With Republicans raising the volume of their protests and House Democratic leaders uncertain if they have enough rank-and-file support, some moderate Democrats sense that passing a health care reform bill will be as difficult as the House’s energy bill, which was approved by a slim margin June.

That has caused quite a bit of hand-wringing among the Democrats.

Some  “really anguished” over voting for the energy bill, Rep. Jason Altmire told Fox News, and they “would be reluctant now to vote for health care and take a second vote that might be unpopular in their district.”

House Republicans who voted unanimously against the energy bill warned its greenhouse gas restrictions would cost jobs, and they are making the same jobs warning about the health bill's requirement's for small businesses. Once again, their opposition is unanimous.

"Those who have just lost their jobs or who feel they're in danger are going to look to Washington and go, 'What are they doing?'" said Rep. Shelly Capito, R- W.Va.

It's an argument that could resonate with the public as the government reports a 10.2 percent unemployment rate, the highest since 1983, and an all-time high $1.42 trillion dollar budget deficit.

Moderate Democrats say historically they're the people who pay for their party's tough votes.

"The people that lost seats were people representing swing districts that tended to be more moderate legislators reflecting the views of those districts," said Rep. Earl Pomeroy, D-N.D.

Polls suggest the economy's deep recession has raised all voters’ concerns about spending and debt, and the White House is finding it hard to decouple that from health care.

"I think if you have a job and you lose your health care, it's an economic concern," White House spokesman Robert Gibbs said Friday.

And a summer of angry town hall confrontations and tea party demonstrations, the White House says, is poisoning the debate on the issues.

"Imagine five years ago somebody comparing health care reform to 9/11," Gibbs said. "Imagine just a few years ago, had somebody walked around with images of Hitler."

The Republican National Committee thinks Democrats are flirting with an issue that could cost them control of Congress in 2010 like the partisan votes on energy and gun control they say led to the Republican takeover in 1994.

But Rep. Altmire said it's more what Democrats didn't do.

"I think one of the things that cost Democrats control of Congress in '94 was the inaction on what President Clinton said at the time was the number one issue facing the country: health care reform."

Rep. Altmire is still not sure how he'll vote on the health care bill. He said the worst thing would be a bill that makes the situation worse. But doing nothing, he said, would be a very close second.