As the No. 2 member of the House, Steny H. Hoyer of Maryland has a lot riding on the outcome of today's health care vote.
If the measure is defeated, some congressional aides predict privately that Democrats will lose their House majority in the fall elections. Hoyer's job as majority leader would disappear, along with its power and influence.
In an interview Saturday, Hoyer said Democrats still don't have the votes they need to pass the legislation but anticipated they will get them.
"We have the leverage," he said.
As he spoke in his spacious, sunlit Capitol office on the first day of spring, the strains of the last-minute push were evident in the head cold the 70-year-old Hoyer was combating.
He acknowledged that Republicans had been effective in generating public opposition to the Democratic plan, using what he termed "scare tactics." But with a laugh, he derided opposition claims that his party is jamming the proposal through Congress.
"This is the slowest jam that I've ever seen in my entire life," remarked Hoyer, who has said that there's been more input on this measure than any in his 30 years in Congress and 12 years in the Maryland Senate.
Party strategists warn that failure to gain approval of the measure now would be catastrophic, with voter anger at Washington already approaching levels seen in 1994, the last time Americans dumped a Democratic majority from power.
"You get the worst of all worlds," said Paul Maslin, a Democratic pollster. "The Republican attack will be: You wanted this government takeover, and you didn't even have the votes."
Democrats regard enactment of President Barack Obama's signature legislative initiative as politically vital. They need it to re-energize the same voters who helped put Obama in office and have grown increasingly dispirited by the inability of Democratic politicians to produce change, despite controlling the White House and both houses of Congress.
"This is a base issue," said Tony Coelho, a former California congressman and former head of the party's House campaign committee. "What a lot of Democrats [in Congress] need to do is stop worrying about these people who are going to be against them whether they vote for the bill or against the bill. What they need to be doing is identifying the people that this bill helps."
Hoyer rejects the argument that losing the health care vote would cost Democrats control of the House. But he recognizes a direct link between the issue and the 2010 elections, when every House seat is at stake.
The nation's voters, he predicts, will come to see that overhauling one-sixth of the U.S. economy will be good for them and for the country.
"I think they are going to have a positive response," he said, "when you get past this rhetoric and difference and shoving and confrontation."
The legislation would be a landmark: the largest expansion of health coverage since the creation of Medicare 45 years ago. It would move the U.S. closer to universal health care, extending coverage to 32 million people, and to 95 percent of Americans, by the end of the decade.
Seniors who spend a substantial amount of money for prescription drugs would get a more generous benefit, including a $250 rebate this year. Young adults could remain on a parent's insurance plan until age 26, and no one with a pre-existing health condition could be denied insurance coverage.
Individuals would pay a penalty of at least $695 if they fail to get insurance. A so-called public option, designed to compete with private insurers as a way of lowering costs, is not included.
Getting that plan approved, after a marathon struggle that dragged out months longer than Hoyer would have liked, would also be a defining moment for the Democratic leadership.
It would establish California's Nancy Pelosi as one of the most effective House Speakers in recent memory. Her success would spill over to Hoyer, whose decades-long rivalry with the Baltimore-born Pelosi remains a preoccupation of Washington insiders.
"Everything I hear, whether it's from liberals, conservatives or moderates, is that his star is very, very strong," said Coelho, who is close to Hoyer. "He gets in there and fights at the right time. He backs off at the right time. He doesn't try to hog the light. He's a very strong leader."
Oddly, perhaps, Hoyer and Pelosi were partners in one of the damaging missteps of the health care fight. It came at a particularly inopportune time - in the middle of August's contentious town hall meetings.
An opinion article by Pelosi and Hoyer, published in USA Today, called the angry protesters "un-American" for "drowning out" opposing views. Republicans immediately jumped on that language to portray the Democratic leaders as intolerant.
Hoyer says now that he regrets using the phrase "un-American."
"The rhetoric was not good," he said, explaining that he "read it quickly" when a final version of the article was provided to him. "I didn't catch it, and I'm ticked at myself for not catching that, because opposition is not un-American."
Hoyer was on the road at the time, pursuing another facet of his job: the care and feeding of 252 Democratic colleagues in preparation for the 2010 election. He's visited 41 districts already and helped raise more than $2.3 million for House campaigns, according to his staff.
He's worked especially hard to protect, as best he can, the freshmen and sophomores whose election gave Democrats their majority and who, at the moment, are among those most at risk of losing. Independent analysts project that more than 20 Democrats will be unseated and say a Republican takeover of the House is possible if an anti-Democratic wave crests in November.
This weekend, amid the push to win over the last undecided Democratic lawmakers, Hoyer estimated that he's conferred one-on-one with 75 to 100 House Democrats over the issue.
His closing message, in public and in private, is about dollars and cents: that the $940 billion health measure would produce "the largest deficit reduction of any bill we've adopted in the Congress since 1993."
The nonpartisan Congressional Budget Office has projected that the plan would reduce the federal budget deficit by $118 billion over the next decade, though it also said that the new health system could wind up increasing the deficit if Congress failed to make tough political decisions affecting the cost of health care during the next few years.
Hoyer's efforts target his party's damaged image on spending. Recent national polling indicates that Republicans have taken back what had been a Democratic advantage on fiscal responsibility.
The budget issue is of particular importance in swing districts represented by many of the most vulnerable Democratic incumbents. It also meshes with his role as a bridge-builder between the largely liberal House leadership and House moderates, many of whom aren't comfortable with Pelosi and don't feel the White House listens to them enough.
A former aide says Hoyer understands the needs of those Democrats from marginal districts because their constituents aren't all that different from his own in Southern Maryland.
"He represents a district that's somewhat conservative," said Karin Johanson, a former chief of staff. "He has to watch his own district, and can compare his own situation to theirs."
Hoyer hasn't faced a competitive challenger in his Southern Maryland district since 1992, however, and none has surfaced this year.
Because of his leadership position, Hoyer will be prominent in the closing debate on the House floor, with a final vote expected by late afternoon or early evening today.
No Republicans are expected to support the legislation, but Hoyer plans to quote liberally from Republican presidents, including Richard M. Nixon, who called for expanded health coverage during their time in office.
"It's not a partisan issue," he said. "For a century, we've thought to ourselves, in a country like the United States of America you've got to have access to affordable health care for all our people."
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