SCENARIOS: Healthcare bill carries risks for all sides

WASHINGTON (Reuters) - Senate passage on Thursday of landmark legislation to overhaul healthcare is packed with potential political risks and rewards.

With the next congressional elections set for November 2010, and President Barack Obama up for a second four-year term in 2012, here's a look at some of them.

FINAL HURDLE

The fight on Capitol Hill isn't over yet.

Before Obama can sign a measure into law, differences must be resolved between the Senate bill and one passed last month by the U.S. House of Representatives. Democratic leaders have voiced confidence that Obama will get a final bill next month.

"Democrats must produce a bill," said Ethan Siegal of the Washington Exchange, a private firm that tracks legislation and politics for institutional investors. "If they don't, they'd be seen as unable to govern."

OBAMA

A victory on healthcare is critical for Obama, whose political standing and legislative agenda could hinge on its success. Obama's approval rating has dropped to just under 50 percent from more than 60 percent earlier this year, due largely to the double-digit U.S. unemployment rate.

A signed bill would give Obama a boost -- provided it proves to be popular and, as advertised, brings down costs, ends what are seen as insurance industry abuses and provides coverage to millions of uninsured Americans.

Polls show public support for the legislation eroded to under 50 percent in recent months. Obama is certain to use his bully pulpit to try to raise those numbers.

REPUBLICANS

No Republicans voted for the Senate bill and just one voted for the House bill. So Republican lawmakers will likely rise or fall together on this issue, depending on the success or failure of the overhaul.

Republicans rallied their conservative base in recent weeks by denouncing the legislation as too expensive in televised speeches on the Senate floor. But the debate is now over.

"Republicans not only lost today's vote, they lost the spotlight," Siegal said.

DEMOCRATS

If the legislation proves to be effective, Democrats may be able to count on a new legion of supporters: the estimated 30 million Americans who would secure insurance coverage.

But this centerpiece of the bill isn't due to kick in until 2014 -- after the next two congressional elections and after voters decide on whether to give Obama a second term.

Other provisions take effect in 2010.

They include making it illegal for insurance companies to drop coverage for Americans who get sick and providing grants for states to create ombudsmen to act as consumer advocates regarding health insurance coverage.

Democrats are certain to promote these provisions as they head toward next year's election, when all 435 seats in the House and 38 of 100 in the Senate are up for election.

SENATE MAJORITY LEADER HARRY REID

Other than Obama, perhaps no one has more at stake than Reid, who faces a tough re-election campaign next year back home in Nevada.

Reid calls himself the most powerful senator the state has ever had, and proved his mettle by drafting and redrafting the Senate bill to nail down the needed votes.

While Reid receives high marks from congressional analysts for getting a bill through the Senate, the verdict back home will likely depend on whether voters decide they like it.

"Reid may be viewed more highly in Washington than he is by voters in Nevada," said Norman Ornstein, a congressional scholar at the American Enterprise Institute.

(Editing by Will Dunham)