagnosed this year, and about 4,070 women will die from it, according to American Cancer Society estimates. Half of women diagnosed with cervical cancer have never had a Pap, and another 10 percent haven't had one in five years.

Cervical cancer is caused by certain strains of the extremely common sexually transmitted virus called HPV, for human papillomavirus. There is a new HPV vaccine that should cut cervical cancer in the future; ACOG's guidelines say for now vaccinated women should follow the same Pap guidelines as the unvaccinated.

But the updated guidelines reflect better understanding of HPV. Infection is high among sexually active teens and young adults. Women's bodies very often fight off an HPV infection on their own without lasting harm, although it can take a year or two. The younger the woman, the more likely that HPV is going to be transient.

Moreover, ACOG cited studies showing no increased risk of cancer developing in women in their 20s if they extended Pap screening from every year to every two years.

As for adolescents, ACOG said cervical cancer in teens is rare one or two cases per million 15- to 19-year-olds while HPV-caused cervical abnormalities usually go away on their own, and unnecessary treatment increases the girls' risk of premature labor years later.

(Copyright 2009 by The Associated Press. All Rights Reserved.)

The 220-215 roll call Saturday by which the House passed a Democratic-written health care bill.

A ``yes'' vote is a vote to pass the bill.

Voting yes were 219 Democrats and 1 Republican.

Voting no were 39 Democrats and 176 Republicans.

X denotes those not voting.

Present denotes those who voted they were ``present'' at the time of the vote but did not vote yes or no on the issue.

GEORGIA

Democrats Barrow, N; Bishop, Y; Johnson, Y; Lewis, Y; Marshall, N; Scott, Y.

Republicans Broun, N; Deal, N; Gingrey, N; Kingston, N; Linder, N; Price, N; Westmoreland, N.


ALABAMA

Democrats Bright, N; Davis, N; Griffith, N.

Republicans Aderholt, N; Bachus, N; Bonner, N; Rogers, N.

ALASKA

Republicans Young, N.

ARIZONA

Democrats Giffords, Y; Grijalva, Y; Kirkpatrick, Y; Mitchell, Y; Pastor, Y.

Republicans Flake, N; Franks, N; Shadegg, N.

ARKANSAS

Democrats Berry, Y; Ross, N; Snyder, Y.

Republicans Boozman, N.

CALIFORNIA

Democrats Baca, Y; Becerra, Y; Berman, Y; Capps, Y; Cardoza, Y; Chu, Y; Costa, Y; Davis, Y; Eshoo, Y; Farr, Y; Filner, Y; Garamendi, Y; Harman, Y; Honda, Y; Lee, Y; Lofgren, Zoe, Y; Matsui, Y; McNerney, Y; Miller, George, Y; Napolitano, Y; Pelosi, Y; Richardson, Y; Roybal-Allard, Y; Sanchez, Linda T., Y; Sanchez, Loretta, Y; Schiff, Y; Sherman, Y; Speier, Y; Stark, Y; Thompson, Y; Waters, Y; Watson, Y; Waxman, Y; Woolsey, Y.

Republicans Bilbray, N; Bono Mack, N; Calvert, N; Campbell, N; Dreier, N; Gallegly, N; Herger, N; Hunter, N; Issa, N; Lewis, N; Lungren, Daniel E., N; McCarthy, N; McClintock, N; McKeon, N; Miller, Gary, N; Nunes, N; Radanovich, N; Rohrabacher, N; Royce, N.

COLORADO

Democrats DeGette, Y; Markey, N; Perlmutter, Y; Polis, Y; Salazar, Y.

Republicans Coffman, N; Lamborn, N.

CONNECTICUT

Democrats Courtney, Y; DeLauro, Y; Himes, Y; Larson, Y; Murphy, Y.

DELAWARE

Republicans Castle, N.

FLORIDA

Democrats Boyd, N; Brown, Corrine, Y; Castor, Y; Grayson, Y; Hastings, Y; Klein, Y; Kosmas, N; Meek, Y; Wasserman Schultz, Y; Wexler, Y.

Republicans Bilirakis, N; Brown-Waite, Ginny, N; Buchanan, N; Crenshaw, N; Diaz-Balart, L., N; Diaz-Balart, M., N; Mack, N; Mica, N; Miller, N; Posey, N; Putnam, N; Rooney, N; Ros-Lehtinen, N; Stearns, N; Young, N.

HAWAII

Democrats Abercrombie, Y; Hirono, Y.

IDAHO

Democrats Minnick, N.

Republicans Simpson, N.

