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Many House Democrats have warned that they would not vote for the Senate-passed bill, including liberals unhappy with the packages affordability levels for the middle class and the Cadillac tax on insurance plans that would affect millions of middle-class workers.
But a stinging defeat in Massachusetts Tuesday could change the dynamic, with liberals seeing their decades-long struggle for sweeping health care reform potentially slipping away and moderate Democrats fearing the outcome portends a wholesale slaughter across the country in November.
A Senate Democratic aide said nobody is expecting Pelosi will agree to take the Senate bill.
Maybe in the aftermath of a loss in Massachusetts, that calculus will change, but its impossible to predict how a loss will affect the climate in the House, said a Senate Democratic aide.
Another theoretical possibility would involve passing the Senate bill alongside a companion bill through reconciliation.
But using reconciliation would be messy, which is why Senate Democratic leaders and Obama have been loath to use it. For starters, it gives Republicans the ability to require votes on hundreds of politically charged amendments on the Senate floor without debate. And there are limitations on what can be accomplished. Unless 60 Senators vote to waive the rules, the reconciled bill can only deal with issues that affect the budget. Democrats would have the ability to include the Cadillac tax compromise, but their hands could be tied when it comes to language on abortion, for example, or on removing antitrust protections for insurance companies.
Democrats could also make another run at winning moderate Sen. Olympia Snowes (R-Maine) vote, appealing to her sense of history, but restarting those overtures would be awkward to say the least after Reid dismissed his negotiations with her as a waste of time in a recent New York Times interview.
Its also not clear how Snowes involvement could make life any easier for Democrats, given that on some issues she is likely to pull the bill further to the right, and away from the more liberal House position. And her plan for a public insurance option trigger had garnered a filibuster threat from Sen. Joe Lieberman (ID-Conn.).
Yet giving up isnt an option either, according to several Democratic aides. Its a lot easier to run with something than to run and say you couldnt get it done even when you had a large majority, said a House Democratic aide.
House Democratic leaders are likely to discuss the situation at their leadership meeting Tuesday afternoon, aides said.
Abortion, meanwhile, has shadowed the health care bill for months, with Democratic factions sniping at each other after Rep. Bart Stupak (D-Mich.) and a band of abortion opponents forced Pelosi to allow his amendment strictly forbidding women from buying insurance plans covering the procedure if they receive federal subsidies.
House and Senate negotiators have yet to resolve the abortion issue, but Pelosi has said she wants to strip out the Stupak language, which could cost her about 10 votes, according to Stupak.