Existing state of play: The House of Representatives and the Senate have passed their own versions of President Obama’s signature healthcare reform bill. As is often the case during the passage of American legislation, both versions have been heavily amended during the debates.
Under normal circumstances, the next step for the bill to become legislation would see the Senate and House versions amalgamated in a series of backroom meetings. This final draft of the bill would then need to be passed by both the House and the Senate.
Defeat in Massachusetts, however, leaves the Democrats without their filibuster-proof super majority in the Senate and therefore unable to get the bill past an obstructive Republican party. All of the radical options left open to save the flagship healthcare would leave the Democrats open to charges of arrogance or autocracy.
Option one: The simplest would be to force through a vote in the Senate before Scott Brown is officially certified as Senator for Massachusetts – thereby using their old 60-seat super majority. If they were very quick, they could push a vote through in the next 15 days before Mr Brown is seated – or even more controversially they could try to delay the electoral formalities in Massachusetts to give themselves more time. Paul Kirk, a Democrat and friend of the deceased Ted Kennedy, has been serving as an interim appointment in the Senate - he will remain in the seat until Mr Brown is sworn in.
Problem: The Democrats would be wilfully disregarding the electorate (in one of the country’s most liberal states) – and they would be left looking surreptitious.
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Option two: The majority leadership in the House could try to persuade the Democrats to disregard the version of the bill hammered out in the House and instead vote through the exact bill passed by the Senate on Christmas Eve. If the existing Senate bill was passed unaltered by the House there would be no need for another vote in the Senate.
Problem: Although the Democrats have a 40-seat majority in the House they only passed the previous version of the bill by a five seat margin. Many Democrats would take issue, on principle, with having to accept the Senate’s weaker version of the legislation. They would also risk angering their own constituencies by meekly following the party leadership’s orders.
Option three: Another possibility would be to pass the Senate’s bill and repackage the additional measures into a budget reconciliation bill – this kind of legislation can be passed with a simple majority of 51 in the 100-seat Senate.
Problem: This would be portrayed a backhanded method to subvert the American democratic process – and could prove very unpopular. In their defence the Democrats could point out that George W. Bush used the same tactic to enact his controversial tax cuts in 2001 and 2003.
Option four: Convince a moderate Republican senator to switch sides. Some GOP senators, such as Susan Collins of Maine, were tempted by healthcare reform and could possibly be won over if swingeing concessions were granted by the Democrats.
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Problem: Not one Republican backed the bill before Christmas so it seems unlikely that any would risk the wrath of the Republican machine in order to help pass the controversial legislation. Indeed, after the dramatic electoral verdict in Massachusetts a swathe of Democrat senators may have found their own support for reform to be wavering.
Further concessions would leave the weakened bill open to accusations that it was not worth enacting.
Option five: The Democrats could just accept what decades of Liberals have had to swallow in the past and give up on healthcare reform.
Problem: Abject failure for Mr Obama may prove a bigger vote loser for the Democrats than even an unpopular legislative slight of hand. If no healthcare bill is passed, Mr Obama would limp towards the November mid-term elections in the same tarnished state that saw Bill Clinton lead the party to electoral meltdown in 1994.