House Democrats were able to pass comprehensive health care reform Saturday night by a 220-215 vote, despite the defection of 39 members of the Democratic caucus. The tight margin is indicative of the divisive nature of the bill, as well as the volatile political atmosphere of the country.

Members know that each major vote cast on the floor of the House chamber could be the issue that defeats them in the following election. All but one Republican opposed the bill, and the party, down 81 seats, is already using the vote as a wedge issue for next year's midterm elections.

The National Republican Congressional Committee released the following statement shortly after the vote to media in the congressional districts of nearly 50 of the Democrats who supported the bill:

"As the country recoils against the Democrats' reckless crusade for higher spending and more government control, Dina Titus just walked off a cliff at the request of her party bosses by voting for a bill that hikes taxes, slashes Medicare, kills jobs, and puts small businesses and middle class Nevada families in an even bigger bind."

In 2008, John McCain won 49 districts that also elected a Democrat to the House. On Saturday, 31 of the 39 Democrats who opposed the bill represent districts McCain carried, including 19 where McCain won 55 percent of the vote or more. Of the 31 McCain districts, 11 are represented by freshmen.

Fifteen of the 41 Democrats elected in 2008 voted against the bill, while just two from the even larger 2006 class opposed it. Just fewer than half of the centrist Blue Dog Coalition, whose votes the Democratic leadership aggressively lobbied for, voted against the bill -- the 24 Blue Dogs made up more than 60 percent of the bill's Democratic opposition.

Rep. Dennis Kucinich (D-Ohio), one of the most liberal members of Congress and whose Cleveland-based district Obama won with 59 percent, opposed the bill because it didn't go far enough. Kucinich favored a "robust" public option, which leadership eventually concluded could not win enough support to pass.

Two of the opposing votes came from Members who are running for higher office next year -- Rep. Artur Davis (D-Ala.), who's running for governor, and Rep. Charlie Melancon (D-La.), who is challenging Sen. David Vitter (R-La.). McCain won at least 59 percent in both states in 2008.

Other noteworthy opposing votes came from Reps. Rick Boucher and Glenn Nye, both from Virginia, whose congressional districts were won Tuesday by Republican Bob McDonnell in the race for governor. The other two
Virginia Democrats whose districts McDonnell won, Reps. Gerry Connolly and Tom Perriello, voted in favor of the bill.

The lone Republican to support the bill was Rep. Joseph Cao (R-La.), whose district leans heavily Democratic and has one of the 10 highest percentages of African American voters. Cao is widely considered the most vulnerable incumbent in the country, as his election in 2008 hinged on ethical and legal woes of incumbent Bill Jefferson (D-La.).