In November, the House passed health care by a vote of 220-215.  If she thought the first vote was a nail-bitter, Speaker of the House Nancy Pelosi’s cuticles are about to get even shorter.  Death (Murtha), resignation (Wexler and Abercrombie) and defection (Cao) has made the vote even tighter.  If a roll call occurred today and all other votes remained the same, health care would squeak breathlessly by 216-214.

Of course, the assumption that the yeses of November will remain the ayes of March is a perilous prediction.  The possibility of defections runs in both directions as this article makes clear, but the most important voting bloc and the most probable defectors are Bart Stupak and his anti-abortion apostles.  The pro-life Michigan Democrat revealed this morning that he and as many as twelve other House Democrats will not vote for health care legislation largely because of the bill’s more lenient treatment of abortion coverage.

Within the confines of the House chamber, Pelosi holds the advantage.  Through her office pass all of the pearls enjoyed by Democratic House members, including committee assignments, campaign contributions and election year political support.  However, when a House member turns his cell phone to the “off” position for the plane ride back to the district, the advantage shifts decidedly away from Pelosi.  Virulent town hall protests, notable anti-Washington election wins and polls chronicling voter disgust with Congress clearly demonstrate that health care legislation is a poison pill and that only Democrats from navy blue districts can easily support it.

Moreover, time isn’t on the side of Speaker Pelosi.  March 26 marks the last day that the House and Senate are open for business prior to a two week Easter recess.  With November elections fast approaching, that recess is sure to be dominated by electoral considerations, including visits with irate constituents and uncomfortable Q-and-A sessions with local media.  If the House hasn’t voted by March 26, it seems unlikely that Pelosi will be able to schedule a successful vote after House members return.

Despite long-holding center stage, the Senate story is quietly taking shape.  Comments from Senate Majority leader Harry Reid and Senate Majority whip Dick Durbin have made clear that Democratic leaders are willing to use reconciliation to pass health care.  (A description of reconciliation, a controversial parliamentary procedure, may be found here.)  While a pro-reconciliation Senate whip count hasn’t been released, statements by centrist Senate Democrats suggest that reconciliation likely enjoys support sufficient to pass the final components of health care legislation, assuming the House can move the bill to the Senate.

At the moment, Congressional Democrats and Administration officials are huddled in behind-closed-doors sessions, hammering out legislative language which the President is expected to release later this week.  With the announcement of the President’s version of health care all eyes will turn to the U.S. House of Representatives and the curtain will rise on the final, climatic scene of the health care epic: can Pelosi twist enough arms to secure 216 ayes or will rank-and-file Democratic dissenters twist enough knives into the President’s health care bill to kill it on the floor of the House?