Struggling to salvage health reform, Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi have begun considering a list of changes to the Senate bill in hopes of making it acceptable to liberal House members, according to sources familiar with the situation.

The changes could be included in separate legislation that, if passed, would pave the way for House approval of the Senate bill - a move that would preserve President Barack Obama's vision of a sweeping health reform plan.

But the move comes with political risk, because it would open Democrats up to charges that they pressed ahead with roughly the same health care bill that voters appeared to reject in the Massachusetts Senate race Tuesday. Republican Scott Brown won on a pledge to try to block Obama-style health reform.

The effort also puts Reid and Pelosi on the side of giving a sweeping reform bill one more try, instead of adopting a course being floated by some Democrats in Congress and at the White House of adopting a scaled-back bill including popular reform provisions.

The changes are being worked on this weekend with plans for Pelosi to present them to her caucus next week, according to sources familiar with the situation. But, sources stressed, neither Reid nor Pelosi know if this strategy can win the support of their members, but they are attempting it because it is the quickest path to passage.

Earlier this week, Pelosi said she did not have the votes to pass the Senate bill through the House unchanged. And Reid, who lost his 60-vote majority on Tuesday, does not have the votes to make wholesale changes to legislation his chamber passed last month.

So, leaders are considering making limited changes that can be passed using a budget process called reconciliation, which only requires 51 votes in the Senate.

The changes being considered track closely with the agreements House and Senate leaders made in White House meetings last week, according to a source. They include the deal with labor unions to ease the tax on high-end insurance plans, additional Medicare cuts and taxes, the elimination of a special Medicaid funding deal for Nebraska and a move to help cover the gap in seniors' prescription drug coverage. Pelosi is also working to change the Senate provision that sets up state insurance exchanges. The House prefers a single, national exchange.

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There is great uncertainty around both the politics and policy of the reconciliation strategy. Under the budget reconciliation process, the bill's changes would have to be germane to the budget so there is a real question about how many of the proposed tweaks could be included.

Politically, Democrats, shell shocked from Tuesday's election, may be wary of using procedural maneuvers to pass the bill in place before Brown's election, which cost Democrats their 60-seat majority.