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A vote is under way in the US House of Representatives on a healthcare reform bill at the heart of President Barack Obama's domestic agenda.

The result, after impassioned debate, is expected to be very close, with no Republicans supporting the measure.

Senior Democrats believe they have the 216 votes needed to pass the bill, after days of negotiations to persuade wavering party members to back it.

If passed, the measures would extend health coverage to 32m more Americans.

On the floor of the House, Republicans and Democrats have been arguing fiercely over procedural issues governing the terms of the debate.

The first hurdle towards approving the reforms was cleared when the House voted by 224 to 206 to pass a set of rules governing the debate.

Lawmakers are expected to hold two more key votes, one on a Senate version of a health reform bill and one on a package of changes that would be made to that bill.

ANALYSIS Mark Mardell, BBC News, Washington

Emotions have been running high at times with Republicans warning of Government tyranny, European style nanny state and an end to freedom. Equally emotional speeches from the other side talked about "healing America". But the real work was going on behind the scenes to secure the last necessary votes. Negotiations had been going on for several days with Bart Stupak, who leads anti-abortion Democrats. He won an executive order to be signed by the president once the vote has taken place.

Read Mark's thoughts in full

Speaking before the debate, Democratic House Caucus leader John Larson said: "We have the votes. We are going to make history today."

House Speaker Nancy Pelosi, who was heckled by anti-reform demonstrators on her way to the Capitol, said: "We are doing this for the American people."

In a move designed to win the support of a bloc of anti-abortion lawmakers, Mr Obama on Sunday announced he plans to issue an executive order assuring that healthcare reform will not change the restrictions barring federal money for abortion.

The Republicans are unanimously opposed to the legislation, which they say is unaffordable and represents a government takeover of a large part of the country's economy.

Senior House Republican Mike Pence told CNN he was doubtful the Democrats did have the votes needed to approve the bill and said his party would do whatever it could to prevent its passage.

VOTES BEFORE HOUSE

Vote on rules governing debate on the reconciliation package and the Senate health reform bill Vote on reconciliation package, setting out "fixes" to be made to Senate bill Vote on Senate bill itself

Q&A: US healthcare reform Your views on healthcare reform Obama's speech: Full text

Eric Cantor, the second-ranking Republican in the House, told ABC: "The American people don't want this to pass. The Republicans don't want this to pass. There will be no Republican votes for this bill."

If all three votes are passed in the House, Mr Obama will be able to sign the legislation into law.

Democratic Senate Majority Leader Harry Reid assured House lawmakers on Saturday he had the "commitment of a significant majority" in the Senate to ensure the package of changes the House wants to its bill will pass there.

The BBC's Richard Lister in Washington says that whatever happens, this will be a significant day in American politics.

Either healthcare will be significantly reformed, he says, or reform will be kicked into the long grass for perhaps decades to come - which could have all kinds of budgetary implications for the future, as the US cannot afford to continue on its existing track.

If passed, the reforms will deliver on Mr Obama's top domestic priority by providing insurance to some 32 million of the Americans who currently lack coverage.

Deficit reduction

The House of Representatives and the Senate adopted different versions of the bill in November and December.

The usual procedure would be for two versions of legislation to be combined into a single bill for Mr Obama to sign into law.

But after Senate Democrats lost the 60-seat majority required to defeat a filibuster by Republicans, Democratic leaders decided to use a controversial procedure to ensure the bill's passage.

Under the plan, the House will vote on a package of reconciliation "fixes" amending the Senate bill.

The Senate will then be able to make changes in a separate bill using a procedure known as reconciliation, which allows budget provisions to be approved with 51 votes - rather than the 60 needed to overcome blocking tactics.

According to Congressional Budget Office, the final version of the Democrats' healthcare plan will cut the federal deficit by $138bn over 10 years.

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The non-partisan body said the proposed legislation would cost about $940bn over a decade.

The reforms would increase insurance coverage through tax credits for the middle class and expansion of the Medicaid programme for the poor.

If approved, they would represent the biggest change in the US healthcare system since the creation in the 1960s of Medicare, the government-run scheme for Americans aged 65 or over.

US HEALTHCARE AND WORLD COMPARISONS Healthcare reform is a priority for Barack Obama. The US spends about $2.2tn a year on its system - which includes private, federal or employer schemes. US expenditure on healthcare is the equivalent of about 16.2% of GDP - nearly twice that of some other OECD countries. The US falls behind some OECD countries for life expectancy and has a higher rate of infant mortality. Almost 46m US citizens do not have health insurance. BACK {current} of {total} NEXT

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