WASHINGTON, Jan 22 - The sweeping healthcare overhaul pushed by President Barack Obama faces dire prospects in the U.S. Congress, but Democrats scrambling for a new approach still hope to salvage at least a scaled-back plan.
Every option under discussion among stunned Democrats presents its own obstacles and drawbacks, but many worry the failure to pass any healthcare reform bill would be a huge political liability in November's congressional elections.
"We have to get a bill passed," House of Representatives Speaker Nancy Pelosi said on Thursday. "We know that."
The Senate and House already passed separate versions, both of which would both extend insurance coverage to more than 30 million uninsured Americans, create exchanges where individuals can shop for insurance plans and bar insurance practices like refusing coverage to people with preexisting conditions.
But the two chambers still needed to reconcile the differences between their versions and pass a merged bill again before it could be sent to Obama to be signed into law.
Those efforts were brought to a quick halt by the upset election of Massachusetts Republican Scott Brown, an opponent of the overhaul. His win deprived Democrats of the 60 votes they need to push a merged healthcare plan through the Senate.
Despite the Democratic proclamations of resolve to pass a healthcare bill, there is a strong possibility they will not be able to agree on an approach before this year's elections.
Here is a look at some of the alternatives -- likely and unlikely -- for a healthcare plan.
THE HOUSE PASSES SENATE BILL UNCHANGED
This was the favored alternative of the White House and many Senate Democrats, but House Democrats have balked at swallowing the Senate bill without significant changes. Pelosi rejected the idea on Thursday.
"In its present form, without any change, I don't think it's possible to pass the Senate bill in the House," Pelosi told reporters.
House Democrats are unhappy with Senate provisions like a tax on high-cost insurance plans, a less restrictive policy on using federal funds to cover abortions, and full federal payment in Nebraska for an expansion of Medicaid, the federal health program for the poor.
CONGRESS PUTS TOGETHER A SCALED-BACK BILL
Some Democrats in the House and Senate have discussed pulling together some of the more popular and easier to pass healthcare provisions into a new bill that could win some Republican support.
Other Democrats have suggested putting many of those same provisions together in three or four different packages that could be passed individually or attached to other bills.
The smaller approach could focus on insurance reforms like federal funding for high-risk pools; prohibiting insurers from dropping coverage for those who become sick; extending coverage for children on their parents' plan and repealing the insurance industry's antitrust exemption.
It also could try to expand coverage through some form of federal tax credits; extend credits to small businesses to help them provide health benefits; and offer financial incentives for states to expand Medicaid.
But putting together a new package would require a careful culling of the existing 2,000-page bills, which include numerous interlocking provisions. It also could take more time than nervous Democrats, worried about November's elections, want to spend talking about healthcare.
THE USE OF RECONCILIATION PROCESS
Some healthcare changes -- either a stand-alone package or the House's preferred changes to the Senate bill -- could be passed through a parliamentary procedure called reconciliation that requires a simple majority of 51 Senate votes and can be used only for budget issues.
Democrats so far have shown little appetite for that approach, which bypasses Republicans and could risk another political backlash on a bill polls show is already unpopular with the public.
LET HEALTHCARE DIE FOR THE YEAR
With congressional elections looming, Democrats are anxious to turn to a debate on job creation and bolstering the economy. Few want to see another extended battle on a healthcare issue that they fear has made them targets.