ILLINOIS

Democrats Bean, Y; Costello, Y; Davis, Y; Foster, Y; Gutierrez, Y; Halvorson, Y; Hare, Y; Jackson, Y; Lipinski, Y; Quigley, Y; Rush, Y; Schakowsky, Y.

Republicans Biggert, N; Johnson, N; Kirk, N; Manzullo, N; Roskam, N; Schock, N; Shimkus, N.

INDIANA

Democrats Carson, Y; Donnelly, Y; Ellsworth, Y; Hill, Y; Visclosky, Y.

Republicans Burton, N; Buyer, N; Pence, N; Souder, N.

IOWA

Democrats Boswell, Y; Braley, Y; Loebsack, Y.

Republicans King, N; Latham, N.

KANSAS

Democrats Moore, Y.

Republicans Jenkins, N; Moran, N; Tiahrt, N.

KENTUCKY

Democrats Chandler, N; Yarmuth, Y.

Republicans Davis, N; Guthrie, N; Rogers, N; Whitfield, N.

LOUISIANA

Democrats Melancon, N.

Republicans Alexander, N; Boustany, N; Cao, Y; Cassidy, N; Fleming, N; Scalise, N.

MAINE

Democrats Michaud, Y; Pingree, Y.

MARYLAND

Democrats Cummings, Y; Edwards, Y; Hoyer, Y; Kratovil, N; Ruppersberger, Y; Sarbanes, Y; Van Hollen, Y.

Republicans Bartlett, N.

MASSACHUSETTS

Democrats Capuano, Y; Delahunt, Y; Frank, Y; Lynch, Y; Markey, Y; McGovern, Y; Neal, Y; Olver, Y; Tierney, Y; Tsongas, Y.

MICHIGAN

Democrats Conyers, Y; Dingell, Y; Kildee, Y; Kilpatrick, Y; Levin, Y; Peters, Y; Schauer, Y; Stupak, Y.

Republicans Camp, N; Ehlers, N; Hoekstra, N; McCotter, N; Miller, N; Rogers, N; Upton, N.

MINNESOTA

Democrats Ellison, Y; McCollum, Y; Oberstar, Y; Peterson, N; Walz, Y.

Republicans Bachmann, N; Kline, N; Paulsen, N.

MISSISSIPPI

Democrats Childers, N; Taylor, N; Thompson, Y.

Republicans Harper, N.

MISSOURI

Democrats Carnahan, Y; Clay, Y; Cleaver, Y; Skelton, N.

Republicans Akin, N; Blunt, N; Emerson, N; Graves, N; Luetkemeyer, N.

MONTANA

Republicans Rehberg, N.

NEBRASKA

Republicans Fortenberry, N; Smith, N; Terry, N.

NEVADA

Democrats Berkley, Y; Titus, Y.

Republicans Heller, N.

NEW HAMPSHIRE

Democrats Hodes, Y; Shea-Porter, Y.

NEW JERSEY

Democrats Adler, N; Andrews, Y; Holt, Y; Pallone, Y; Pascrell, Y; Payne, Y; Rothman, Y; Sires, Y.

Republicans Frelinghuysen, N; Garrett, N; Lance, N; LoBiondo, N; Smith, N.

NEW MEXICO

Democrats Heinrich, Y; Lujan, Y; Teague, N.

NEW YORK

Democrats Ackerman, Y; Arcuri, Y; Bishop, Y; Clarke, Y; Crowley, Y; Engel, Y; Hall, Y; Higgins, Y; Hinchey, Y; Israel, Y; Lowey, Y; Maffei, Y; Maloney, Y; Massa, N; McCarthy, Y; McMahon, N; Meeks, Y; Murphy, N; Nadler, Y; Owens, Y; Rangel, Y; Serrano, Y; Slaughter, Y; Tonko, Y; Towns, Y; Velazquez, Y; Weiner, Y.

Republicans King, N; Lee, N.

NORTH CAROLINA

Democrats Butterfield, Y; Etheridge, Y; Kissell, N; McIntyre, N; Miller, Y; Price, Y; Shuler, N; Watt, Y.

Republicans Coble, N; Foxx, N; Jones, N; McHenry, N; Myrick, N.

NORTH DAKOTA

Democrats Pomeroy, Y.

OHIO

Democrats Boccieri, N; Driehaus, Y; Fudge, Y; Kaptur, Y; Kilroy, Y; Kucinich, N; Ryan, Y; Space, Y; Sutton, Y; Wilson, Y.

Republicans Austria, N; Boehner, N; Jordan, N; LaTourette, N; Latta, N; Schmidt, N; Tiberi, N; Turner, N.

