Democrats are still sounding resolute, but are bracing for the worst if a special election in Massachusetts puts a Republican in the Senate and the health insurance bill in peril.
Congressional Democrats are meeting with House Speaker Nancy Pelosi on Tuesday, but the acrimony is starting to reveal itself as Democrats speak more and more in terms of who mismanaged the debate.
If GOP state Sen. Scott Brown defeats Democratic Attorney General Martha Coakley in Tuesday's election, it would put the seat held by the late Sen. Edward M. Kennedy in the hands of a committed opponent of the bill and deprive Democrats of the 60-vote majority needed to pass health care in the Senate.
Democrats are considering their options for health care should they lose in Massachusetts. One possibility is for the House to approve the Senate-passed version of the bill, despite House Democrats' numerous qualms with that version. This would send the legislation straight to the president's desk -- under the current process, by contrast, negotiators are trying to hammer out a compromise that both chambers of Congress would have to approve.
House Majority Leader Steny Hoyer on Tuesday expressed a willingness to consider taking up the Senate bill.
"I think moving ahead on health care is essential. ... I think clearly the Senate bill is better than nothing," he said. Asked if it would be possible to pass legislation in the 15-day mandatory window during which the Massachusetts election is certified, Hoyer said, "Yes."
Other alternatives, like a process called reconciliation, are still on the table and would require only 51 votes in the Senate instead of 60.
But that would mean rewriting the bill in such a way it could be treated as a budget measure and that means issues like preventing insurance companies from excluding pre-existing conditions would be taken off the table.
Democrats are already floating the idea that 60 votes was never a guarantee that legislation could get passed, and suggested that Republicans will no longer be able to complain about being excluded from the conversation.
"Republicans will at last have to shut up about Democrats having 60 votes. Seriously, they always say that, 'Democrats have 60 votes. They can do X, Y, Z'. Now, they'll have to actually do something besides obstruct," a Senate Democratic leadership aide told Fox News.
Pelosi on Monday told supporters in San Francisco that she is pressing ahead with her role in getting the legislation to President Obama's desk.
"I just keep my eye on the ball that I am responsible for and leave it to others to deal with the politics of their particular state and what happens. Certainly the dynamic will change depending on what happens in Massachusetts. Well, just a question of how we will proceed. But it doesn't mean we won't have a health care bill," she said.
But after more than a year of trying to produce signature legislation, Democrats have no good options, a situation that Democratic strategist Mary Anne Marsh laid at the president's feet.
"Health care was not lost in Massachusetts," she said, referring to Tuesday's election. "It was lost last summer when the White House took the summer off and didn't define this debate while the right and others were out there defining it for them. that's the reality. As a result you are going to see a lot of Democrats reluctant to go ahead with health care."
Marsh said taking the summer off allowed the media to focus on town hall meetings where angry voters overwhelmingly criticized the content of the bill. It wasn't until this fall that the White House tried to jump start the talks, she said.
"It hasn't helped," Marsh added.
Democrats of all different stripes have strong objections to the bill for all sorts of reasons, including 41 House Democrats who voted for tough restrictions on abortion that are not matched in the Senate bill.
Abortion opponents are already preparing for the return of lawmakers to Washington, holding a protest Tuesday with more threatening signs than in the past, including direct ones like "You're Fired" that warn lawmakers that passage of the legislation will be a career killer in November.
Fox News' Jim Angle and Trish Turner contributed to this report.