Though reeling from a political body blow, House Democrats rejected the quickest fix to their health care dilemma and signaled that any agreement on President Barack Obama's signature issue will come slowly, if at all.
Democrats weighed a handful of difficult options as they continued to absorb Republican Scott Brown's election to the Massachusetts Senate seat long held by Edward M. Kennedy. Several said Obama must forcefully help them find a way to avoid the humiliation of enacting no bill, and they urged him to do so quickly, to put the painful process behind them.
House leaders said they could not pass a Senate-approved bill, standing by itself, because of objections from liberals and moderates alike. Such a move could have settled the matter, because it would not have required further Senate action. Brown's stunning victory restored the GOP's power to block bills with Senate filibusters.
Democratic leaders weighed two main options, both problematic. The first would require congressional Democrats to muscle their way past stiff GOP objections despite warning signs from Massachusetts voters and worries about next November's elections.
The other would pare down the original health care legislation in hopes of gaining some Republican support. But the compromise process is more difficult than many lawmakers suggest.
Democrats' hopes of settling on a strategy by the weekend seemed to fade, as lawmakers struggled to comprehend the drawbacks of every option.
"We have to get a bill passed," said House Speaker Nancy Pelosi, D-Calif., because her party would have no excuse for failing to revamp health care when it controls Congress and the White House.
Some lawmakers said it will take time for congressional Democrats, who huddled repeatedly Thursday, to realize how limited their options are. "People are at various levels of the seven stages of grief," said Rep. Anthony Weiner, D-N.Y.
The first chief option would require House Democrats to approve the Senate-passed bill along with a guarantee that the Senate would make several simultaneous changes to health law desired by the House. Senate Democrats presumably would do so with a tactic called "budget reconciliation." It requires only a simple-majority vote for certain budget-related matters, but it cannot be used for every issue. Both parties have used the tactic at times.
When Brown is sworn in, Democrats will control 59 of the Senate's 100 seats. They need 60 to block GOP filibusters.
The second option calls for drafting a new, compromise bill more palatable to moderates, including some Republicans. But numerous officials said it's far easier said than done.
For instance, a widely popular goal is to bar health insurers from refusing coverage to people already suffering medical problems. But without requiring most people to buy coverage, millions might wait until they have a serious problem before buying a policy, driving coverage costs to unsustainable levels.
Moreover, "individual mandates" to buy insurance would almost certainly require government subsidies for low-income people. And that in turn would require new government revenues, such as taxes.
Many of these interconnected features drew strong objections, especially from Republicans, when the House and Senate passed competing versions of health care revisions last month.
Pelosi cited the dilemma Thursday.
"I don't think anybody disagrees with 'Let's pass the popular part of the bill,'" she told reporters. "But some of the popular parts of the bill is the engine that drives some of the rest of it," which is far less popular, she said.
Outside groups were more blunt.
"You can't do it," said Ron Pollack of the liberal-leaning Families USA. Enacting popular "insurance reforms" won't work without the more controversial and expensive steps of expanding coverage to the uninsured, he said.
Some lawmakers talked of placing partial limits on insurance companies' ability to deny coverage to those with pre-existing medical conditions. Companies might be required to cover sick children, or to keep covering customers who become sick and failed to disclose every detail of their medical histories when first buying their policies.
Such compromises could leave Obama well short of the universal coverage he touted during his 2008 campaign.
House Democrats cite many objections to the Senate-passed bill, which make them wary of adopting it without some type of ironclad guarantee of improvements by the newly configured Senate.
But budget reconciliation is one of Congress's most complex and controversial exercises, and it's not clear how many House objections can be remedied with the process.
A widely criticized feature of the Senate bill made special Medicaid concessions to Nebraska, demanded by Democratic Sen. Ben Nelson. Senators promised to expand the help to all 50 states, but Brown's election cut that negotiation process short.
Congressional budget referees said Thursday it would cost $35 billion over 10 years to extend the so-called "Cornhusker Kickback" to every state.
Some Democrats said Obama must lead his dispirited party to a resolution.
"He has got to bring the Senate and the House together," said Rep. Elijah Cummings, D-Md. "He has got to help all of us pave a way to get it done."
White House spokesman Robert Gibbs said Obama thinks the best path is "giving this some time, by letting the dust settle, if you will, and looking for the best path forward." He said Obama does not believe a major health care revision is dead.
Asked what is next for the legislation, Sen. Debbie Stabenow, D-Mich., shaped her hand like a gun and pointed to her head. "We're looking to see what there's support to do," she said.
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