WASHINGTON -- The House voted 224-206 Sunday to approve the rules for debate of a massive health insurance overhaul that evidently satisfies few but is viewed by House Democrats as better than no reform.
House Republicans were doing all they could to slow the increasingly inevitable march toward the overhaul and were joined by 28 Democrats who voted with Republicans against the rule, which laid out plans to limit debate.
Two more showdown votes were left -- passage of the Senate bill and then the package of changes to the Senate-passed bill, including deletion of special Medicaid benefits for Nebraska known as the " cornhusker kickback" and other deals made to win Senate support.
President Obama will have to sign the Senate bill into law before any "fixes" bill goes to the Senate under fast-track rules that would enable Democrats to pass it without facing a Republican filibuster. Democrats control 59 of the Senate's 100 seats, one vote shy of the number needed to overcome bill-killing filibusters from a united GOP.
But senators have given no guarantees they will pass the fixes, which are strictly the wishes of House Democrats.
Dismissing calls for months to scrap the plan and start over, House Democrats grew increasingly confident throughout the day that they would have the 216 votes needed to pass the legislation approved in the Senate on Christmas Eve.
Dilatory tactics aimed at pushing the vote later into the evening did little to comfort opponents of the massive $870 billion, 10-year plan.
Seeing the writing on the wall, Rep. David Dreier, R-Calif., managing the time for Republicans as the ranking member on the House Rules Committee, repeatedly asked for a clock check during debate on the rules to be employed for passing the legislation.
That was followed by a parade of Republicans seeking to "revise and extend" their remarks, a privilege aimed at allowing them to add their statements to the Congressional Record while also showing the GOP's unified opposition.
The parade came shortly after Democratic Rep. Bart Stupak of Michigan, the leader of a bloc of pro-life Democrats said he would accept an executive order by President Obama reaffirming his commitment to existing law banning federal funding for abortion except in rape, incest and dangers to the life of the mother.
The decision to go with the president's executive order -- which Stupak hinted was moot since House lawmakers had the 216 votes needed for passage -- was met with anger by pro-life Republicans, who said acceptance of the president's word was tantamount to a pro-choice vote.
"From a pro-life prospective, I find absolutely no comfort in this executive order. This puts the fate of the unborn in the hands of the most pro-abortion president in history," said Rep. Joe Pitts, R-Pa., hearing about
At the dais, Rep. Jesse Jackson, Jr., played the umpire as lawmakers squabbled over points of order and parliamentary inquiries accompanied by boos, shouting and general disorder that resembled more the unruly British House of Commons than the U.S. House of Representatives.
Jackson, serving as the presiding officer over House rules, was forced to umpire several exchanges between Rep. Louise Slaughter, D-N.Y., the chairwoman of the Rules Committee, Dreier.
With arms crossed and a booming voice, he declared the chamber out of order on several occasions, including when the jeering began during an exchange between Slaughter and Dreier about whether the Senate bill becomes law with or without House "fixes."
When Slaughter acknowledged that passage of the Senate bill would become law without obligation by the Senate to pass fixes proposed by the House, Dreier cut her off. Yelling began on both sides as Jackson shouted for order.
"The House is not in order," he yelled in an effort to overpower the cacophony.
Prior to the beginning of debate, House Democratic leaders walked in lockstep outdoors -- the long route to the House floor -- to convey their unity of mind in passing the bill.
As debate began, Rep. Paul Ryan, R-Wis., called the bill the "mother of all unfunded mandates."
Slaughter responded that it was time to stop talking about procedure and begin delivering health care to those who are currently without it.
President Obama spent Sunday in the West Wing making and taking calls with lawmakers as Democrats worked to lock down votes on the bill. He postponed a trip to Indonesia, Australia and Guam to work the phones and win a victory on his signature piece of legislation.
He was expected to speak after the final vote.
Earlier in the day, Rep. Brian Baird, D-Wash., was the earliest Democrat Sunday to announce a switch to a "yes" vote.
House Majority Leader Steny Hoyer and Connecticut Rep. John Larson, chairman of the Democratic caucus in the House, said they have the votes needed to pass the bill but had yet to nail down commitments from a handful of members.
"There are still members looking at it and trying to make up their minds," Hoyer said on "Meet the Press" in the hours before the vote. He added that the holdouts numbered in "the low single digits."
"We think there are going to be 216-plus votes when we call the roll," Hoyer said.
Larson stopped just short of declaring victory.
"We have the votes now -- as we speak," Larson, D-Conn., said on ABC's "This Week."
But Rep. Debbie Wasserman Schultz, D-Fla., the party's deputy whip, said the votes were not yet in hand, telling "Fox News Sunday" that Democrats were still short of "a hard 216."
A persistent snag tying up lawmakers is the widespread distrust among House members that the Senate would be able to pass the "fixes" to the bill. Clyburn's Senate counterpart, Sen. Dick Durbin of Illinois, said on CBS' "Face the Nation" that he has commitments of support from at least a majority of the 100-member chamber, but Democratic leaders have not released a list of supporters.
Republicans remain resolutely opposed to the legislation and warned they will make Democrats pay dearly in the fall elections if the fiercely debated measure becomes law.
"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," Rep. Eric Cantor of Virginia, the House's second-ranking Republican, told ABC.
The Associated Press contributed to this report.