OKLAHOMA

Democrats Boren, N.

Republicans Cole, N; Fallin, N; Lucas, N; Sullivan, N.

OREGON

Democrats Blumenauer, Y; DeFazio, Y; Schrader, Y; Wu, Y.

Republicans Walden, N.

PENNSYLVANIA

Democrats Altmire, N; Brady, Y; Carney, Y; Dahlkemper, Y; Doyle, Y; Fattah, Y; Holden, N; Kanjorski, Y; Murphy, Patrick, Y; Murtha, Y; Schwartz, Y; Sestak, Y.

Republicans Dent, N; Gerlach, N; Murphy, Tim, N; Pitts, N; Platts, N; Shuster, N; Thompson, N.

RHODE ISLAND

Democrats Kennedy, Y; Langevin, Y.

SOUTH CAROLINA

Democrats Clyburn, Y; Spratt, Y.

Republicans Barrett, N; Brown, N; Inglis, N; Wilson, N.

SOUTH DAKOTA

Democrats Herseth Sandlin, N.

TENNESSEE

Democrats Cohen, Y; Cooper, Y; Davis, N; Gordon, N; Tanner, N.

Republicans Blackburn, N; Duncan, N; Roe, N; Wamp, N.

TEXAS

Democrats Cuellar, Y; Doggett, Y; Edwards, N; Gonzalez, Y; Green, Al, Y; Green, Gene, Y; Hinojosa, Y; Jackson-Lee, Y; Johnson, E. B., Y; Ortiz, Y; Reyes, Y; Rodriguez, Y.

Republicans Barton, N; Brady, N; Burgess, N; Carter, N; Conaway, N; Culberson, N; Gohmert, N; Granger, N; Hall, N; Hensarling, N; Johnson, Sam, N; Marchant, N; McCaul, N; Neugebauer, N; Olson, N; Paul, N; Poe, N; Sessions, N; Smith, N; Thornberry, N.

UTAH

Democrats Matheson, N.

Republicans Bishop, N; Chaffetz, N.

VERMONT

Democrats Welch, Y.

VIRGINIA

Democrats Boucher, N; Connolly, Y; Moran, Y; Nye, N; Perriello, Y; Scott, Y.

Republicans Cantor, N; Forbes, N; Goodlatte, N; Wittman, N; Wolf, N.

WASHINGTON

Democrats Baird, N; Dicks, Y; Inslee, Y; Larsen, Y; McDermott, Y; Smith, Y.

Republicans Hastings, N; McMorris Rodgers, N; Reichert, N.

WEST VIRGINIA

Democrats Mollohan, Y; Rahall, Y.

Republicans Capito, N.

WISCONSIN

Democrats Baldwin, Y; Kagen, Y; Kind, Y; Moore, Y; Obey, Y.

Republicans Petri, N; Ryan, N; Sensenbrenner, N.

WYOMING

Republicans Lummis, N.

(Copyright 2009 by The Associated Press. All Rights Reserved.)

WASHINGTON (AP) A bipartisan House coalition voted Saturday to prohibit coverage of abortions in a new government-run health care plan that Democrats would establish to compete with private insurers.

The 240-194 vote on an amendment by Rep. Bart Stupak, D-Mich., was a blow to liberals, who would have allowed the Obama administration and its successors to decide whether abortions would be covered by the government plan. Sixty-four Democrats joined 176 Republicans in favor of the prohibition.

Stupak's measure also would bar anyone getting federal health subsidies from purchasing private insurance polices that included abortion coverage.

``Let us stand together on principle no public funding for abortions, no public funding for insurance policies that pay for abortions,'' Stupak urged fellow lawmakers before the vote.

The amendment would bar the new government insurance plan from covering abortions, except in cases of rape, incest, or where the life of the mother is in danger. The Democrats' original legislation would have allowed the government plan to cover abortions, if the Health and Human Services secretary decided it should.

The amendment also would prohibit people who receive new federal health subsidies from buying insurance plans that include abortion coverage.

The Democrats' original bill would have allowed people getting federal subsidies to pay for abortion coverage with their own money. Abortion opponents dismissed that as an accounting gimmick.

Abortion rights advocates called the measure the biggest setback to women's reproductive rights in decades. Anti-abortion Democrats forced House leaders to bring it up for a vote by threatening to oppose the underlying bill, and efforts to reach a compromise fell apart Friday night.

``Like it or not, this is a legal medical procedure and we should respect those who need to make this very personal decision,'' said Rep. Diana DeGette, D-Colo.

