SCENARIOS-U.S. healthcare bill faces uncertain future

WASHINGTON Feb 26 (Reuters) - Congressional Democrats prepared on Friday to launch a final push to pass President Barack Obama's sweeping healthcare overhaul, one day after a summit on the issue appeared to win no Republican converts.

With their options limited by political setbacks and Republican opposition, Democrats focused on a parliamentary tactic called reconciliation that would bypass the need for Republican support.

"I think we have good prospects for passing legislation," House of Representatives Speaker Nancy Pelosi told reporters.

Democrats in the Senate and House approved healthcare bills last year that would reshape the $2.5 trillion industry by cutting costs, regulating insurers and expanding coverage to tens of millions of Americans.

But efforts to merge the different measures and send a final version to Obama collapsed in January after Democrats lost their crucial 60th Senate vote in a special election in Massachusetts.

Democrats are ready to forge ahead with the overhaul through the reconciliation process after evaluating the prospects of passing either a scaled-back version that could attract Republicans or breaking up the overhaul into pieces.

White House spokesman Robert Gibbs said Obama would announce a decision sometime next week on how to proceed.

Here is a look at some of the alternatives -- likely and unlikely -- for a healthcare plan.

THE RECONCILIATION PROCESS

This approach, which can only be used for budget-related measures, bypasses the need for 60 votes to clear procedural hurdles in the 100-member Senate. It requires only a simple Senate majority of 51 votes.

The Congressional Research Service said reconciliation had been used successfully 19 times since 1980.

Many Democrats had hoped to avoid using reconciliation, which will attract heavy Republican criticism and risk another political backlash on a bill that polls show is already unpopular with the public.

But congressional Democrats believe the approach is the last viable means for passing the comprehensive overhaul sought by Obama.

Under the method, the House would approve the Senate-passed bill. Then changes to the Senate bill sought by the House would be passed through reconciliation.

Many of those provisions, such as changes to a tax on high-cost insurance plans and additional federal subsidies to make coverage more affordable, were incorporated in a proposal released by Obama on Monday.

Pelosi said Senate Democratic leader Harry Reid should take the first step and determine what provisions can carry the Senate on a simple majority vote. Reid and Pelosi have their next weekly meeting on Tuesday.

Each provision would be subject to parliamentary challenges to determine whether they meet the requirement that they be budget-related -- meaning changes to areas like federal funding for abortion would not be possible through the process.

There also could be questions about whether House Democrats can still muster a majority for the bill, which passed with only three votes to spare in November.

CONGRESS PUTS TOGETHER A SCALED-BACK BILL

Some Democrats in both chambers had discussed pulling together some of the more popular and easier to pass healthcare provisions into a new bill that could win Republican support.

Other Democrats suggested taking a few popular provisions and passing them piece by piece. The House took a small step in that direction earlier this week by overwhelmingly approving a bill to eliminate the health insurance industry's exemption from antitrust laws.

The White House has even prepared a fallback option including a smaller bill that adds about 15 million to the insurance rolls rather than 31 million under the Senate bill.

Any of those approaches would take more time than nervous Democrats facing November congressional elections can afford. Democrats are anxious to pivot to a debate on job creation and the economy for the campaign.

"That isn't happening," one Senate aide said of a White House backup plan.

Putting together a new bill would require a careful culling of the existing 1,700-page bills, which include numerous interlocking provisions. Many crucial measures such as blocking insurance companies from refusing to cover those with pre-existing medical conditions could not be pulled out.

"Doing this incrementally just doesn't work," Pelosi said.

LET HEALTHCARE DIE FOR THE YEAR

With congressional elections looming, few Democrats want to see another extended battle on healthcare, which they fear has already made them political targets.

But Democrats also believe they could face an even bigger political risk if they do nothing after spending six months wrangling over healthcare. (Editing by Peter Cooney)