Nine congressmembers who voted against health reform could flip

A small number of House Democrats who opposed health overhaul legislation on the first go-round may be President Barack Obama's most important constituency when he unveils a revised proposal on Wednesday.

At least nine of the 39 Democrats who voted "nay" when the House passed sweeping overhaul legislation 220-215 in November are now undecided or withholding judgment until they see Obama's final product, according to an Associated Press survey.

It may seem improbable that any lawmaker would want to switch his or her vote on the measure, courting the flip-flopper label after a year of controversy over legislation that's slid ever downward in polls.

But it will almost certainly have to happen in order for House Speaker Nancy Pelosi, D-Calif., to round up the votes necessary to pass the Senate's version of the legislation, along with a package of changes that Obama will update on Wednesday. The changes — designed to make the Senate bill more palatable to House Democrats by rolling back a tax on high-value insurance plans, among other things — would get through the Senate under controversial rules allowing for a simple majority vote.

That's the only option for Democrats because they no longer control a filibuster-proof 60 votes in the Senate, and Republicans are unanimously opposed.

Obama's announcement on Wednesday is expected to be a freshened blueprint of the changes he wants made to the Senate's health care bill, updated with ideas that at least have the fingerprints of Republicans, possibly in the areas of medical malpractice reform and rooting out waste and fraud from the medical system.

That's not likely to win him any votes from Republicans, who want Obama to tear up the existing bills and start over, but it could give wavering Democrats political cover by showing the party has been willing to compromise in the wake of last week's televised bipartisan health care summit.

With four vacancies in the House, Pelosi will need 216 votes. She would command exactly that many if all the remaining Democrats who voted "yes" in November did so again. But many lawmakers expect defections, especially of members who oppose federal funding for abortion and feel the Senate language is too permissive in that regard.

For every yes vote that switches to no, Pelosi and the White House must persuade one of the 39 Democrats who voted "nay" in November to switch to yes.

Some of the top targets may be the nine lawmakers who told The Associated Press directly or through spokesmen that they're undecided or undeclared. Three are retiring and don't have to worry about getting punished by voters, and five others are freshmen, mostly in competitive districts — lawmakers whom Pelosi will give a pass on tough votes when she can, but might call on when a major piece of legislation hangs in the balance.

The retiring lawmakers are Reps. Brian Baird of Washington and Bart Gordon and John Tanner of Tennessee. The freshmen are Suzanne Kosmas of Florida, Frank Kratovil of Maryland, Scott Murphy of New York, Glenn Nye of Virginia and Michael McMahon of New York. The ninth is Rick Boucher of Virginia. Several lawmakers' offices did not reply to the AP queries and a handful of others said they would definitely vote "no."

"It's still sort of up-in-the-air right now. If the bill that comes back to the House looks anything like the first bill, he'll vote against it," Kratovil spokesman Kevin Lawlor said Monday. "We don't really know what we'll see, though. Cost was the No. 1 issue as far as the first bill goes. In order for him to vote for anything, it would have to be a bill where the cost is sustainable."

House Majority Leader Steny Hoyer said Tuesday he believes members of Congress who help pass legislation overhauling the system will be anxious to defend it to voters in the fall elections.

The Maryland Democrat said on CBS's "The Early Show" that thinks the public supports many key elements of a new medical care system, including "affordable health insurance for all Americans and families."

Hoyer said there still is a chance that a retooled bill the White House will outline later this week can win passage and said the legislation already circulating has strong provisions aimed at containing spiraling health care costs.

At its core the Democrats' legislation would extend coverage to 30 million uninsured Americans over 10 years with a first-time mandate for nearly everyone to buy insurance and a host of new requirements on insurers and employers. However, the package soon to reach the House will be less expensive than the one that passed in November and will contain no government-run insurance program to compete with private insurers, making it more appealing to some moderates.

Since Thursday's summit, Obama has been involved in a series of meetings in which the new White House proposal is being shaped. Press secretary Robert Gibbs said Obama has worked to get votes in every round of the health care debate. "I don't doubt that he will ... do the same thing this time to get the votes necessary," Gibbs said.

One possible reason for the recent show of determination by Democratic leaders: They have received polling data showing that while the general idea of health care overhaul fares poorly with the public, the specific elements of the effort score high marks, including with crucial independent voters.

The information underscores the poor job of salesmanship Democrats have done, but it also raises the prospects that if it is enacted the measure could end up getting a strongly positive public reception, Democrats said.

"I see this as being a very salable issue," said Robert A. Crittenden, who leads of coalition of labor and other groups that have been helping Democrats frame their messaging on the issue. "You can break through and start showing what's in the bill that's helpful to them, because it really matches what they want."