Some Republicans considered voting ``present'' in hopes that might unravel support for the underlying health care bill among anti-abortion Democrats, but only one did, Rep. John Shadegg, R-Ariz.

``If I felt that the (health overhaul) bill could be killed by not advancing the Stupak amendment then it seems it would be prudent to vote in such a way that wouldn't advance the bill, but it doesn't appear that that's a possibility,'' Rep. Michele Bachmann, R-Minn., said before the vote.

The National Right to Life Committee and the U.S. Conference of Catholic Bishops lobbied lawmakers in both parties on the abortion measure. The bishops said they would oppose the bill if it lacked a strict prohibition on any federal funding for abortions.

Stupak's language applies to policies sold in a federally regulated insurance exchange that would be set up in 2013. The overhaul bill envisions both private companies and the government offering policies in the exchange.

Under the Stupak amendment, people who do not receive federal insurance subsidies could buy private insurance plans in the exchange that include abortion coverage. People who receive federal subsidies could buy separate policies covering only abortions if they use only their own money to do it.

Companies selling insurance policies covering abortions would be required to offer identical policies without the abortion coverage.

Abortion-rights supporters say private insurers will not likely offer policies with abortion coverage in the exchange because many potential buyers will be getting federal subsidies and therefore wouldn't be able to purchase them.

Around 21 million people are expected to get coverage through the exchange by 2019, according to the Congressional Budget Office. The majority of Americans who get their insurance coverage from their employers would not be affected.

Abortion-rights supporters say the restrictions in the amendment go further than current law.

A law called the Hyde amendment which must be renewed annually bars federal funding for abortion except in cases of rape, incest or if the mother's life is in danger. The restrictions apply to Medicaid, forcing states that cover abortions for low-income women to pay for them with state revenues. Separate laws apply the restrictions to the federal employee health plan and the military.

Currently abortion coverage is widely available in the private market. A Guttmacher Institute study found that 87 percent of typical employer plans covered abortion in 2002. A Kaiser Family Foundation survey in 2003 found that 46 percent of workers in employer plans had abortion coverage. The studies asked different questions, which might help explain the disparity in the results.

Abortions in the first trimester typically cost between $350-$900, according to Planned Parenthood.

A health overhaul bill pending in the Senate also bars federal funding for abortion, but the language is less stringent. Discrepancies between the House and Senate measures would have to be reconciled before any final bill is passed.

(Copyright 2009 by The Associated Press. All Rights Reserved.)

WASHINGTON (AP) In a victory for President Barack Obama, the Democratic-controlled House narrowly passed landmark health care legislation Saturday night to expand coverage to tens of millions who lack it and place tough new restrictions on the insurance industry. Republican opposition was nearly unanimous.

The 220-215 vote cleared the way for the Senate to begin a long-delayed debate on the issue that has come to overshadow all others in Congress.

A triumphant Speaker Nancy Pelosi likened the legislation to the passage of Social Security in 1935 and Medicare 30 years later and Obama issued a statement saying, ``I look forward to signing it into law by the end of the year.''

``It provides coverage for 96 percent of Americans. It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it,'' said Rep. John Dingell, the 83-year-old Michigan lawmaker who has introduced national health insurance in every Congress since succeeding his father in 1955.

In the run-up to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. They prevailed on a roll call of 240-194.

Ironically, that only solidified support for the legislation, clearing the way for conservative Democrats to vote for it.

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price fixing and market allocation.

At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private firms.

A cheer went up from the Democratic side of the House when the bill gained 218 votes, a majority. Moments later, Democrats counted down the final seconds of the voting period in unison, and let loose an even louder roar when Pelosi grabbed the gavel and declared, ``the bill is passed.''

The bill drew the votes of 219 Democrats and Rep. Joseph Cao, a first-term Republican who holds an overwhelmingly Democratic seat in New Orleans. Opposed were 176 Republicans and 39 Democrats.

From the Senate, Majority Leader Harry Reid of Nevada issued a statement saying, ``We realize the strong will for reform that exists, and we are energized that we stand closer than ever to reforming our broken health insurance system.''

In his written statement, Obama praised the House's action and said, ``now the United State Senate must follow suit and pass its version of the legislation. I am absolutely confident it will.''

Nearly unanimous in their opposition, minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

United in opposition, minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

``We are going to have a complete government takeover of our health care system faster than you can say, `this is making me sick,''' jabbed Rep. Candice Miller, R-Mich., adding that Democrats were intent on passing ``a jobs-killing, tax-hiking, deficit-exploding'' bill.

But with little doubt about the outcome, the rhetoric lacked the fire of last summer's town hall meetings, when some critics accused Democrats of plotting ``death panels'' to hasten the demise of senior citizens.

