To get them, the White House is backing off a promise to ban special deals for individual states, like the so-called "Cornhusker Kickback."
The deals will be allowed, as long as they benefit more than one state.
The stakes could not be higher.
"Lobbyists from the insurance industry are descending on Capitol Hill like locusts and trying to pressure people to vote against this bill," White House advisor David Axelrod said.
"This is the most brazen act of political arrogance that I can remember since the Watergate years, not in terms of breaking the law, but in terms of thumbing your nose at the American people," said Republican U.S. Sen. Lamar Alexander of Tennessee.
The legislation would provide insurance to millions of people who do not have it and would bar insurance companies from denying coverage because of pre-existing conditions.