Tuesday’s Massachusetts special election to replace the late Sen. Ted Kennedy (D-Mass.) altered the composition of the U.S. Senate. Once thought to be only a matter of time, the future of health care reform now hangs in doubt.

State Senator Scott Brown (R-Mass.) defeated State Attorney General Martha Coakley (D-Mass.) 52 percent to 47 percent, giving Republicans 41 votes in the U.S. Senate, and removing Democrats previously held filibuster-proof margin. Health care reform proponents are now scrambling to decide on a course of action, weighing the political relevance of the Massachusetts election to national efforts to pass comprehensive health care reform.

Unofficial exit polls suggest that Sen. Brown’s opposition to health care reform played a major role in the voting booth. He pledged during his campaign that he would oppose health care reform efforts currently being considered on Capitol Hill. Despite Tuesday's outcome, the late Sen. Ted Kennedy’s seat will continue to be occupied by his interim replacement until Sen. Brown’s swearing-in, which could take several days; thus, albeit temporarily, Democrats will retain a filibuster-proof majority.

Meanwhile, House and Senate Democratic leaders are weighing options to pass health care reform before losing Sen. Kennedy’s seat to the Republicans. The following are possible scenarios currently being discussed:

• The House of Representatives will pass the Senate bill under an agreement that high priority items of concern between the two versions would be addressed in separate legislation under budget reconciliation rules, which require only a simple majority vote. Issues such as the deal unions made with the House and Senate leaders, as well as the administration, and House preference for a national health insurance exchange over a state-based exchange are prime examples of what the House would like to see addressed under budget reconciliation.
• Continue negotiations with congressional leaders and the administration with the expectation that they can reconcile House-Senate differences, send a final bill to the Congressional Budget Office for scoring, and allow the bill to be posted for 72 hours before a final vote is taken.
• Scale back a bill to pass in the coming weeks or months that can garner Republican votes in the Senate.
• Let the bill die altogether and start over.

House and Senate leaders spent the better part of 2009 attempting the massive overhaul of the health care system. President Obama made it his number one domestic agenda item beside the stimulus legislation. Going forward, each option comes with its own barriers and political consequences. Now congressional leaders will have to weigh the consequences of not passing a bill where so much political capital has been spent versus passing some form of health care reform in the face of Massachusetts historic election.

Despite the recent political shift in the U.S. Senate, NSBA remains committed to passing comprehensive health care reform that serves the needs of small businesses. In fact, NSBA has maintained focus on addressing the House and Senate shortcomings in order to develop a reasonable health care reform bill that serves the needs of all Americans--regardless of politics.

Click here to view the checklist of what small business wants in health care reform.

Click here to read NSBA’s recent and detailed letter to House and Senate leaders requesting needed changes to a final bill.

Stay tuned to the NSBA Web site for calls to action and specific measures or updates on the NSBA Health Reform Today Web site as more information is made available.