In an 11th-hour barrage, both sides in the health care debate are pouring millions of dollars into last-minute television commercials aimed at influencing the votes of members of Congress.

The air wars over health care have already steered more than $200 million to local broadcast and cable outlets, making the issue the most expensive single advocacy campaign in a single year. Most of that money, especially in recent months, has been spent in opposition to the Democratic attempt to overhaul the health care system.

The newest commercials include one, above, from Americans for Prosperity, a conservative group opposed to a health care bill. Its advertisement, which is running in 18 Congressional Districts and costs $750,000, features a woman who says new guidelines from a government panel on delaying mammograms would have left her cancer undetected.

And the ads include one from Americans United for Change, a liberal group that supports the legislation. It is spending $500,000 on radio and television commercials featuring President Obama and attacks against the insurance industry. It is aimed primarily at African-Americans viewers and their representatives.

The new buys come on top of an announcement earlier this week by a coalition of business groups, including the United States Chamber of Commerce, that it would spend between $4 million and $10 million on a new round of commercials to try to stop the legislation. America’s Health Insurance Plans, the trade group for insurance companies, also said it would buy more than $1 million of television time to explain why insurance premiums have been rising.

With such cacophony in the air, it is not clear how influential this last-minute round of advertising will be. Read more…

Of all the grief Democrats have taken in the health care debate, perhaps no aspect of it caused greater heartburn than the extra Medicaid money for Nebraska that Senate Democratic leaders inserted into the Senate bill in hopes of locking in the support of Senator Ben Nelson, Democrat of Nebraska.

Mr. Nelson has long since disavowed the provision, which Republicans continue to deride as the “Cornhusker kickback.” Democrats plan to remove it from the final health care legislation.

Harry Hamburg/Associated Press Senator Ben Nelson on Capitol Hill on Wednesday.

But now that Democrats are planning to include an overhaul of student loan programs in the expedited budget package along with the final health care legislation, they may end up losing Mr. Nelson’s support anyway.

Mr. Nelson is a strong ally of Nelnet, a private student lending company based in Nebraska. Nelnet is one of several private banks whose lending practices have been questioned by federal and state officials.

In 2007, the Bush administration determined that Nelnet improperly collected $278 million in federal subsidies, but the company was allowed to keep the money.

Jake Thompson, a spokesman for Mr. Nelson, said that the senator would wait to see final legislative language before deciding how to vote, but that Mr. Nelson was reluctant to support any legislation that ended the role of private banks in federal student loan programs.

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The Congressional Budget Office on Thursday released a revised cost analysis of the health care bill that the Senate adopted on Dec. 24.

The new cost analysis does not include the various changes that President Obama and Congressional Democrats are planning to include in an expedited budget package. But the updated numbers are necessary for Democrats to move forward with the budget reconciliation process.

The new budget office analysis puts the price tag of the new insurance coverage provisions in the Senate-passed bill at about $875 billion over 10 years, an increase of about $4 billion from the previous estimate. Because the cost would be more than offset by revenues from new taxes and reductions in government spending, particularly to slow the growth of Medicare, the budget office predicted that the bill over all would reduce future federal deficits by $118 billion over 10 years.

In its earlier estimate, the budget office said the bill would reduce future deficits by $132 billion.

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Alex Wong/Getty Images The House speaker, Nancy Pelosi, at a press conference on Capitol Hill on Friday.

House Speaker Nancy Pelosi said at a news conference Friday that she was hopeful the House would vote on far-reaching health care legislation by March 21 and that President Obama would be in Washington see it happen.

The White House said Mr. Obama had delayed his departure for a trip to Guam, Indonesia and Australia to March 21, from next Thursday, so he could stay in Washington to rally support for the health care bill.

Ms. Pelosi said Democrats were nearly ready to move forward but were still waiting for a cost analysis of the bill from the Congressional Budget Office.

“I’m delighted that the president will be here for the passage of the bill,” Ms. Pelosi said. “It’s going to be historic. And it would not be possible without his tremendous, tremendous leadership, his persistence, his concern for the American people, always guided by his statement that we will measure our success by the progress being made by America’s working families. This legislation not only makes history, but it will make progress for America’s working families.”

Pressed on the timing, Ms. Pelosi said she would not commit to March 21 as a firm deadline. “I said we’ll take the time that we need to pass the legislation,” she said. Still, she acknowledged her hope that the bill would be approved before Mr. Obama left the country. “I’m hoping it will be in that time frame,” she said.

Ms. Pelosi said House Democrats were also happy that a proposed overhaul of student loan programs would be included with the health care legislation in an expedited budget measure. The education bill is popular in the House, and Democrats believe it will help generate further support for the health care bill.

The speaker said it offered a reminder of how successful the House had been in carrying out the Democratic agenda.

“If I may just step back for a moment, this goes back to our budget bill that we passed in the House a hundred days after the president’s inauguration,” she said. “So calculate that, in the spring of last year. In that bill the president had a blueprint in the budget, for lowering taxes, reducing the deficit, creating jobs, stabilizing our economy well into the future, around three pillars. Those three pillars were investments in education and innovation, which go together; investments in energy and climate change; and investments — first among equals — in health care.”

Ms. Pelosi continued, “We have passed all three of those bills.”

Senate Democrats approved their version of health care legislation on Dec. 24, but they have approved neither the education measure nor a climate change bill.

Alex Wong/Getty Images Marcelas Owens, 11, with pictures of his mother, who died of untreated hypertension after losing her health insurance, at a rally sponsored by Democrats on Thursday in Washington.

Senate Democratic leaders on Thursday sought to put a human face on the health care debate, and a cute face at that.

Marcelas Owens, a fifth grader from Seattle who turned 11 on Wednesday, joined the Senate majority leader, Harry Reid of Nevada, and other senior Democrats at a news conference on Thursday.

