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WASHINGTON, Nov 21 (Reuters) - With some crucial conservatives still vowing to defy Republican leaders and vote 'no', the U.S. House of Representatives opened debate on Friday on sweeping legislation to overhaul the Medicare health program for the elderly.
The legislation, a priority of President George W. Bush as he prepares to seek re-election next year, would add a prescription drug benefit to Medicare and introduce far-reaching reforms to restrain costs and expand the role of private managed-care plans in caring for the elderly.
An earlier version of the House bill squeaked through by a single vote in June after Republican leaders extended the time allowed for votes and openly exerted pressure on the floor to pry loose that last vote.
With the outcome still uncertain after a full day of Republican leaders trying to line up votes, lawmakers say a similar drama is possible in the wee hours of Saturday.
Conservatives maintained that the $395 billion 10-year bill was too expensive and included too little market reform.
Prospects of Senate passage improved when Senate Minority Leader Tom Daschle, a South Dakota Democrat, said he would not try to block the bill with a filibuster, a procedural move that would require the Republicans to muster 60 votes but carries some political risk. The Senate plans to open debate on Saturday with a vote likely on Monday.
The concept of adding a drug benefit has wide support, although Democrats say this bill is too skimpy. But the two parties have waged an intense fight over the other changes in the bill designed to contain costs and add market competition.
Democrats say it is the first step toward privatizing Medicare. Republicans say it will save the financially-strapped program for future generations.
Trying to firm up House support, Bush called at least four lawmakers en route home from his trip to London, White House officials said. Earlier in the week, Bush's adviser, Karl Rove, made calls from Buckingham Palace, several lawmakers said.
Tennessee Republican Rep. Zach Wamp said the pressure had been so intense all day that some of his colleagues had gone into "stealth mode" to avoid it.
As the debate unfolded, Republicans said they were improving Medicare by adding drugs and some preventive care while Democrats maintained that the bill would put billions of dollars in the pockets of insurers and drug companies.
"This bill does shockingly little for seniors," said Texas Democratic Rep. Martin Frost.
"It's a poison pill for America's seniors and for Medicare itself," said Robert Menendez, a New Jersey Democrat, saying it would encourage businesses to drop retirees' health care.
Democrats complain that poor people would not get subsidies if they have even a few thousand dollars of assets, and many older Americans would experience a coverage gap called a "doughnut hole" when they would be paying monthly premiums but not getting any benefits.
Indiana Republican Mike Pence, heading a bloc of 19 "solid no conservative votes," said the Republicans should "not veer off the path of limited government that was the vision of (former President) Ronald Reagan."
But he acknowledged the disciplined Republican leadership would likely prevail. "I don't think we'll stop this bill," he said.
House leaders, including Majority Leader Tom DeLay, a Texas Republican respected by conservatives, have been working hard to keep enough of their right wing on board to pass the bill. (Editing by Anton Ferreira; Reuters messaging: firstname.lastname@example.org; 202-898-8300))