The yearlong legislative fight over health care is drawing to a frenzied close as a multimillion-dollar wave of advertising that rivals the ferocity of a presidential campaign takes aim at about 40 House Democrats whose votes will help determine the fate of President Obama’s top domestic priority.The coalition of groups opposing the legislation, led by the United States Chamber of Commerce, is singling out 27 Democrats who supported the health care bill last year and 13 who opposed it. The organizations have already spent $11 million this month focusing on these lawmakers, with more spending to come before an expected vote next weekend.
An alliance of groups supporting the health care plan, which works closely with the White House and Democratic leaders, had been spending far less and focusing on fewer districts. But after pharmaceutical companies made a $12 million investment for a final advertising push, spending by both sides for the first time is now nearly the same.
Not only are these swing Democrats being pummeled in the new spate of advertising — which could total $30 million before week’s end — but extensive efforts are under way in Congressional districts, where groups on both sides of the issue are using tactics similar to get-out-the-vote drives to urge constituents to contact their lawmakers. Mr. Obama is calling lawmakers, too, and on Monday is traveling to Ohio to open a weeklong campaign to close this act of the health care debate.
Representative James E. Clyburn of South Carolina, the No. 3 Democrat in the House, said Sunday on “Meet the Press” on NBC that he had yet to lock down enough votes to pass the bill. But he added: “We’ll be working it going into the week. I am also very confident that we’ll get this done.”
Several on-the-fence Democrats said they were scrambling to sort out their constituents’ views as the outside noise grows deafening.
“There is definitely more passion from people opposed to the bill,” said Representative Jason Altmire of Pennsylvania, whose offices have been inundated with protests and calls. “I have to decide between passing this bill or doing nothing at all. I need to do what’s best for my district.”
Mr. Altmire was among the 39 Democrats who voted against the bill last year. He is included in what party leaders call the “No to Yes” campaign. Others are targets of “Yes to Yes,” which encourages Democrats who reluctantly supported health care to do so again, even if the measure is considerably different.
With Republicans unified in opposition to the legislation, the party’s Congressional committee is turning its attention to a small contingent of Democrats and issuing “Code Red” alerts each time a lawmaker says how he or she intends to vote.
The Chamber of Commerce is leading the opposition to the health care bill with a coalition called Employers for a Healthy Economy. In two weeks, the group has bought more than $7 million in television advertising and plans to spend up to $3 million more. Americans for Prosperity, a group financed by David Koch, the oilman, is also jumping into the fray with an advertising campaign of nearly $1 million.
For weeks, Democrats who support the health care legislation have struggled to compete with the opposition. A disparity in radio and television advertisements, along with calls and mailings, meant that the lawmakers Mr. Obama and Speaker Nancy Pelosi were trying to persuade to vote for the measure were taking a pounding in their districts.
The new money from Pharma, the association of drug makers, as well as contributions from labor unions and other groups helped equalize the advertising fight. This week, officials said, the groups backing the legislation will focus extensively on the insurance industry with this theme: “When insurance companies win, you lose.”
The strategies for the climactic week ahead go well beyond vote counting in the corridors of the Capitol. Until this week, a divided Democratic Party struggled to raise money to compete with forces rallying against the measure, so creative approaches were used.
Television advertisements were cost-prohibitive in the district of Representative John Adler of New Jersey, who voted against the health care bill last year, so proponents formed a special grass-roots action campaign. A dozen members of the clergy who support overhauling the health care system recently met with the congressman’s rabbi, who said he would talk to Mr. Adler about the legislation.
Mr. Obama is making daily telephone calls to Democrats who supported the health care bill last year, but have yet to decide how they intend to vote this time. He is also focusing on those who opposed the legislation, including Representative Dennis J. Kucinich of Ohio, who said the measure did not go far enough.
The president’s trip to Ohio includes Mr. Kucinich’s district, and he invited the congressman to join him aboard Air Force One. Mr. Kucinich said he was grateful for the ride and for the president’s visit, but added that he was disinclined to support the bill as it stands.
“Barack Obama is my president; I want him to succeed,” Mr. Kucinich said in an interview. “But I think it’s important to have real health care reform. I wish I could vote for it, but I don’t think I can.”
The health care debate is unfolding against the backdrop of an already difficult political year for Democrats. The White House has signaled to lawmakers that assistance for midterm elections — for example, presidential visits and fund-raisers — will be prioritized for those who support the bill.
Organizing for America, the network of volunteers that developed from the Obama campaign, is also developing an extensive plan to help explain the health care bill to voters in the event that it passes.
“We want to make sure that members know as they get ready to take this hard vote that they have troops underneath them to fight and scrap to get this passed and to help sell it,” said Brad Woodhouse, communications director for the Democratic Party.
A few Democrats have been offered dispensations, including Representative Artur Davis of Alabama, who is no longer being pressed to vote for the bill because he is running for governor and the health care measure is not popular in Alabama. Other Democrats voting against the bill also have been taken off the target list, party officials said, to save money for lawmakers who are more apt to be won over.
As the urgency for Democrats increases for the health care overhaul, a pragmatic air is settling in among some Democratic groups that once were lukewarm to the legislation.
Moveon.org, the liberal advocacy group, took a vote of its membership last week and found that 83 percent said the House should pass the Senate bill. Not long ago, the group was urging Democrats to push for a stronger measure that included a public option.