President Obama and congressional leadership are nearing the end of the road on health care reform. The only option left to pass their grandiose visions of a government overhaul of the nation’s health care system into law is to pass the Senate-passed bill in the House.  However, House Democrats will only go along with this if the bill is followed by a side-by-side bill including changes to the Senate bill, which could only clear the Senate using reconciliation, a method which would be both unpopular and unprecedented.

This does not come without its own laundry list of problems, as Democrats acknowledged this morning on National Public Radio’s Morning Edition.  According to Bill Hoagland, a lobbyist for CIGNA and former Republican Staff Director for the Senate Budget Committee, “reconciliation cannot amend something that’s not law…so, if you’re trying to make changes to the health care reform bill to get it more appealing to the House members, they first have to hold their nose and cross their fingers and vote to pass the Senate-passed health care reform bill and send it to the President.”

This comes with certain sticking points for Democrats.  The Senate bill would have to be passed first, without any assurance that the changes required by the House would later pass or even make it to a reconciliation vote.  As Rep. Peter DeFazio (D-OR) admits, “I’d say at this point, for any House member to vote for something that they object to, with the future potential possible prospect that the Senate will fix it later, when later often never comes in Washington, DC, is an unbelievable leap of faith.”

And passage in the Senate is anything but certain, as several Senate Democrats are leery of the process.  Said Senator Kent Conrad (D-ND), “Look, I’m obviously not going to say I will support a package and I’ve never seen the package.”

Finally, former Senate Parliamentarian Robert Dove says “That vote counts as a real vote and is used against senators who can claim all they were doing was protecting the budget process, but suddenly are on record as refusing to weigh the budget act to deal with Guantanamo or trying people in New York—I can imagine the list of amendments will be sent forward.”

Reconciliation will not prove an easy path to the finish line for Democrats’ health care bills.  President Obama and the congressional majority leaders still face several hurdles to passing their unpopular version of health care reform.  Clearly, one of them will be assuaging the concerns of fellow Democrats.