The US House of Representatives convened Sunday for one last critical showdown on a sweeping overhaul of the health care system, dpa reported.
Democratic leaders remained convinced they had secured the 216 votes needed for the legislation to pass over the opposition of Republicans and some moderate Democrats. But a handful of lawmakers had yet to publicly declare where they stood on President Barack Obama's top domestic priority.
The House was to hold a series of procedural votes throughout Sunday afternoon and a final vote was expected by the early evening. Lawmakers were to deliver some final impassioned pleas of their case during the proceedings.
"Will we choose the path of liberty, or will we choose the path of government tyranny?" asked Republican congressman Ted Poe, who strongly opposes the legislation.
Obama was on Capitol Hill Saturday rallying his fellow Democrats one last time to vote for the package of reforms, which were aimed at imposing new regulations on insurance companies and extending coverage to more than 30 million Americans who lack health insurance.
But a group of some 10 Democrats were still holding out over concerns that the bill could leave the door open for federal funding of abortions. Last-minute negotiations on a compromise could result in Obama issuing an executive order barring abortion funding.
The year-long debate over health care reforms has sharply divided the US public and united conservatives in opposition. A few hundred demonstrators gathered outside Capitol Hill and some had to be removed from inside the House chamber as debate got underway.
Obama's left-leaning Democrats have also been divided, with some preferring a more ambitious bill and others pushing for less drastic changes.
"This piece of historic legislation is built on the private insurance system that we have now and runs straight down the centre of American political thought," Obama told House Democrats Saturday.
Sunday will not be the final step in the long-running debate over how to reform a health system than engulfs about 17 per cent of the US economy.
The House will vote on a version of the health legislation that was approved by the Senate in December, and send the measure to Obama's desk for signature. But it will also adopt a round of changes that will have to go back to the Senate for final approval.
The drawn-out process has eroded Obama's popularity over the past year, and Republicans are hoping public anger toward the reforms will translate into electoral gains in November, when one-third of the Senate and the entire House will be up for grabs in mid-term congressional elections.
Democrats fear the failure to pass the reforms would be even more damaging, and are gambling the storm will pass once health care is actually approved.
Under the bill, Americans will for the first time be required to buy at least basic health insurance or face a fine. The Congressional Budget Office (CBO), a non-partisan arbiter of legislative costs, last week estimated that the reforms will cost 940 billion dollars over 10 years and expand coverage to about 32 million more Americans.
The costs will be offset by a mix of new taxes and savings from within the system. The CBO predicted the entire bill would actually lower the federal budget deficit by 138 billion dollars over the next 10 years, and by 1 trillion dollars in the following decade.