The bill is projected to expand coverage to 36 million uninsured, resulting in 96 percent of the nation's eligible population having insurance.

To pay for the expansion of coverage, the bill cuts Medicare's projected spending by more than $400 billion over a decade. It also imposes a tax surcharge of 5.4 percent on income over $500,000 in the case of individuals and $1 million for families.

The bill was estimated to reduce federal deficits by about $104 billion over a decade, although it lacked two of the key cost-cutting provisions under consideration in the Senate, and its longer-term impact on government red ink was far from clear.

Democrats lined up a range of outside groups behind their legislation, none more important than the AARP, whose support promises political cover against the cuts to Medicare in next year's congressional elections.

The nation's drug companies generally support health care overhaul. And while the powerful insurance industry opposed the legislation, it did so quietly, and the result was that Republicans could not count on the type of advertising campaign that might have peeled away skittish Democrats in swing districts.

Over all, the bill envisioned the most sweeping set of changes to the health care system in more than a generation, and Democrats said it marked the culmination of a campaign that Harry Truman began when he sat in the White House 60 years ago.

Debate on the House floor had already begun when Obama strode into a closed-door meeting of the Democratic rank and file across the street from the Capitol to make a final personal appeal to them to pass his top domestic priority.

Later, in an appearance at the White House, he said he had told lawmakers, ``to rise to this moment. Answer the call of history, and vote yes for health insurance reform for America.''

It appeared that a compromise brokered Friday night on the volatile issue of abortion had finally secured the votes needed to pass the legislation.

As drafted, the measure denied the use of federal subsidies to purchase abortion coverage in policies sold by private insurers in the new insurance exchange, except in cases of incest, rape or when the life of the mother was in danger.

But abortion foes won far stronger restrictions that would rule out abortion coverage except in those three categories in any government-sold plan. It would also ban abortion coverage in any private plan purchased by consumers receiving federal subsidies.

Disappointed Democratic abortion rights supporters grumbled about the turn of events, but pulled back quickly from any thought of opposing the health care bill in protest.

One, Rep. Jan Schakowsky, D-Ill., detailed numerous other benefits for women in the bill, including free medical preventive services and better prescription drug coverage under Medicare. ``Women need health care reform,'' she concluded in remarks on the House floor.

A Republican alternative was rejected on a near party line vote of 258-176.

It relied heavily on loosening regulations on private insurers to reduce costs for those who currently have insurance, in some cases by as much as 10 percent. But congressional budget analysts said the plan would make no dent in the ranks of the uninsured, an assessment that highlighted the difference in priorities between the two political parties.

Associated Press writers Phil Elliott, Alan Fram and Erica Werner contributed to this report.

(Copyright 2009 by The Associated Press. All Rights Reserved.)

WASHINGTON (AP) President Barack Obama is traveling to Capitol Hill on Saturday to try to close the sale on his signature health care overhaul, facing a make-or-break vote in the House certain to be seen as a test of his presidency.

Obama scheduled a late-morning visit with House Democrats convening a rare Saturday session on legislation to remake the U.S. health care system, extending coverage to tens of millions now uninsured and banning insurance company practices such as denial of coverage based on pre-existing medical problems.

Late Friday, House Democrats cleared an abortion-related impasse blocking a vote and officials expressed optimism they had finally lined up the support needed to pass Obama's signature issue.

Under the arrangement, Democratic Reps. Bart Stupak of Michigan, Brad Ellsworth of Indiana and other abortion opponents were promised an opportunity to insert tougher restrictions into the legislation during debate on the House floor.

The leadership's hope is that no matter how that vote turns out, Democrats on both sides of the abortion divide will then unite to give the health care bill a majority over unanimous Republican opposition.

``We wish to maintain current law, which says no public funding for abortion,'' Stupak said. ``We are not writing a new federal abortion policy.''

Ellsworth added, ``From day one, my goal has been to ensure federal tax dollars are not used to pay for abortions and to provide Americans with pro-life options on the exchange. And I am proud to be part of an effort to help make this goal a reality.''

With Democrats' command of the necessary votes looking tenuous in the final hours, Obama threw the weight of his administration behind the effort to round up support. He and top administration officials worked the phones to pressure wavering lawmakers.

Rep. Jason Altmire, D-Pa., said he heard Friday from Obama, White House Chief of Staff Rahm Emanuel, Health and Human Services Secretary Kathleen Sebelius and Education Secretary Arne Duncan.

Their message: ``This is a historic moment. You don't want to end up with nothing,'' said Altmire, who remained undecided.

