The Obama administration and the Democratic leadership appears to have finally won its titanic struggle to pass health care reform, after a last-minute compromise on abortion designed to win over wavering conservative Democrats just hours before the crucial vote this evening in Washington.

The deal requires President Obama to issue an executive order barring the use of federal funds for insurance that could pay for abortions. While it will cause dismay among the Democratic party's liberal wing, the passage of the healthcare legislation is an enormous triumph for the Obama administration, and one on which Obama's presidency will now stand.



The talk from the Democratic House leadership is that it now has the votes – over the crucial 216 level – to pass the healthcare reform bill before it. The Republicans, meanwhile, are forced back on procedural delaying tactics.

In scenes more reminiscent of Britain's Commons on a bad day, the congressional debate was punctuated by points of order and bitter complaints about rules, speaking order and timing, as tempers flared on the House floor.

As the vote drew closer, attention focussed on on Bart Stupak, the Democrat congressman who authored the controversial "Stupak amendment" on the original House bill that placed onerous conditions barring abortion provision from health insurance subsidised by federal funds. The last-minute deal was lashed together, involving President Obama, in order to win over Stupak and several of his allies.

Stupak held a late afternoon press conference announcing his dramatic change of heart, and pledged that he and several of his anti-abortion conservative Democrat colleagues would support the bill after seeing President Obama's proposed executive order.

Crucially, the Stupak bloc gives the Democrats some leeway and a cushion of extra votes, so that no vulnerable Democrat representative can be targeted as the single "swing" vote that passed healthcare reform during November's 2010 midterm elections.

Meanwhile, unions were upping the pressure on another key vote, Pennsylvania congressman Jason Altmire, who remains a declared "no". Now a letter from the AFL-CIO president tells Altmire: "Congressman, we will not be able to explain to the members of our unions why you voted against this bill. The feeling of betrayal will be very deep and long-lasting."

A sign of how tough the battle has become, when Democrat representatives took their seats this afternoon, many of them found a sheet with the portraits of the House Democrats who voted for Bill Clinton's controversial budget bill after a similar, bare-knuckle partisan battle. All of them lost their seats in the 1994 election.

Outside on Capitol Hill there were a continuation of the ugly scenes seen on Saturday. The New York Times politics blog reported: