Health care headache for House Democrats

Amid signs of division in the Democratic ranks, majority leader Steny Hoyer acknowledged that Speaker Nancy Pelosi and her team had yet to secure the 218 commitments needed for passage. Obama, who picked up the phone and asked fence-sitting Democrats to get on board with his top domestic priority, delayed a trip to Capitol Hill until today. Representatives were put on notice that the floor vote may be postponed until tomorrow afternoon or even early next week.

“There are many people who are still looking to get a comfort level that this is the right thing to do,’’ Hoyer said in a conference call with reporters yesterday.

There are 258 Democrats in the House, but a number of conservative “Blue Dog’’ Democrats are against the bill or wavering because of concerns about raising taxes to pay for the insurance coverage expansion and about the scope of the plan. Some are also pausing over abortion and immigration, volatile side issues.

House leaders raced to satisfy those concerns, wary that they must strike a careful balance appeasing worried centrists without alienating pro-overhaul allies such as Hispanic lawmakers, who oppose the Blue Dogs’ efforts to prevent illegal immigrants from buying insurance.

There were also signs of trouble from the left: Representative Eric Massa of New York, who supports a single-payer insurance system, announced that he planned to vote against the overhaul package, telling home state reporters that it would “enshrine in law the monopolistic powers of the private insurance industry.’’

The White House said Obama put off his scheduled trip to the Capitol yesterday because of the Fort Hood shootings and because he wanted to go closer to the vote.

Even so, he and his top aides worked feverishly to help secure votes, arguing to moderate Democrats that they could improve the bill later but if it fails this weekend, the effort could collapse.

“There is definitely a sense of urgency that you can feel,’’ said Representative Jason Altmire, a Blue Dog Democrat from western Pennsylvania who hadn’t made up his mind. Altmire said he spoke with Obama for 10 minutes yesterday morning. He also took calls from Rahm Emanuel, the White House chief of staff, Health and Human Services Secretary Kathleen Sebelius, Education Secretary Arne Duncan, and a number of House leaders.

“The pitch is the significance of the issue,’’ Altmire said. “That we don’t want to end up with nothing.’’

The proposal would require most Americans to obtain health insurance.

It would cover 36 million of the nearly 50 million who lack coverage by expanding Medicaid and providing subsidies to people who can’t afford it. The cost would be about $1 trillion over the next decade, which would be more than offset by tax increases on the wealthy and by constraining Medicare spending. The measure, which includes a controversial public insurance option designed to compete with private plans and pressure them to hold down costs, has garnered endorsements from an array of interests, including AARP, the seniors’ lobby; the Consumers Union, the nonprofit publisher of Consumer Reports; and the American Medical Association.

House leaders want to pass the bill this weekend because it is so vast and complex that if they wait longer, members could raise new concerns and for Republican opponents could deploy fresh tactics to derail the effort.

In the last few days, as thousands of conservatives descended on the Capitol to protest the legislation, and calls, e-mails, and letters have poured into Congressional offices, a procession of Blue Dog Democrats has issued statements opposing the legislation.

“While I applaud the efforts to improve this bill, I am still concerned that this bill does not do enough to bend the long-term cost curve and that it lacks adequate provisions to reduce the deficit and protect small business,’’ said Representative Frank Kratovil, a freshman Democrat of Maryland who is a member of the Blue Dog caucus, and whom protesters hanged in effigy last summer.

Some seemed deeply torn late yesterday afternoon.

“There are a lot of concerns that I have,’’ said Representative Dennis Cardoza, a Democrat from California’s Central Valley. “I have a district that’s very underserved in many ways, but at the same time I’m a Blue Dog who’s very concerned with cost, and so we’re balancing a lot of different things.’’

Republican leaders kept up a relentless assault against the bill, vowing that every member of their caucus would oppose it. Seizing on news yesterday that the national unemployment rate had spiked to 10.2 percent, the highest level in more than 26 years, House minority leader John Boehner called the legislation a “job killer’’ that had failed to win the public’s confidence.

As the Rules Committee deliberated what amendments should be included in the bill late last night, Representative Virginia Foxx, the North Carolina Republican who earlier this week said Americans have more to fear from the health care bill than they do from terrorism, warned that expanding Medicaid would lead to more crowded emergency rooms. She cited a study that she said showed Medicaid enrollees used the emergency room twice as often as the uninsured.

“If you want to make the case that more and more people in this country should be uninsured, fine,’’ snapped Representative James McGovern, a Democrat of Springfield. “I just disagree with you.’’

McGovern lamented the tone of the debate, calling conservative arguments invoking socialism and terrorism “nuts.’’

If bills pass the House and Senate, they would have to be reconciled in a conference committee before being sent back to both chambers for another round of voting. A number of differences separate the plans. The Senate version is expected to have a weaker public insurance option, with an opt-out provision for states, and would be paid for in part with taxes on high-cost health plans, not a new tax on the wealthy. Hoyer said yesterday he expected a “relatively lengthy and difficult’’ negotiation in conference committee before a final bill is produced.