While job creation is said to be the legislative priority this year, the president and Democratic leadership in Congress say health care reform must be completed. With Senate Democrats down to 59 votes after losing the late Senator Edward M. Kennedy's Massachusetts seat, compromising the House and Senate reform bills got a lot more complicated.

Conversations between the two chambers now focus as much on the process by which the bill will get through, as on what's in it.

"We're going to do health care reform this year," Senate Majority Leader Harry Reid (D-Nev.) said Thursday. The only question, he said, "is procedurally how do we do it."

One option being considered is a two step process where the House would pass the Senate version of the bill and the Senate would then pass budgetary changes to the bill using reconciliation -- a parliamentary move that would require only 51 votes. The House would also vote on the changes.

It was a struggle for Reid to find the 60 votes necessary to pass the Senate bill early Christmas Eve morning. By changing the bill, some Democrats are expected to drop their support, either because they don't like the changes or are against using the reconciliation process, which allows the majority to circumvent the filibuster on matters pertaining to the budget.

So far, Senators Blanche Lincoln (D-Ark.) and Evan Bayh (D-Ind.) have announced they would not support this process. Both are running for re-election this year, and Lincoln particularly is in danger of losing her seat. Meanwhile, a poll released this week showed Bayh trailng Rep. Mike Pence (R-Ind.) in a hypothetical match-up, though Pence said shortly thereafter he was running for re-election and not interested in challenging Bayh.

Still, that knocks the Democratic votes in favor of reconciliation down to 57, with just seven to spare. (They would need only 50 votes, as Vice President Biden could break a tie.)

Other Democrats who could join Lincoln and Bayh are Senators Ben Nelson (D-Neb.) and Mark Pryor (D-Ark.), although both said this week they're not necessarily against using reconciliation.

"If I support a bill, I would vote for it whether it takes 50 or 60 votes. I'm not focused on the process," Nelson told the Lincoln Journal Star.

According to the Arkansas News, Pryor said reconciliation was not his first choice but "he was not necessarily opposed to the idea." Pryor also indicated doubts that it would be attempted.

On Wednesday, Politico identified a total of eight Democrats (including Sen. Joe Lieberman, I-Conn., who caucuses with Dems) who were wary of reconciliation, including Senators Mary Landrieu (La.), Mark Begich (Alaska) and Claire McCaskill (Mo.). Nelson was included in that count as well.

As Senate Budget Committee Chairman Kent Conrad said this week, reconciliation is no easy fix for health care. Unlimited amendments and the necessity of cutting the annual deficit by $1 billion represent two possible bumps in the road.

Democrats could turn to breaking the bill up and voting on pieces of it separately, leaving comprehensive reform for the future.