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US on the brink of sweeping health care reforms

After a debate that has consumed US politics for nine months, the House of Representatives last night edged towards passage of the most sweeping health care reform in nearly half a century; reshaping an expensive and inefficient sector that accounts for a sixth of the economy.

As the final showdown approached over a $940bn (£625bn) measure on which Barack Obama has virtually staked his Presidency, Democratic leaders were confident they had rounded up the majority of 216 votes needed for passage. “We have the votes now, as we speak,” claimed John Larson, head of the House Democratic Caucus, on ABC's This Week programme.

But simple maths pointed to a cliff-hanger. With all 178 House Republicans set to vote “no”, the Democrats had to find the 216 votes on their own. At least 30 of the party's 253 members have indicated they would oppose the bill, meaning that the outcome hinged on a handful of undecideds.

Yesterday, frantic negotiations for their support continued, apparently with some success. Most of the holdouts were socially conservative Democrats demanding tighter curbs on federally-backed insurance coverage for abortion, and who regard the Senate bill, on which the House will be voting, as too lax. The most likely compromise was for Mr Obama to issue an executive order to that effect.

As the political temperature inside the Capitol building increased, tensions boiled over outside, where thousands of protesters, many of them from the grass roots “Tea Party” movement, had gathered.

On Saturday evening, some heckled and hurled insults at black and gay lawmakers, among them the veteran Georgia Congressman John Lewis, a hero of the 1960s civil rights movement. “They were shouting the n-word,” a colleague of Mr Lewis said.

Two critical votes were scheduled last night. In the first, the House was deciding whether to adopt the bill passed by the Senate on Christmas Eve. If approved, that measure would be sent to Mr Obama for his signature, and health reform would become law.

The second vote was on a package of fixes to meet House objections to the Senate version. If approved, it would go to the Senate under a procedure that requires only a simple majority of 51 votes, not the 60-vote one that the Democrats lost in January.

The US is the only advanced industrial country that does not provide guaranteed healthcare coverage for all its citizens.

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