Pelosi faces biggest test on U.S. healthcare vote

The leader of the U.S. House of Representatives - a persuasive arm-twister and deal maker - faces her toughest challenge yet in the coming weeks: getting 216 votes to pass final legislation revamping the U.S. healthcare system.

House Speaker Nancy Pelosi is scrambling to hit that number and will likely have to rely solely on fellow Democrats, many of them undecided. All Republicans appear lined up against it.

If all Democrats voted as they did last year on an earlier version of the bill, Pelosi would reach 216. But many may switch from yes to no - or no to yes.

"This is her toughest political and legislative battle since becoming speaker" in 2007," said Ethan Siegal of The Washington Exchange, a private firm that tracks Congress for institutional investors.

"She doesn't have the votes yet, but nobody is counting her out," Siegal said. "She's proven that she knows how to get them."

If Pelosi prevails, President Barack Obama will be a big step closer toward signing into law an overhaul of the $2.5 trillion U.S. healthcare system.

But if Pelosi falls short of 216, a simple majority, public anger about the often-gridlocked Congress may mount, making it more difficult for Democrats to retain control of the House in the November election. If Republicans take over, Pelosi's reign as the chamber first woman speaker would end.

Last year, Pelosi won House approval of virtually every item on Obama's agenda, including a $787 billion economic stimulus package, regulatory reform, pay equity for women and an earlier version of healthcare reform.

Another top priority, legislation to curb global warming, appeared to be in trouble in June. But Pelosi lobbied members, one by one, until she got the votes to pass it.

Though much of the House-passed legislation got stalled in the Senate by Republicans and some energy-state Democrats, Pelosi's long list of successes won her praise from outside congressional experts and got her a runner-up spot in Time magazine's annual "person of the year."

"Pelosi has been as effective as any speaker in modern times," said Norman Ornstein, a congressional scholar at the conservative-leaning American Enterprise Institute.

"A lot of people don't like Pelosi," Ornstein said. "She gets a lot of flak from her left. But she constantly pushes ahead to make the House do things,"

DON'T CROSS PELOSI

Chris Krueger, a congressional analyst at Concept Capitol, said Pelosi is able to effectively work with House Democrats, liberals, conservatives and moderates.

"She also raises money like a rock star (for them), commands loyalty and she is tough," Krueger said. "People are afraid to cross her."

A Democratic leadership aide said, "Pelosi knows members' concerns, she visits their districts, her door is always open to them and she works hard. It's contagious."