Jay Cost: Uphill campaign for health care steepens

The biggest trouble will be in the House, not in the Senate. Consider:

-The vote on final passage of the Affordable Health Care for America Act was 220 to 215, with 38 Democrats voting with Republicans.

-John Murtha has since passed away.

-Robert Wexler has since resigned, and Florida's 19th Congressional District will not elect a replacement until early April.

-Neil Abercrombie of Hawaii's 1st Congressional District will resign at the end of this month. The special election to replace him will be held May 22. Thanks to the peculiar election rules, Republicans actually stand a chance of replacing him.

-Reports indicate that Joseph Cao, the sole Republican to support the reform efforts in November, will not do so this time around.

-That puts the number at 216-216, which is insufficient for passage.

Special election coming in John Murtha's PA district, which voted for Kerry in '04, McCain in '08

Without Murtha in the 12th district, however, the special election will be seriously contested. Murtha's district is the only one in the country won by Sen. John Kerry (D-Mass.) in 2004 and by Sen. John McCain (R-Ariz.) in 2008, according to Republican sources, and that trend line coupled with the volatile national environment for Democrats ensures Republicans will heavily target the contest.

Prior to Murtha's passing, there were two Republicans in the race: 2008 nominee Bill Russell and businessman Tim Burns. It remains to be seen whether either or both men run in the special election although, regardless, it is a certainty the field will grow as ambitious Republicans (and Democrats) see the chance to get to Congress in an abbreviated campaign.