Nov. 7 (Bloomberg) -- House Speaker Nancy Pelosi said her chamber today will pass legislation on the most far-reaching changes in U.S. health-care policy in four decades as President Barack Obama urged Congress to “rise to this moment.”

“We will be making history with our vote,” Pelosi told reporters after she and fellow Democrats met with Obama on Capitol Hill before the House began debating the measure. “We will pass health-care reform.”

Obama told the lawmakers they should approve the legislation now so he can sign a bill by the end of the year, White House spokesman Bill Burton said. The president has made the measure his top domestic priority.

“They’ve brought us closer than we’ve ever been to passing health-insurance reform,” Obama later told reporters at the White House. “Now’s the time to finish the job.”

The House began debate at about 2 p.m. and planned to vote later tonight on the legislation, designed to cover 36 million uninsured Americans and curb medical costs. Leaders cleared the way to begin after agreeing to a demand by 40 lawmakers to allow a vote on restricting funds for abortion -- a move that’s drawn opposition from Democrats who support abortion rights and may jeopardize passage of the bill.

After House action, the spotlight would turn to the Senate, which is still struggling to find consensus on its own plan. If both the House and Senate pass legislation, lawmakers from each chamber would work together on a compromise for a new round of votes, a process that could take months.

218 Votes

Obama and House leaders have spent the last few days trying to win the 218 votes needed to pass the measure among the 258 Democrats in the House. All Republicans are opposed, criticizing the 10-year plan’s $1 trillion price tag and its creation of a government-run program to compete with private health insurers.

The measure represents the biggest expansion of health care since the 1965 creation of the Medicare program for the elderly. It would require Americans to get insurance, set up insurance- purchasing exchanges for people who don’t have employer-provided benefits, and provide subsidies to help people obtain coverage.

Representative Robert Andrews, a New Jersey Democrat, said Obama spoke extemporaneously for about 30 minutes and said his words inspired lawmakers, including “a few” Democrats who were undecided and afterward told him they would back the bill.

Dingell’s Gavel

During the debate, Republicans complained that the requirement that employers with payrolls of more than $500,000 must insure workers will discourage job growth now that the unemployment rate has reached 10.2 percent. The measure will “destroy millions more American jobs” and “do lasting damage to our economy,” said Michigan Representative Dave Camp.

Opponents also argued that the spending was careless, given the government’s trillion-dollar budget deficits.

“Rome is burning while this Congress fiddles,” said California Republican Devin Nunes. “This Congress is so reckless it’s like watching a broke, drunk gambler trying to double down just to break even.”

Michigan Representative John Dingell, 83, a Democrat who succeeded his father in the House in 1955, presided this morning over proceedings to adopt the ground rules for debate. Greeted with sustained applause from Democrats, he wielded the same gavel he used during the 1965 debate over Medicare.

Rules Vote

After an initial back-and-forth between Republicans and Democrats that resulted in lawmakers shouting over each other and Dingell repeatedly gaveling for order, Republicans came to the podium to complain about what they called a “job-killing bill.” Lawmakers finally voted 242-192 to approve the ground rules, opening the way for debate on the legislation.

“We stand here today on the brink of history,” said New York Representative Louise Slaughter, a Democrat who runs the House Rules Committee. She called the fight for universal health care “one of the greatest political struggles of our era.”

Obama and members of his Cabinet lobbied wavering Democrats as House leaders orchestrated the 11th-hour effort to secure votes needed to pass the legislation.

Representative Jason Altmire, an undecided Democrat from Pennsylvania, said yesterday that Obama and White House Chief of Staff Rahm Emanuel called him to make the pitch that “this is an historic moment.”

Administration and House leaders stressed the House bill isn’t the final product, as the Senate is deliberating over a version, “but if we didn’t do this, it’s dead,” Altmire said.

Abortion Issue

The abortion issue looms as a stumbling block to a vote, as does the question of how to prevent illegal immigrants from benefiting from government subsidies to buy insurance.

Democratic leaders will let the lawmakers offer an amendment that would impose tougher limits on the use of federal money to finance abortions for people buying insurance on the federally subsidized online exchanges. The amendment was proposed by Michigan Democrat Bart Stupak.

The rules committee met for almost 12 hours, voting just before 2 a.m., Washington time, on parameters for debate on the abortion amendment as well as alternative legislation proposed by Republicans. Even as the committee met, a steady stream of lawmakers visited Pelosi’s office to negotiate on abortion.

Anti-abortion Democrats are concerned that lower-income Americans in the proposed health-insurance exchanges could use federal subsidies to pay for abortions. House Republican Leader John Boehner told reporters today that his party also would support the amendment on abortion, and Stupak predicted it would pass. “I think we’ll get more than 39, 40 Democrats,” he said.

Looming Battle

On the other side, Colorado Representative Diana DeGette, a Democrat who leads a coalition of 190 lawmakers who favor access to legal abortion, said her group would oppose any final measure that makes it harder for women to gain access to the procedure.

Some Democrats have voiced displeasure with other aspects of the legislation. Representative Stephanie Herseth Sandlin of South Dakota said she wouldn’t back the measure. “The House bill misses a critical opportunity to address access, quality and costs,” she said in a statement.

Herseth Sandlin, a leader of the Blue Dog Coalition of self-described fiscally conservative Democrats, held out the possibility the measure may be revised during negotiations with the Senate, which would follow passage in each chamber.

Another Blue Dog, John Tanner of Tennessee, issued a statement saying he wouldn’t support the bill because it “will not help control the long-term costs of health care.”

To contact the reporters on this story: Kristin Jensen in Washington at kjensen@bloomberg.net; Nicole Gaouette in Washington at ngaouette@bloomberg.net

Last Updated: November 7, 2009 19:02 EST