Missouri ? Democrats claimed momentum Wednesday in their drive to enact the sweeping health care legislation sought by President Barack Obama, citing near agreement on crucial issues despite persistent Republican efforts to knock them off stride.

Obama himself, rallying support outside Washington for the second time this week, shouted to a crowd in St. Charles, Mo., “The time for talk is over. It’s time to vote.”

At the Capitol, House Speaker Nancy Pelosi said that after days of secretive talks, key Democrats were “pretty close” to accord on additional subsidies to help lower-income families purchase insurance, more aid for states under the Medicaid program for low-income Americans and additional help for seniors who face a coverage gap under current Medicare drug plans.