WASHINGTON As lawmakers clashed fiercely over major health care legislation on the House floor, Democrats struggled Tuesday to defend procedural shortcuts they might use to win approval for their proposals in the next few days.

House Democrats are so skittish about the piece of legislation that is now the vehicle for overhauling the health care system the bill passed by the Senate in December that they are considering a maneuver that would allow them to pass it without explicitly voting for it.

Under that approach, House Democrats would approve a package of changes to the Senate bill in a budget reconciliation bill. The Senate bill would be deemed passed if and when the House adopts rules for debate on the reconciliation bill or perhaps when the House passes that reconciliation bill.

The idea is to package the changes and the underlying bill together in a way that amounts to an amended bill in a single vote. Many House Democrats dislike some provisions of the Senate bill, including special treatment for a handful of states, like Medicaid money for Nebraska, and therefore want to avoid a direct vote on it.

Republicans paraded to the House floor on Tuesday to denounce the maneuver as a parliamentary trick. Representative Ted Poe, Republican of Texas, said Democrats were using a sneaky snake oil gimmick to pass their bill. Lets have an up-or-down vote on this bill and not hide behind some procedural mumbo jumbo, Mr. Poe said.

At the White House on Tuesday, the debate over procedural tactics proved uncomfortable for President Obamas press secretary, Robert Gibbs. He sidestepped numerous questions about whether Mr. Obama wanted an explicit, separate vote on the Senate bill and deferred to Speaker Nancy Pelosi of California.

The final decision is the speakers, Mr. Gibbs said.

Representative Chris Van Hollen, Democrat of Maryland and assistant to the speaker, said Republicans were trying to deceive the public about the legislation that Democrats were working on.

They want to send a signal to the American people that the product that is going to come out of the House is the Senate bill, but the fact of the matter is we are amending the Senate bill, Mr. Van Hollen said. We are going to get rid of the Nebraska deal. We are going to get rid of other provisions in the Senate bill that shouldnt have been there.

The House Democratic leader, Representative Steny H. Hoyer, also defended the maneuver on Tuesday. It is consistent with the rules, Mr. Hoyer said. It is consistent with former practice.

An analysis of the procedural device prepared by Ms. Pelosis office says, Some opponents of reform are objecting to the process in an attempt to kill the bill.

But some Democrats who support the bill have expressed reservations about the maneuver and said House leaders might rethink their plans if the chorus of criticism continued to grow.

House Democratic leaders said they still expected the full House to vote on health care by this weekend, even though they are still tinkering with the text of the legislation and do not have a final cost estimate from the Congressional Budget Office.

Democrats are trying to hold the cost of the new insurance coverage provisions in the bill to roughly $950 billion over 10 years, in keeping with a limit suggested by the president. Also, under budget reconciliation rules, they must meet goals for reducing future deficits.

To make the numbers come out right, Democrats said, they are considering bigger cuts in payments to private Medicare Advantage plans, which cover about one-fourth of the 45 million Medicare beneficiaries. And they may ask pharmaceutical companies to pay more to help close a gap in Medicare coverage of prescription drugs.

Ms. Pelosi said she had a massive whip operation trying to round up votes for the bill.

The ferocious floor fight on Tuesday was the opening clash in what is shaping up to be the decisive week in the yearlong battle over health care legislation.

Democrats are aiming for a vote by the weekend that would approve both the bill that the Senate adopted on Dec. 24 and a package of changes in an expedited budget reconciliation bill.

In a fusillade of one-minute speeches, the two sides argued over both substance and procedural issues.

Republicans on Tuesday accused Democrats of resorting to legislative sleight of hand by planning to approve the Senate-passed health care bill tucked into the rule that sets the parameters of debate rather than holding a stand-alone vote on the Senate measure and a separate vote on a package of revisions to be included in an expedited budget bill.

The Democrats, in turn, said the Republicans were arguing about arcane rules and procedures because they could not make a cogent, substantive case against the legislation.

Democrats said the procedures they wanted to focus on were insurance industry practices that the legislation would ban, including denying coverage based on pre-existing medical conditions, imposing annual and lifetime limits on benefits, and revoking coverage on technical grounds even when premiums have been paid in full.

Either you want to stand up for the American people, or you want to stand up for the insurance companies, said Representative Ben Ray Lujn, Democrat of New Mexico.

Democratic leaders said they were confident that they could muster the 216 votes needed to pass the legislation, though they stopped short of claiming to have firm commitments in hand.

I believe that we have the votes, and I am confident about our victory, said Representative John B. Larson of Connecticut, the Democratic conference chairman.

If Mr. Larson is right, however the House approves the Senate bill either deeming it approved as part of the rules of debate, or with a stand-alone roll call vote President Obama would be able to declare victory on his top domestic priority.

House Republicans said Tuesday that they were intent on never letting that happen.

The American people are appalled by what they have seen in this health care debate, but the worst is still ahead, the Republican leader, Representative John A. Boehner of Ohio, thundered in his speech.

Mr. Boehner added: The majority plans to force the toxic Senate bill through the House under some controversial trick. There is no way to hide from this vote. It will be the biggest vote most members ever cast.

His comments made clear that Republicans would hold Democrats responsible for the health care legislation regardless of the procedures used to advance it.

The campaign committee for House Republicans, the National Republican Congressional Committee, unveiled a television advertisement on Tuesday that warns wavering Democrats they will be held accountable if they vote for the health care bill.

The ad describes the legislation as a corrupt bill filled with pork-barrel spending and special deals for Florida, Louisiana and Nebraska.

Republicans on Tuesday also attacked a plan by Democrats to overhaul federal student loan programs that will be included in the budget reconciliation bill along with the health care revisions.

Democrats say the existing program is a giveaway to private banks, which are paid fees to make risk-free loans using taxpayer money.

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