It's gut-check time for President Barack Obama and congressional Democrats on their health care overhaul.
A stinging loss Tuesday in Massachusettscost Obama the 60-vote Senate majority he was counting on to pass the far-reaching legislation.
The outcome splintered the rank and file on how to salvage the bill, energized congressional Republicans and left Obama and the Democrats with fallback options that range from bad to worse.
A leading idea involves persuading House Democrats to pass a Senate bill that many of them have serious problems with. Another alternative calls for Senate Democrats to promise to make changes to the bill later on. Some Democrats said their big hopes would have to be scaled back.
House Speaker Nancy Pelosi refused to acknowledge that as a possibility as she left the Capitol near midnight Tuesday after meeting with her top lieutenants to discuss the way forward.
Pelosi and others contend that because Massachusetts already has near-universal health coverage under a state law, the upset victory by GOP state Sen. Scott Brown to take Edward M. Kennedy's old seat could not be seen as a referendum on the issue.
"Massachusetts has health care. ... The rest of the country would like to have that too," Pelosi, D-Calif., said. "So we don't say a state that already has health care should determine whether the rest of the country should."
"We will get the job done. I'm very confident. I've always been confident," she added.
Before Senate Democrats gathered Wednesday morning to discuss their next moves, Majority Leader Harry Reid, D-Nev., held out hope for the bill, saying, "There are a lot of different options out there."
Others saw miles of bad road in any direction and suggested that regrouping was in order.
"We shouldn't show the arrogance of not getting the message here," said liberal Rep. Anthony Weiner, D-N.Y., contending independents had turned against the bill and the Democratic base had lost its enthusiasm. "I don't think it would be the worst thing to take a step back" and turn the focus to jobs, in conjunction with scaled-back health care goals.
Republicans said don't even bother: The election of Brown over the once-favored Democrat Martha Coakley in the Democratic stronghold sent a message that the health legislation should be scrapped altogether.
Losing the Massachusetts seat will cost the Democrats the 60th vote needed to overcome Republican efforts to block legislation in the Senate.
Republican Party Chairman Michael Steele said Americans were breathing "a sigh of relief" over the potential derailing of the health care bill.
"People across the country are saying, 'Slow it down," Steele said Wednesday on ABC's "Good Morning America."
But David Plouffe, who led Obama's presidential campaign, rejected calls to scrap the bill. "We have a good health care plan," he said on ABC. "We need to pass that. We have to lead."
Senate Democrats were scheduled to meet at midday Wednesday, and a sign of their intentions could emerge then. Obama will have to exert a mighty influence to keep jittery moderates from giving up on the effort.
Democrats don't appear to have enough time to resolve differences between the two bills passed by the House and Senate -- and get cost and coverage estimates back from the Congressional Budget Office -- before Brown is sworn in.
Moderate Sen. Jim Webb, D-Va., said the Senate should not hold any further votes on health care until Brown is seated. Other Democrats said they feel the need to act even more urgently.
"There is only one guarantee -- that if we don't pass something the notion of trying to put Humpty Dumpty together again is a real long shot," said Rep. Patrick Kennedy, D-R.I., son of Edward Kennedy. "It's a lot easier to pass something and fix it later."
The legislation would expand coverage to more than 30 million Americans now uninsured, while attempting to rein in the growth of health care costs. Democratic lawmakers will have to move in virtual lockstep to enact the bill now, even as Republican opposition intensifies.
That could be too much to ask from rank-and-file Democrats demoralized by losing a seat held in an almost unbroken line by a Kennedy since 1953. Efforts to woo Maine Republican Sen. Olympia Snowe as a convert could increase. But with polls showing voters souring on health care legislation, the president could be abandoned by lawmakers of his own party.
The cleanest option calls for the House to quickly pass the Senate bill and send it to Obama for his signature. That ignores at least two significant problems.
Labor unions are adamantly opposed to an insurance tax in the Senate bill, and they successfully negotiated with Obama last week to weaken it in key respects. Second, a core group of anti-abortion Democrats says the Senate bill's provisions on restricting taxpayer funding for abortion are too weak.
On top of that, many House Democrats do not believe the Senate bill provides enough aid to make health insurance affordable.
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