By Laurie Kellman
WASHINGTON (AP) - The landmark health care bill about to be signed into law is as large as it is due in no small part to House Speaker Nancy Pelosi's stewardship. When Democrats in Congress and the White House were despondent and inclined to retreat on health care just two months ago, Pelosi stood firm against despair and downsizing.
As a result, she could emerge from the yearlong struggle among the most powerful speakers in history.
'It's safe to say that she's going to change some of the ways that we look at effective speakers, and maybe create a new definition of how to get things done under incredibly difficult circumstances,' said Ray Smock, who was House historian for a dozen years under former speakers Tip O'Neill, Jim Wright and Tom Foley.
Those close to Pelosi say she considers health care reform a moral imperative that transcends political ambitions and election cycles. But she invoked those baser ambitions, too, as she coaxed and cajoled everyone from President Barack Obama and his aides to her Democratic troops behind a bill to extend health coverage to 32 million uninsured Americans.
''We are not kicking this can down the road,'' Pelosi told Obama by phone last month just before their seven-hour televised health care conference, according to Rep. Louise Slaughter of New York and three other officials who heard the call.
It was an abrupt reminder to those on the White House end of the line: Whatever is said at the big bipartisan meeting, there would be no substantive rewrite of the bill as Republicans were demanding. Obama said he understood and agreed: They were moving in one direction only, toward passage. And soon.
'She has this singular focus,' Slaughter said Monday. 'This really is her bill.'
It is, of course, Obama's bill, too. The president campaigned on making health care reform his top domestic priority, shuttled around the country selling the idea on a skeptical public, leaned hard on lawmakers and postponed a foreign trip to see it through.
But there probably would be no comprehensive health care bill without Pelosi's influence, which extended beyond Capitol Hill.
When Democrats panicked after Republican Scott Brown won Edward Kennedy's Senate seat, Pelosi rebuffed feelers by White House Chief of Staff Rahm Emanuel and others for a smaller version of the bill. She dismissed that approach as incrementalism and derisively dubbed it, 'kiddie care.'
Observers said Pelosi succeeded in part because of her willingness to work each wavering member's political calculus, their concerns and their moods for a year until the arithmetic added up to the crucial 216 votes required for passage. And that didn't happen until a few hours before the vote late Sunday night, a 219-212 victory.
There was a swagger in her. As Congress was leaving town for last summer's recess, she challenged the notion that liberals in the party might sink the bill because it was not ideologically pure. 'Are you asking me, 'Are the progressives going to take down universal, quality, affordable health care for all Americans?' she told reporters. 'I don't think so.'
With some lawmakers, she was abrupt.
In a private caucus meeting in October, Rep. Earl Pomeroy, D-N.D., interrupted Pelosi's presentation about one version of the bill with questions about its cost. According to Pomeroy and others, she cut him off - twice - with a question of her own:
Is there any version you could support? she asked.
Yes, he said, but not the one likely to pass. Pelosi moved on.
They patched things up, and on the final vote Sunday, Pomeroy was a yes.
The final crunch did not come until a week before the vote. On the plane from her home near San Francisco back to Washington, Pelosi began making calls to the 68 Democrats said to be wavering on the bill. Pelosi, the first female speaker of the House, is a former Democratic whip, the vote counter, and clearly has not lost that skill.
With others, she delegated. A knowledgeable Democratic official said that Pelosi, a Roman Catholic, asked the Rev. Theodore Hesburgh, president emeritus of Notre Dame and frequent appointee to presidential commissions, to call Rep. Joe Donnelly of Indiana on behalf of the legislation. In the end, Donnelly voted yes.
As the week wore on, Pelosi peeled off Rep. Marcy Kaptur of Ohio, one of the Democrats holding out because they did not consider the bill to have an adequate firewall against taxpayer dollars being used to subsidize abortion coverage.
Kaptur said in a telephone interview that on the House floor and elsewhere, she suggested some ways to amend the bill. And each time Pelosi made clear that that would be impossible.
'She just shook her head to me, and I knew that the option was off the table,' Kaptur said. 'Through body language, facial expressions, she lets you know that.'
Kaptur worked through her concerns with the White House and endorsed the bill on the day of the vote.
And by convening the rest of that faction in one room of the speaker's suite and female abortion-rights Democrats in a nearby parlor, Pelosi was able to broker the content of a presidential executive order that restated existing law banning federal money from being used for elective abortions.
The speaker didn't succeed with everyone. On Thursday, she could be spotted sitting in a back corner of the House chamber with Rep. Zack Space of Ohio for more than 30 minutes, talking health care reform. In the end, Space was one of 34 Democrats who voted no.
Even Pelosi's top Republican detractor, GOP Leader John Boehner, acknowledges her skill. But in her drive, he said, Pelosi stopped listening to Americans 'screaming' to stop.
'She is a strong speaker, there isn't any question about that,' Boehner said. But if Democrats lose their majority because of the legislation, 'How smart is that?'