Democratic leaders hoped to hold the vote Saturday evening, but Majority Leader Steny Hoyer said it could slip.

Democrats hold 258 seats in the House and can afford 40 defections and still wind up with 218, a majority if all lawmakers vote. But all 177 Republicans were expected to vote ``no,'' and Democratic leaders faced a series of complications trying to seal the needed votes for their complex and controversial legislation that would affect one-sixth of the economy and touch the lives of countless Americans.

The final hurdle was a controversy over federal funding for abortion, which simmered into Friday night with tensions running high as Democratic leaders shuttled between meetings of anti-abortion and abortion rights lawmakers.

Federal law currently prohibits the use of federal funds to pay for abortions except in the case of rape, incest of situations in which the life of the mother is in danger. That left unresolved whether individuals would be permitted to use their own funds to buy insurance coverage for the procedure in the federally backed insurance exchange envisioned under the legislation.

Democrats have little room for error, with the prospect of the 2010 midterms looming large and a some of their own moderates already declaring their opposition.

The 10-year, $1.2 trillion House bill would create a new federally supervised insurance marketplace where the uninsured could purchase coverage.

Consumers would have the option of picking a government-run plan, the most hotly contested item in the legislation.

Associated Press writers David Espo and Ricardo Alonso-Zaldivar contributed to this report.

(Copyright 2009 by The Associated Press. All Rights Reserved.)

ATLANTA (AP) Only about a third of adults who have tried to get a swine flu vaccine have been able to get it, according to a new national poll released Friday.

That's true even for people who are at extra risk for severe complications and should be at the front of the line. The numbers are about the same for parents who tried to get the vaccine for their children, the Harvard School of Public Health poll found.

Swine flu vaccine has been available in the United States for about a month, but supplies have been limited because of manufacturing delays. However, availability is picking up, said Dr. Anne Schuchat of the Centers for Disease Control and Prevention. About 38 million doses of swine flu are currently available, a one-week increase of about 11 million doses. Another 8 million doses are expected next week, she added.

Overall, the poll found about 80 percent of the adults in priority groups said they haven't tried to get it yet and 60 percent of parents haven't sought it out for their kids.

The Harvard telephone poll surveyed about 1,000 adults last weekend. The margin of error was plus or minus 3.8 percentage points.

Many of the poll's findings seemed consistent with what the government has been hearing and seeing, said CDC officials. Nearly a third of Americans who tried and failed to get vaccine said they were very frustrated, the poll found, and that frustration has been evident at long lines at vaccination clinics.

But it was encouraging to see that nine in 10 people who couldn't get vaccine will try again, said Schuchat, who heads the CDC's National Center for Immunization and Respiratory Diseases.

The poll also found:

About 5 percent of those surveyed said they'd been vaccinated.

About 60 percent said there were swine flu vaccine shortages in their community.

About half who tried couldn't find information about where to get the vaccine.

Because of limited supplies, there have been situations in which vaccine went to doctor's offices or clinics intended for children or other priority groups and it wasn't publicized, Schuchat said.

``When you have limited supply, advertising is difficult. You don't want to frustrate the demand,'' Schuchat said at a Friday press conference in Atlanta.

Swine flu is currently widespread in 48 states; Hawaii and Mississippi are the exceptions. Mississippi dropped off the list this week, reflecting that flu activity seems to be waning in some parts of the Southeast.

CDC officials said 129 children have died from swine flu complications since the virus was first identified in April. About two-thirds of them had other health conditions, like asthma or neurological problems like cerebral palsy or muscular dystrophy. The government does not keep a close count of all swine flu deaths, but estimates the number is above 1,000. Many millions of Americans have been infected with the virus, though most suffered only mild illness, health officials say.

(Copyright 2009 by The Associated Press. All Rights Reserved.)

WASHINGTON (AP) What's all the fuss about?

After all the noise over Democrats' push for a government insurance plan to compete with private carriers, coverage numbers are finally in:

Two percent.

That's the estimated share of Americans younger than 65 who'd sign up for the public option plan under the health care bill that Speaker Nancy Pelosi, D-Calif., is steering toward House approval.

The underwhelming statistic is raising questions about whether the government plan will be the iron-fisted competitor that private insurers warn will shut them down or a niche operator that becomes a haven for patients with health insurance horror stories.

Some experts are wondering if lawmakers have wasted too much time arguing about the public plan, giving short shrift to basics such as ensuring that new coverage will be affordable.

