Health bill gains ground but release delayed

WASHINGTON (AP) - President Barack Obama's sweeping health care legislation won precious support from a longtime liberal holdout in the House on Wednesday and from a retired Catholic bishop and nuns representing dozens of religious orders - gaining fresh traction ahead of a climactic weekend vote.

"That's a good sign," said Obama, two weeks after taking personal command of a campaign to enact legislation in what has become a virtual vote of confidence on his still-young presidency.

But Democrats delayed the planned release of formal legislation at least until Thursday as they sought to make sure it would reduce federal deficits annually over the next decade.

At the White House, Obama met with Richard Trumka, the head of the AFL-CIO. Officials said the labor leader raised concerns over the details of a planned excise tax on high-cost insurance plans as well as other elements of the as-yet-unreleased legislation.

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 nation'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.

Together, the measures are designed to extend coverage to more than 30 million who now lack it and ban the insurance industry from denying coverage on the basis of pre-existing medical conditions. Obama also has asked lawmakers to slow the growth of medical spending generally, a far more difficult goal to achieve.

Rep. Dennis Kucinich's announcement in the Capitol made him the first Democrat to declare he would vote in favor of the legislation after voting against an earlier version, and he stressed he was still dissatisfied with key parts.

"I know I have to make a decision, not on the bill as I would like to see it but as it is," said the Ohio lawmaker, who twice ran for president advocating national health care. "If my vote is to be counted, let it now count for passage of the bill, hopefully in the direction of comprehensive health care reform."

Referring to the political struggle under way, Kucinich said, "You do have to be very careful that the potential of President Obama's presidency not be destroyed by this debate. Even though I have many differences with him on policy, there's something much bigger at stake here for America."

Obama lobbied Kucinich heavily for his vote, including aboard Air Force One earlier in the week on a trip to northeastern Ohio for a presidential speech.

Republicans are opposed to the legislation, arguing it still amounts to a government takeover of health care, largely paid for through higher taxes and deep cuts in Medicare that will harm seniors. In recent days, they have also turned their criticism on Pelosi, who says the House may approve the Senate-passed bill without casting a separate vote on it. Instead, under a rule that would itself be subject to a vote, it would be considered passed automatically if the second fix-it bill passed.

This approach has been used numerous times in recent years by both political parties, but Republicans added it to their list of grievances as they sought to send Obama's top domestic priority down to defeat.

"The only way to stop this madness is for a few courageous Democrats to step forward and stop it," said Sen. Mitch McConnell of Kentucky, the Senate GOP leader.

"Historians will remember this as a new low in this debate, the week that America was introduced to the scheme-and-deem approach to legislating. They'll remember this as the week that Congress tried to pull the wool over the eyes of the public in order to get around their will."

Without disclosing details, Democrats say the fix-it bill would add funds to federal subsidies designed to make health care more affordable for the working poor and middle class, to benefit states that already meet standards the bill sets for health care for the poor and to gradually close a gap in Medicare prescription drug coverage known as the doughnut hole.

The revisions are also expected to repeal a Nebraska-only increase in federal Medicaid funds that cleared the Senate, a provision that became politically toxic as news of it spread last year.

In a bid to reassure nervous lawmakers in the House that they would also approve the bill, Senate Democrats circulated a letter pledging their support. Ironically, officials said it had been drafted in the House and presented to the Senate leadership to seek signatures. Jim Manley, a spokesman for Senate Majority Leader Harry Reid, said that was not the case.

There was no formal White House announcement of Trumka's White House visit, in keeping with the administration's practice of minimal disclosure of the president's private lobbying on the issue.

Several Democrats said that in addition to talks on the tax on high-cost plans, the union leader sought to preserve a Senate-passed provision under which all construction companies except those with fewer than five workers and a payroll of $250,000 would be required to pay a penalty if they don't provide coverage for their workers. Businesses in other industries are exempt from the penalties if they have fewer than 50 workers. These officials spoke on condition of anonymity, saying they were not permitted to discuss details of the White House meeting.

Reflecting growing opposition among states to the health care bill, Idaho Gov. C.L. "Butch" Otter, a Republican, signed a measure 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.

Shortly after Kucinich's announcement, a letter was released from 60 leaders of women's religious orders urging lawmakers to vote for the legislation.

"Despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions. It will uphold long-standing conscience protections and it will make historic new investments - $250 million - in support of pregnant women," wrote the nuns, in a letter released by Network, A National Catholic Social Justice Lobby. "This is the REAL pro-life stance, and we as Catholics are all for it."

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

"This is not an abortion bill," McCarthy, 80, said in an interview. "This is an extraordinarily important bill providing health care for 30 to 40 million people who don't have it. It's not perfect, we can come back later and improve it. But let's not kill it at this crucial moment." He served as bishop of the Austin diocese from 1986-2001.

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

The abortion issue has long split Democrats, 40 of whom voted for an earlier House bill only after it was changed at the last minute to stiffen restrictions on the availability of abortions under a new insurance marketplace that would be established under the bill.

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Associated Press writers Ricardo Alonso-Zaldivar, Charles Babington, Alan Fram, Erica Werner and C.J. Jackson contributed to this report.