If Martha Coakley loses the special election for the Massachusetts Senate seat, the big question in Washington is what would happen to health care. It is clear the White House is pushing for the House to pass the Senate bill as is.

For the moment, at least, the preferred Plan B would be to try to persuade House Democrats to approve the health care bill that the Senate adopted on Christmas Eve, obviating the need for an additional Senate vote and sending the measure directly to President Obama for his signature, administration officials and Congressional aides said on Sunday.

This should surprise no one. The Obama has made it clear all along that he favored the Senate bill. The big question is: can they force the Senate bill through the House? Such a move would face some very angry progressives, representatives in labor heavy states who don’t want the excise tax, and a small group of conservative Democrats in the House who might bolt at the bill’s lack of Stupak’s anti-choice amendment. Getting the House to swallow the Senate bill whole would be an extreme uphill battle.

One of the other options is to jam the compromise bill through the Senate before Republican Scott Brown is seated. I don’t know if this would even be technically possible, and I doubt you could get all 60 Democratic votes for that move, anyway.

The last option is to use reconciliation, which can’t be filibustered. As Chris Van Hollen said, “reconciliation is an option.” They could use reconciliation to pass a new, redesigned health care bill, or they can pass the Senate bill and a reconciliation measure right after to fix the Senate bill.

Using reconciliation to pass a new bill would require a rewriting of the bill so it only deals with budgetary matters. This would probably mean a strong employer mandate, a Medicare buy-in/public option, and a large expansion of Medicaid/SCHIP as the primary ways to expand coverage. Going this route could help make the Stupak abortion language issue moot since Medicaid, Medicare, and SCHIP are already under the existing anti-abortion Hyde amendment.

Passing the Senate bill first, and then fixing it with reconciliation, could also create strong political and policy pressure for reviving the public option or Medicare buy-in. Probably the only way they could jam the Senate bill “as is” through the House would be to get labor on board. To get labor, you need to promise to fix the excise tax, and probably the only way to do that is by using reconciliation. The unions agreed to a “fix” of the excise tax that would cost $60 billion. That money needs to be recouped through other tax increases or cost-cutting measures. Even a weak, “level playing field” public option would save $25 billion, and increasing Medicaid from 133% to 150% FPL should save another several billion.

If Coakley loses in Massachusetts, I don’t see how health care reform passes without reviving reconciliation, and, by default, the public option. The evidence indicates that Nancy Pelosi could not find the votes to pass the Senate bill as is. It would seem her only option is to promise to seriously fix the bill right away with reconciliation, or pass a completely redesigned bill using reconciliation. Either way, I don’t see how health care reform could move forward without using reconciliation in some manner.