With their signature issue struggling for survival, liberal groups are now rallying behind the budget reconciliation route to pass health care reform, despite concerns about the practicality of the legislative maneuver and some skepticism on K Street about pursuing the politically troublesome issue.

Ralph Neas, president of the National Coalition on Health Care Action Fund, recently announced that his organization and other groups, including Families USA and the union-backed Health Care for America Now, would prod Congress to employ a procedure that will not require a supermajority in the Senate to approve health care reform.

Such an approach has become necessary, in the view of these groups, after the election of Republican Scott Brown to the Massachusetts Senate seat that deprived Democrats of the 60 votes they would need to approve the bill.

“We have changed circumstances,— said Neas, whose group was previously opposed to using reconciliation as a vehicle for health care reform.

Under the plan being floated, the House would pass the Senate health care bill and both chambers would approve a budget reconciliation measure that would include negotiated compromises between the two chambers. A reconciliation bill requires just a simple majority Senate vote but can only include budget-related provisions.

Neas expressed confidence that the tax and subsidy issues that still need to be resolved would meet the reconciliation rules. Neas’ group had previously maintained that the reconciliation limitations would preclude including important health care reforms, such as changes to the insurance market.

“There would be many issues that would not be consistent with the reconciliation rules,— Neas said. “You would end up with Swiss cheese legislation.’—

But Neas said that those insurance provisions are already addressed in the Senate legislation, which the House could approve as long as its Members were satisfied that reconciliation would deal with their differences with the other chamber.

But not all Democrats in the House and Senate are sold on reconciliation. Nor has President Barack Obama recommended a path to proceed with health care, an issue he did not even mention until more than a half-hour into his State of the Union address last week.

Furthermore, experts in Congressional procedure warn that reconciliation is not a slam-dunk.

‘Painstaking Process’

Robert Dove, a former Senate Parliamentarian who now works at Patton Boggs, said that every provision of the reconciliation bill can be challenged by any Senator who questions their budgetary impact.

“It is a long, painstaking process, something I never want to do again,— said Dove, who refereed a reconciliation measure in 1995.

He said reconciliation provisions are generally vetted months before the bill comes to the floor. Such an approach would also require the bills to go back to the two Senate and three House committees that originally handled health care reforms. The bills would then be bundled and sent to the budget committees before sent to the floor for a vote.

“I don’t think it will be easy,— Dove said. “If it were easy, it would have been done by now.—

Others on K Street doubted that either the White House or Congressional Democrats are keen on pushing through comprehensive health care reform in the face of the difficult political environment.

“There is very little appetite to pursue this in any meaningful way,— said one longtime health care lobbyist who has supported the comprehensive health care effort.

The lobbyist said that Democratic leaders may continue to talk up health care so as not to demoralize groups that have invested so much money and passion in the issue.

But the lobbyist likened the current situation on health care to how families deal with end-of-life predicaments.

“Drastic measures may be considered but often aren’t successful,— the lobbyist said.

“I don’t think health care will have a clear obituary date,— the lobbyist said. “People will at some point look back and realize we are not doing it anymore.—

Staying Alive

Various groups with a stake in health care reform are now struggling with what their strategy should be to keep health care alive, including whether to continue the expensive broadcast ad wars that have raged during the health care debate.

Health Care for America Now, which has spent millions of dollars in a media campaign promoting the health plan, is not running any spots now and has not decided whether to do so in the future.

HCAN spokeswoman Jacki Schechner said the group had halted advertising partly for budgetary reasons and because of questions over whether it is the best way to reach key lawmakers at this point.

But she said HCAN is planning field actions around the country, which would include rallies and petitions to urge Congress to deliver on health care. “The idea is to keep the pressure on,— she said.

The Service Employees International Union, which represents health care workers, is currently focusing on getting its members to call and visit lawmakers in support of the reconciliation path. Unions, in particular, want changes to the Senate bill because it contains a tax that organized labor objects to on “Cadillac— health plans.

Progressive leaders have opposed calls by some in Congress to pass slimmed-down health proposals because they say it will not address interconnected health issues.

And they warn that the failure of lawmakers to approve a bill will depress Democratic voters, whom the party will need to limit expected losses in the midterm elections.

“It is hard to get our members energized if the leaders aren’t showing the courage to take on the issues they need to be dealing with,— said Lori Lodes, SEIU spokeswoman.

Ron Pollack, the president of Families USA, agreed that failure to pass health care “would be the biggest liability [lawmakers] would take into the 2010 elections.—

Endgame

Pollack said that while there are currently not enough votes in the House or Senate to pass reconciliation, he expects the numbers to be there after leaders complete negotiations.

Other medical stakeholders have not expressed public opinions about which approach Congress should take but have pressed lawmakers not to drop the issue.

The American Medical Association, which backed the House and Senate bills, sent a letter to Obama and lawmakers recently urging them to continue their work on health care reform.

“While the Senate election in Massachusetts altered the political landscape, the issues that created the pressure to enact reforms must still be addressed,— wrote J. James Rohack, AMA’s president, in Tuesday’s letter.

The influential senior citizens group AARP has also backed both health care bills and is particularly focused on filling the “doughnut hole— in the Medicare prescription drug plan. The Senate measure does not completely address the issue, meaning it would likely have to be included in any reconciliation bill.

David Certner, AARP legislative affairs director, said he assumed the Medicare drug subsidy would meet the reconciliation rules.

However, he said his group was not recommending a specific approach that lawmakers should take in moving ahead with health care.

“We’re not jumping into the ‘you need to do it this way,’— Certner said. “Our lobbying is focused on the endgame.—