Party members clashed openly over what to do next. Sen. Max Baucus, a top Senate Democrat, appeared to throw cold water on a bill that would focus only on stiffer insurance regulations. Rep. Charles Rangel, chairman of the House Ways and Means Committee, scotched another idea, a complicated parliamentary maneuver to usher a bill quickly to the president's desk.

In an interview with ABC News, President Obama said he would be open to scaling back the legislation in order to salvage it. "I would advise that we try to move quickly to coalesce around those elements in the package that people agree on," Mr. Obama said. White House Communications Director Dan Pfeiffer said later the president would prefer Congress to pass the comprehensive package, and hasn't given up on that option.

To compensate for this opposition, there is a proposal that the House would then pass a second measure making changes to the Senate bill. That measure could then pass through the upper chamber at a later date under special budgetary rules known as reconciliation, which allow legislation to pass with a simple majority.

Since Democrats and allied independents still control 59 seats, strategists believe it would be relatively easy to pass a second measure that would contain compromises reached between Senate and House negotiators, such as a limit on the tax imposed on high-cost insurance plans.

 

But Democratic lawmakers were split Tuesday evening over the prospect of passing the Senate bill and hoping for a later fix.

Ever since health care reform flamed out in the 1990s, Democrats thought lots of things might derail their longtime dream this time around. Losing a Senate seat in liberal Massachusetts was not on the list.

But that is the harsh reality sinking in among Democrats -- that a Republican victory could spell the end of health reform because there is no good option to rescue the plan from this latest brush with political death.

Publicly, the White House and top Democrats held firm to their stance that health care reform will pass this year. And Speaker Nancy Pelosi (D-Calif.) said Monday that Democrats will need to figure out a way to proceed if Republican Scott Brown wins, "but that doesn't mean we won't have a health care bill."

"Let's remove all doubt that we will have health care one way or another," Pelosi told reporters in San Francisco.

But privately, Democrats are getting cold feet about pushing ahead full bore on health care. Moderate Democrats who have long been skeptical of the administration's focus on the issue could begin to peel away in the face of a convincing loss for Democrat Martha Coakley, dealing a fatal blow to legislation that had no room for error in either chamber. 

As the underdog GOP nominee in one of the most Democratic states in the nation, the state senator's message has been simple: If he upsets Democratic state Attorney General Martha Coakley in the Jan. 19 election to fill the seat once held by the late Sen. Ted Kennedy, he will provide the critical vote to halt the Democrats' health care bill once the final version is negotiated.

"If you feel that Washington and the health care bill that they're proposing is systemic of the problems in Washington and the failure to understand average people anymore, then you vote for me because as the 41st senator I can stop a lot of this stuff in its tracks," Brown told POLITICO. "I can actually force them to go back to the drawing board."

The Democratic Party's decades-long push to remake the U.S. health care system cleared a major hurdle early Monday morning, with the Senate voting to advance a massive $871 billion bill to extend coverage to nearly all Americans and tighten regulations on private insurers...

In the coming negotiations, the House will almost certainly be forced to give up the government-run insurance plan that is part of its bill. The idea failed in the upper chamber after centrists including Connecticut independent Joseph Lieberman drew a line in the sand against it.

The final bill is also likely to embrace a version of the Senate's proposed tax on high-value insurance plans, rather than add a surtax on the wealthy, as the House wanted.