``The public option is a significant issue, but its place in the debate is completely out of proportion to its actual importance to consumers,'' said Drew Altman, president of the nonpartisan Kaiser Family Foundation. ``It has sucked all the oxygen out of the room and diverted attention from bread-and-butter consumer issues, such as affordable coverage and comprehensive benefits.''

The Democratic health care bills would extend coverage to the uninsured by providing government help with premiums and prohibiting insurers from excluding people in poor health or charging them more. But to keep from piling more on the federal deficit, most of the uninsured will have to wait until 2013 for help. Even then, many will have to pay a significant share of their own health care costs.

The latest look at the public option comes from the Congressional Budget Office, the nonpartisan economic analysts for lawmakers.

It found that the scaled back government plan in the House bill wouldn't overtake private health insurance. To the contrary, it might help the insurers a little.

The budget office estimated that about 6 million people would sign up for the public option in 2019, when the House bill is fully phased in. That represents about 2 percent of a total of 282 million Americans under age 65. (Older people are covered through Medicare.)

The overwhelming majority of the population would remain in private health insurance plans sponsored by employers. Others, mainly low-income people, would be covered through an expanded Medicaid program.

To be fair, most people would not have access to the new public plan. Under the House bill, it would be offered through new insurance exchanges open only to those who buy coverage on their own or work for small companies. Yet even within that pool of 30 million people, only 1-in-5 would take the public option.

Who's likely to sign up?

The budget office said ``a less healthy pool of enrollees'' would probably be attracted to the public option, drawn by the prospect of looser rules on access to specialists and medical services.

As a result, premiums in the public plan would be higher than the average for private plans. That could nudge healthy middle-class workers and their families to sign up for private plans.

``The concern was that the public option would destabilize the bulk of private insurance, but in fact what Congress has fashioned is very targeted,'' said economist Karen Davis, president of the Commonwealth Fund. ``It's not going to be taking away the insurance industry's core business.''

It's unclear whether there are enough votes in the Senate for a public plan. The version that Majority Leader Harry Reid, D-Nev., has offered would let states opt out, probably leaving a smaller plan than the House would want.

Insurers aren't buying the budget office analysis. Asked if it might soften that opposition, industry spokesman Robert Zirkelbach of America's Health Insurance Plans responded with a curt ``No.''

While a government plan might start out modestly, insurers fear that Congress could change the rules later, opening it up to all people and setting take-it-or-leave payments for hospitals and medical providers, instead of negotiating, as the House bill calls for.

For the same reason, employer groups also remain wary. Big companies don't want to lose control of their health care budgets and instead have the government send them a tax bill.

``That cost is going to come back to you one way or another ... and it's coming back in the way of taxes and liabilities,'' said Eastman Kodak's chief executive, Antonio M. Perez, speaking for the Business Roundtable. ``We just don't believe that there are miracles out there.''

If Congress passes a public plan that's not much of a sensation, Democrats might have reason to regret all the time and energy they invested in it.

On the Net:

House bill: http://tinyurl.com/lftnuj

(Copyright 2009 by The Associated Press. All Rights Reserved.)

These officials said Majority Leader Harry Reid, D-Nev., intended to make a formal announcement later in the day, and also say he had nearly completed work on the legislation for the full Senate to debate early next month.

Proposals for a government-run insurance option have sparked significant controversy, and in recent days, most of the discussion has focused on an approach under which states would be assumed to participate unless they chose otherwise.

With his announcement, Reid would send a signal of reassurance to liberals who have long pushed for a robust government presence in the insurance marketplace as a way to create competition for private insurers.

Moderate Democrats have tended to shy away from the so-called public option, fearing criticism that they were supporting a government takeover of the nation's health care system.

The officials who described Reid's intentions did so on condition of anonymity, saying they did not want to pre-empt the announcement.

The developments came as Democrats in both houses of Congress struggled to pass legislation that President Barack Obama has set out as his top domestic priority.

At their core, the legislation would expand coverage to millions who lack it; ban insurance industry practices such as denying coverage because of pre-existing medical conditions; and rein in the growth in health care costs nationwide.

Reid has signaled his support for a public insurance option numerous times in recent months, and last week officials disclosed he was leaning toward including it in the legislaiton he is preparing.

Nominally, the majority leader is melding bills passed by the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee earlier this year. But in reality, he has a virtual free hand to craft a new bill in his discussions with the chairman of the two panels and top White House aides.

Any measure would need 60 votes to overcome a threatened Republican filibuster. Given skepticism expressed by some moderates, it was not clear whether Reid yet had the votes to prevail. Once the measure reaches the floor, further changes are always possible.

While the controversy over government-run insurance is the most intense, there are numerous other issues to be settled before legislation can win passage.

