Democratic lawmakers who once saw health care overhaul as a historic quest are now anxious about getting the debate behind them, with Tuesday's Massachusetts Senate race underscoring how hard and joyless the effort has become.
Regardless of whether Democrat Martha Coakley squeaks past Republican Scott Brown, their down-to-the-wire campaign has shaken some Democrats' belief that most Americans will see the proposed health delivery changes as worthwhile. Emboldened Republicans, meanwhile, see the Democrat's struggle in liberal Massachusetts — where health care was a central issue — as a harbinger of GOP gains in November's midterm elections.
Even if the health legislation survives, the Massachusetts experience may erode congressional support for other priorities of President Barack Obama, such as energy and climate-change bills.
A Brown victory on Tuesday could quickly kill Obama's chief domestic priority, because Republicans could block further Senate action on health care with a filibuster. That would leave the White House and Democratic lawmakers with options ranging from bad to horrible.
Democrats could try a strong-arm tactic, such as rushing to hold a final Senate vote before Brown is sworn in, knowing it would ignite a ferocious public outcry.
On Monday, House Speaker Nancy Pelosi, D-Calif., said Democrats would press ahead on health care whatever the outcome in Massachusetts.
"Let's remove all doubt that we will have health care one way or another. Back to the drawing board means a great big zero for the American people," Pelosi told reporters in California.
Worst case scenario
If Brown wins, health care's fate will turn on the Democrats' answer to a wrenching question: Which is worse, enduring such a firestorm of criticism at the start of an election year, or admitting defeat on their top agenda item despite controlling the House, Senate and White House?
"I think Democrats fully understand they have to pass this legislation," said Ron Pollack, head of the Families USA advocacy group. "The alternative is an absolute disaster."
Others are less sure, and opponents have made it clear that they will interpret a Brown victory as a verdict against the Democrats' entire health care agenda.
"If Obama's plan doesn't fly in the most liberal state in this nation, the plan should be forever grounded," said Phil Kerpen of Patients First, a group opposed to the legislation.
Even if Coakley wins, her struggles have shaken some congressional Democrats who expect tough races in November. Colleagues are trying to reassure them, saying there will be time to explain to voters the benefits of the proposed health care package. The public will forget the parliamentary tactics that were used to pass it, no matter how ugly, these Democrats say.
Former President Bill Clinton urged House Democrats last week to do a better job of telling voters how the legislation would help them, such as expanding coverage to the uninsured and establishing networks to offer more insurance options.
"Put the corn where the hogs can get it," Clinton said, using a colorful phrase for making something clear and accessible, according to an aide who took notes at the speech.
Some are urging moderate Democrats not to view a razor-thin Coakley victory as a troubling sign, even in heavily Democratic Massachusetts.
"A win is a win," said Rep. Frank Pallone, D-N.J. "It's a wake-up call" for tough campaigning this fall, he said.
Best chance
If Coakley loses, the White House's best hope of saving the health package may lie in trying to persuade the House to accept the bill the Senate passed last month. Obama could sign it into law without further Senate action.
That could be a tough sell. Many House Democrats already are furious at cuts to the original health care proposals demanded by the Senate, where rules give the minority Republicans considerable power. Accepting every comma of the Senate-passed bill, while dropping their own bill, could be more than some liberal House Democrats will swallow.
Some moderate Democrats might abandon the health bill for other reasons as they brace for tough GOP challenges this fall, although they could open themselves to charges of flip-flopping if they supported the legislation last month.
Liberals oppose the tax on high-cost insurance plans in the Senate bill, while anti-abortion Democrats have termed the Senate's approach to restricting taxpayer funding "unacceptable."
Catholic bishops adamantly oppose the Senate language restricting the use of taxpayer funds to pay for abortion. They support the House's harder line. Liberals, for their part, say the House bill would deny access to a legal medical procedure to millions of privately insured women.
As the clock ticks down on the Massachusetts election results, Democrats ponder a cruel irony: The death of Sen. Edward Kennedy, a lifelong champion of health care reform, has triggered the events that have put the effort at the verge of a last-minute demise.