Obama Pushes Health Reform in Ohio as Democrats Scramble for 216 Votes

Updated 4:16 p.m.

It’s a line that’s been heard many times over the past year, but Democrats’ health care reform efforts truly could be entering their make-or-break stretch this week.

President Obama headed to Ohio Monday afternoon to make the case for reform at a rally near Cleveland.

“I believe Congress owes the American people a final up-or-down vote. We need courage,” he said. “I am calling on Congress to pass these reforms — and I am going to sign them into law.”

Back in Washington, House Speaker Nancy Pelosi is working to secure the 216 votes she will need to make that possible.

Democrats hold 252 seats in the House, so if no Republicans vote for the bill — which seems likely — Pelosi can afford to lose only 36 votes.

On the Sunday talk shows over the weekend, Democrats sounded confident that they could pull the votes together this week. “I think we will have the votes to pass this….It’s a struggle, but I believe we are moving in the right direction.” White House adviser David Axelrod said on CNN’s “State of the Union.”

White House spokesman Robert Gibbs echoed the sentiment on “Fox News Sunday,” saying: “We’ll have the votes when the House votes within the next week.”

Other Democrats were slightly more guarded. Rep. James Clyburn, D-S.C., said on NBC’s “Meet the Press” that “We don’t have [the votes] as of this morning, but we’ve been working this thing all weekend.” He added, however, “I’m also very confident that we’ll get this done.”

Republicans vowed to do what they could to stop the legislation. “We’re going to do everything we can to make it difficult for them, if not impossible, to pass a bill,” House Minority Leader John Boehner said on “State of the Union.”

Meanwhile, the legislative path that Democrats will try to take to a final bill is still not entirely settled. Fundamentally, Democratic leaders want to pass the bill that the Senate approved last year through the House, after which the president can sign it directly into law without needing to go through the Senate again. That’s important, because Democrats now have only 59 votes in the Senate, not the 60-vote supermajority needed to stop a filibuster.

At the same time, the House and then the Senate would pass a separate bill with amendments to the legislation — fixes that House Democrats want, such as offering more subsidies to low- and middle-income Americans — through a process called reconciliation, which cannot be filibustered.

That’s complicated enough, but there are also multiple ways that the whole legislative process can happen. The New Republic’s Jonathan Cohn explains:

According to the sources–which include a senior House leadership aide–three options are on the table:

1) The House would vote on the two bills separately. Upon passage, the Senate bill would be ready for the president’s signature. The amendments, meanwhile, would go to the Senate for approval there. Call this the “Schoolhouse Rock” option.

2) The House would vote once. The vote would be on the amendments. But with that vote, the House would “deem” the Senate bill passed. (Yes, it can do that.) At that point, the main bill would be ready to go to the president for his signature, while the amendments would go to the Senate for consideration there.

3) The House would vote once, just like in option (2). But in this case, the House would deem the Senate bill passed only after the Senate had approved the amendments. Once the Senate approved the amendments, then–and only then–could the main bill go to the president for signature.

While those procedural questions are being worked out, Democrats have already started moving the reconciliation bill through the House.

Democratic staffers worked through last week and over the weekend to draft it. Monday afternoon, the House Budget Committee voted 21-16 to move the still-unfinished bill forward (two Democrats voted with Republicans on the committee against the bill. Next it will go to the House Rules Committee, which will make more changes. If that committee votes it through, the bill will move to the full House for a vote. Politico has a memo from Rep. Chris Van Hollen, D-Md., an assistant to Speaker Nancy Pelosi, laying out a tentative timeline that culminates with a House vote Friday or Saturday.