Officials said over the weekend that Reid did not intend to require large companies to provide insurance for their workers. But any that don't will be liable for large fines if any of their employees qualified for government subsidies to handle the expense of private coverage.

Individuals would be required to purchase insurance, with exemptions for individuals and families who could not find affordable coverage.

Obama has set a $900-billion, 10-year price tag for the legislation, and the program would be funded through cuts in future payments to Medicare providers and higher taxes an income surcharge on million-dollar earners in the House and a new levy on high-cost insurance policies in the Senate.

Organized labor has strongly opposed taxing insurance policies, fearful that union members would be disadvantaged.

But the head of the AFL-CIO, Richard Trumka, seemed to indicate new flexibility on the issue in a conference call with reporters.

``If you show me a definition of a Cadillac plan that hits the Cadillac plans and not the middle class, then we'd take a look at that, of course,'' Trumka said. ``If you wanted to tax the Goldman Sachs plans, I think that's fine,'' he said.

Advocates of the tax say it is one of the most effective ways of restraining the overall cost of health care, a key goal of Obama's.

(Copyright 2009 by The Associated Press. All Rights Reserved.)

WASHINGTON (AP) President Barack Obama declared the swine flu outbreak a national emergency, giving his health chief the power to let hospitals move emergency rooms offsite to speed treatment and protect noninfected patients.

The declaration, signed Friday night and announced Saturday, comes with the disease more prevalent than ever in the country and production delays undercutting the government's initial, optimistic estimates that as many as 120 million doses of the vaccine could be available by mid-October.

Health authorities say more than 1,000 people in the United States, including almost 100 children, have died from the strain of flu known as H1N1, and 46 states have widespread flu activity. So far only 11 million doses have gone out to health departments, doctor's offices and other providers, according to the Centers for Disease Control and Prevention officials.

Administration officials said the declaration was a pre-emptive move designed to make decisions easier when they need to be made. Officials said the move was not in response to any single development.

Health and Human Services Secretary Kathleen Sebelius now has authority to bypass federal rules when opening alternative care sites, such as offsite hospital centers at schools or community centers if hospitals seek permission.

Some hospitals have opened drive-thrus and drive-up tent clinics to screen and treat swine flu patients. The idea is to keep infectious people out of regular emergency rooms and away from other sick patients.

Hospitals could modify patient rules for example, requiring them to give less information during a hectic time to quicken access to treatment, with government approval, under the declaration.

It also addresses a financial question for hospitals reimbursement for treating people at sites not typically approved. For instance, federal rules do not allow hospitals to put up treatment tents more than 250 yards away from the doors; if the tents are 300 yards or more away, typically federal dollars won't go to pay for treatment.

Administration officials said those rules might not make sense while fighting the swine flu, especially if the best piece of pavement is in the middle of a parking lot and some medical centers already are putting in place parts of their emergency plans.

``I think the term emergency declaration sounds more dramatic than it really is,'' said Dr. Peter Hotez, a research professor and chairman of the Department of Microbiology, Immunology and Tropical Medicine at George Washington University. ``It's largely an administrative move that's more preemptive ...'' He said such a step would give emergency rooms and hospitals the flexibility they need.

The national emergency declaration was the second of two steps needed to give Sebelius extraordinary powers during a crisis.

On April 26, the administration declared swine flu a public health emergency, allowing the shipment of roughly 12 million doses of flu-fighting medications from a federal stockpile to states in case they eventually needed them. At the time, there were 20 confirmed cases in the U.S. of people recovering easily. There was no vaccine against swine flu, but the CDC had taken the initial step necessary for producing one.

``As a nation, we have prepared at all levels of government, and as individuals and communities, taking unprecedented steps to counter the emerging pandemic,'' Obama wrote in Saturday's declaration.

He said the pandemic keeps evolving, the rates of illness are rising rapidly in many areas and there's a potential ``to overburden health care resources.''

The government now hopes to have about 50 million doses of swine flu vaccine out by mid-November and 150 million in December. The flu virus has to be grown in chicken eggs, and the yield hasn't been as high as was initially hoped, officials have said.

``Many millions'' of Americans have had swine flu so far, according to an estimate that CDC Director Dr. Thomas Frieden gave Friday. The government doesn't test everyone to confirm swine flu so it doesn't have an exact count. He also said there have been more than 20,000 hospitalizations.

On the Net:

CDC: http://www.cdc.gov/h1n1flu/update.htm

Government's flu site: http://www.flu.gov/

Associated Press writer Jackie Quinn contributed to this report.

(Copyright 2009 by The Associated Press. All Rights Reserved.)