By Shailagh Murray and Paul Kane
Washington Post Staff Writer
Thursday, January 21, 2010; 1:10 PM

House Speaker Nancy Pelosi said Thursday that the Senate will have to amend its version of a health-care reform bill before Democrats in her chamber would be willing to vote for it.

"I don't think it's possible to pass the Senate bill in the House," Pelosi told reporters after a morning meeting with her caucus. "I don't see the votes for it at this time."

Pelosi (D-Calif.) has been struggling for days to sell the Senate legislation to reluctant Democrats in order to get a health-care bill to the president's desk quickly. But House liberals strongly dislike the Senate version, while moderate Democrats in both the House and Senate have raised doubts about forging ahead with the ambitious legislation without bipartisan support.

The only way to keep the Senate bill alive, Pelosi said, would be for senators to initiate a package of fixes that would address House concerns about the bill. In particular, Pelosi described her members as vehemently opposed to a provision that benefits only Nebraska's Medicaid system. Also problematic are the level of federal subsidies the Senate would offer to uninsured individuals and its new excise tax on high-value policies, which could hit union households.

"There are certain things the members simply cannot support," Pelosi said.

Aides said later that the House would not act on the Senate bill until the fixes are made, shifting responsibility for completing the bill across the Capitol. But the Senate has not agreed to move forward with such changes.

Congressional leaders also are considering starting from scratch on a new bill, an undertaking that many Democrats fear could consume months of effort as they brace for a tough 2010 election battle.

Republican Scott Brown's victory Tuesday in a Senate special election in Massachusetts blindsided Obama and Democratic leaders, who had nearly reached the finish line on an ambitious overhaul of the nation's health-care system and were beginning to turn their attention to other challenges, namely creating jobs and lowering the deficit.

The loss of their Senate supermajority has required a frantic reassessment of their strategy. Pelosi and Senate Majority Leader Harry M. Reid (D-Nev.) have pledged to complete work on the massive bill they started nearly a year ago, but they have yet to identify a clear way forward that will appeal broadly to their rank-and-file.

Obama added to the confusion Wednesday when he seemed to endorse Congress starting from scratch, by voting on a scaled-back package of popular provisions that would crack down on insurance companies but provide health coverage to far fewer additional people.

"We know that we need insurance reform, that the health insurance companies are taking advantage of people," Obama told ABC News in an interview. "We know that we have to have some form of cost containment because, if we don't, then our budgets are going to blow up. And we know that small businesses are going to need help."

But the White House quickly moved to clarify that the president still wants comprehensive reform.

"Right now there are a lot of discussions going on about the best path forward," spokesman Reid Cherlin said in a statement. "But let's be clear that the president's preference is to pass a bill that meets the principles he laid out months ago: more stability and security for those who have insurance, affordable coverage options for those who don't, and lower costs for families, businesses, and governments."

In the Senate, however, Democrats are striking a more cautious note. "Obviously we cannot just proceed as if nothing happened. Something very significant happened," said Sen. Charles Schumer (N.Y.), a member of Democratic leadership. "There's a strong view in both caucuses that we want to do some good things on health care and the question is, how? How much, and how quickly?"

Reid told reporters Wednesday that the Senate would take time to consider the various alternatives. "We're not going to rush into anything," he said. "Remember, the bill we passed in the Senate is good for a year. There are many different things that we can do to move forward on health care, but we're not making any of those decisions now."

Moderate members of Reid's caucus also urged restraint, interpreting the Massachusetts outcome as a clear signal against advancing such a huge bill along party lines.

"I felt from the beginning that the best way to adopt anything as major as health-care reform was to do it in a bipartisan way," said Sen. Joseph I. Lieberman (I-Conn.). "You've got to listen to the message from Massachusetts, and I think it was all about, they want us to work together, they don't want us to do too much at once, and they want to feel that we're listening to them."

The health-care legislation is only one of several major bills on which Reid now needs, in the wake of the Massachusetts result, to win Republican votes.

The Senate on Wednesday took up a proposal to increase the nation's debt ceiling, but it is not clear whether, even before Brown is sworn in, enough Democrats are willing to vote for the measure to overcome GOP objections. Bills to change immigration laws and curtail greenhouse-gas emissions, two other Obama priorities, will not even come to the Senate floor without Republican support.

Tuesday's election also deepened the uncertainty surrounding another top administration goal: overhauling the nation's financial regulatory system. A version of the legislation passed the House last month, but it has met stiff resistance from Republicans on the Senate banking committee, primarily over the creation of a Consumer Financial Protection Agency.

Brown was elected to replace the late Edward M. Kennedy (D), the Senate's longtime champion of universal health care. He struck a conciliatory note during a Wednesday news conference in Boston, telling reporters that he supports expanding health-care coverage.

"I think it's important for everyone to get some form of health care," Brown said. "So to offer a basic plan for everybody, I think, is important. It's just a question of whether we're going to raise taxes, we're going to cut half a trillion from Medicare, we're going to affect veterans' care. I think we can do it better."

But if the senator-elect was willing to consider a health-care bill, most Republicans voiced relief that they may have dodged the current Democratic effort. Asked Wednesday whether the bill is dead, Senate Minority Leader Mitch McConnell (R-Ky.) responded, "I sure hope so."

Sen. Susan Collins (Maine) is one of a handful of Republican moderates whose votes are certain to be sought by Obama and Reid in the months ahead on various bills. She said she remains open to a health-care compromise, but she worried that economic issues are more pressing.

"Many of us have heard from our constituents that, in addition to their overall concern about health care, they would like to see the administration and Congress focus on economic issues," Collins said. "That's the message from back home."

Staff writers Lori Montgomery and Perry Bacon Jr. contributed to this report.