“We know health reform is not about numbers, it’s about people,” Mr. Reid said. “It’s about pain, real pain, suffered by real people.”

The boy’s mother, Tiffany Owens, died of pulmonary hypertension in 2007 at age 27 after losing her health insurance because she could no longer work. Ms. Owens had been an assistant manager at a Jack in the Box restaurant.

Senator Patty Murray, Democrat of Washington, said that she met Marcelas at a rally in support of major health care legislation earlier this year. “After I spoke, I turned around and there was this little boy standing next to me looking right straight up at me with his big brown eyes and said to me, ‘You can’t let anybody else die like my mom did.’ Well, that kind of takes you back.”

Marcelas, whose grandmother accompanied him to Washington, said, “I want Barack Obama and Congress and everybody to come together and help get the health care bill passed.”

Bringing everyday folks into contentious political debates can be perilous. And the conservative blogger, Michelle Malkin, quickly chastised the Democrats, calling Marcelas, “a new, dubious poster boy for Demcare.”

But Marcelas seemed up for the challenge. He said that he intended to be an advocate for expanded health care coverage, as was his mother.

As Democratic Congressional leaders and the White House struggle to finish the details of major health care legislation, House Democrats are desperately trying to prevent another of President Obama’s top legislative priorities — an ambitious overhaul of student loan programs — from becoming a casualty of the health care battle.

Democrats in the Senate, where the private student lending industry has strong allies, predicted that the education bill would not be part of an expedited budget measure containing the final revisions to the health care legislation. Other Democrats said that such a move would stall the student loan changes at least for several months and perhaps kill the overhaul altogether.

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The Senate Republican leader, Mitch McConnell of Kentucky, said that President Obama’s new initiative to root out fraud in government health programs could be accomplished without the Democrats’ expansive health care legislation.

“The White House seems to be throwing out every idea it’s got, hoping something will stick,” Mr. McConnell said in a speech on the Senate floor. “I’m glad the administration wants to use the enforcement power of the government to find and prosecute fraud. But that’s something we can and should be doing already. Do we really need to pass a $2.5 trillion spending bill, raise taxes and slash Medicare to implement it?”

Mr. McConnell added: “Finding waste, fraud and abuse is one of the areas where we have agreement — Senators Grassley, Coburn, Cornyn, Lemieux and others have been leading this effort for some time. Tackling fraud and abuse is one of the issues that can and should form the basis of a bipartisan, step-by-step approach to health care reform — not as a hook to drag this monstrous bill over the finish line.”

Mr. McConnell said that Democrats should abandon the bigger legislation, then work with Republicans to fight fraud and abuse. “Democrat leaders should leave this bill on the field,” he said. “Then we can talk about passing common sense ideas like tackling fraud and abuse on their own — one by one.”

President Obama will use a visit to Missouri this afternoon to announce a new plan to crack down on fraud and waste in government health programs, including Medicare and Medicaid.

Alex Brandon/Associated Press President Obama spoke to reporters at the White House on Wednesday.

The program would seek to recoup taxpayer dollars by offering financial rewards to private auditors who root out improper payments, the White House announced. The administration said pilot programs using the tactic had been “highly effective” and projected that the use of so-called payment recapture audits could recover at least $2 billion in taxpayer money over the next three years.

Mr. Obama has issued a presidential memorandum directing federal departments and agencies to expand the use of such audits, and he also announced his support for a bill, separate from the Democrats’ big health care legislation, to expand the government use of the audits.

The White House said that a pilot program run by Medicare in three large states — California, New York, and Texas — recaptured $900 million for taxpayers from 2005 to 2008.

Reclaimed money currently can be used to pay for “recapture audits” in the Medicare fee-for-service program and for government contracts at 20 major agencies that engage in more than $500 million in government contracting. But the administration said this program left out other agencies, as well as grants and payments made to state and local governments.

The White House said the bill had bipartisan support, including the backing of Senators Tom Carper, Democrat of Delaware; Claire McCaskill, Democrat of Missouri; Tom Coburn, Republican of Oklahoma; and Susan Collins, Republican of Maine.

Gerald Herbert/Associated Press Kathleen Sebelius, secretary of health and human services, spoke to insurance industry executives on Wednesday.

Kathleen Sebelius, the secretary of health and human services, pleaded with insurance companies on Wednesday to scrap their campaign against President Obama’s health care bill and to work with the White House to pass it.

Instead of attacking the president’s proposal, Ms. Sebelius said, insurers should use their assets, their influence and their bully pulpit to win approval for the legislation in Congress.

Speaking at the annual policy conference of America’s Health Insurance Plans, a trade group, Ms. Sebelius said, “It’s not too late to work on this issue together, for insurance companies to come to the table and work with us.’’

In addition, Ms. Sebelius asked insurance companies to disclose all their requests for increases in premiums, along with data showing costs and other factors that would justify the higher rates.

Karen M. Ignagni, president of America’s Health Insurance Plans, immediately accepted the suggestion. She said her group would work with the National Association of Insurance Commissioners to develop a standard template for disclosure of data on premiums and costs.

In addition, Ms. Ignagni said her group would quickly suggest specific ways to improve the bill by strengthening its control of health costs.

Ms. Sebelius complained that “over the last year, we have seen tens of millions of dollars, by the insurance industry, spent on ads and lobbyists to help kill health reform.’’

The secretary said she could not understand such efforts, because Mr. Obama was not trying to “eliminate the private insurance market and go to some kind of single-payer system like Europe or Canada.’’

Indeed, the president’s proposal would provide hundreds of billions of dollars in tax credits to help moderate-income people buy private health insurance.

Ms. Sebelius, a former governor and insurance commissioner in Kansas, sounded exasperated at the pace of change.

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