Washington (CNN) – Nervous Democrats debated Wednesday how to save a health care reform plan suddenly pushed to the brink of defeat by an upset GOP Senate win in Massachusetts.
Senator-elect Scott Brown's victory in one of the most progressive states in the nation raised already-high anxiety levels among Democrats looking ahead to midterm elections. It also stripped Democrats of their 60-seat Senate supermajority, giving Republicans enough votes to block any measure in the chamber.
Administration officials and top congressional Democrats are reviewing a diminished range of options to pass a health care bill and salvage victory on President Barack Obama's top domestic priority.
"I think most of us have tried to weigh what happened in Massachusetts and feel that perhaps we need a little breathing space here to reflect on it, and to chart a course," said Sen. Dick Durbin of Illinois, the number two Democrat in the Senate. "We haven't decided on a strategy."
Among the options under consideration is having the House pass an identical version of the bill approved by the Senate in December. Doing so would allow the measure to proceed straight to Obama's desk to be signed into law.
House Speaker Nancy Pelosi told reporters Wednesday it "remains to be seen" whether there's enough support in the House for such a course of action.
"There's a lot of good things in the Senate bill," she said. "As you know, 85 percent of the bills are the same."
Pelosi argued "the message from Massachusetts" was that voters are angry about special state-specific provisions added to the Senate bill in order to win over wavering Democrats. She specifically cited a provision exempting Nebraska from the costs of expanded Medicaid coverage - a provision critics have labeled "the Cornhusker kickback."
"Some of those issues are lightning-rod issues and some of that has to be changed," Pelosi said. "I don't think our members should be asked to support something that even Sen. (Ben) Nelson" - the Nebraska Democrat who initially pushed for the provision - "has backed away from."
A number of House liberals, however, are pushing back hard against the idea of adopting the Senate plan without major changes. The more conservative Senate measure contains a number of provisions unpopular with progressives, including a 40 percent tax on insurance companies providing high-end "Cadillac" health plans.
"If it comes down to that Senate bill or nothing, I think we're going to end up with nothing," Rep. Stephen Lynch, D-Massachusetts, said Tuesday. "I don't hear a lot of support on our side."
Several other Democrats echoed Lynch's concerns, telling CNN that even if there was a firm commitment to follow approval of the Senate version with a second bill containing changes negotiated by House and Senate leaders and the White House, they wouldn't vote yes.
"I don't think I can vote for the Senate bill and I don't think there are the votes in the House for the Senate bill," said Rep. Anthony Weiner, D-New York.
Weiner ridiculed the House Democratic leadership for briefing members Tuesday night on the status of White House negotiations that began before Brown's election.
"We have to recognize we are in an entirely different scenario," he said. "We should internalize that we are not doing things entirely correct here."
A second option under consideration is to draft a new, stripped-down version of the bill capable of passing both chambers.
Such a bill, according to several rank-and-file Democrats, would focus on less controversial provisions, such as barring discrimination by insurers based on pre-existing conditions and closing the Medicare "doughnut hole" to bring down prescription drug costs.
"There are great concerns about the health insurance system and the kind of power that the insurance people have over people to deny care, to raise rates and so on," White House strategist David Axelrod told CNN Wednesday. Obama is "not going to walk away from that."
A third option - trying to ram a compromise bill through the House and Senate before Brown is seated - appears to be losing favor among Democrats. Sen. Jim Webb, D-Virginia, released a statement Tuesday night arguing that it would "only be fair and prudent that we suspend further votes on health care legislation until Senator-elect Brown is seated."
A fourth option is to revisit the idea of trying to push health care through the Senate with only 51 votes - a simple majority.
But to do that Democrats would have to use a process known as reconciliation, which presents technical and procedural issues that would delay the process for a long time, and Democrats are eager to put the health care debate behind them and move on to economic issues, such as job creation, as soon as possible in this election year.
"If there's anybody in this building that doesn't tell you they're more worried about elections today, you should absolutely slam them," Sen. Claire McCaskill, a Missouri Democrat, said Wednesday. "That's what this place thrives on."
Newly empowered Republican leaders on Wednesday urged Democrats to scrap the current version of the bill completely and restart negotiations.
People are "more interested in shrinking unemployment than expanding government," said Senate Minority Leader Mitch McConnell of Kentucky. "They don't want the government taking over health care. ... They made that abundantly clear last night in the commonwealth of Massachusetts."
Congress needs to "stop this unsavory sausage-making process known as health care reform," said Sen. John McCain, R-Arizona. "The people of Massachusetts have spoken for the rest of America."
–CNN's Ted Barrett, Dana Bash, Evan Glass, Suzanne Malveaux, Alan Silverleib and Deirdre Walsh contributed to this report