WASHINGTON – A stinging loss Tuesday in Massachusetts has cost President Barack Obama and the Democrats the 60-vote Senate majority they’ve relied on to push a historic health care overhaul to the verge of enactment.

Now what? It’s miles of bad road in any direction.

Democrats splintered on how to salvage the president’s top domestic initiative even before the results were official. Republicans said don’t bother: The election of state senator Scott Brown sent a message that the health care bill should be scrapped.

Obama and party leaders anxiously worked through fallback options — none good. After a year of improbable twists and turns, the unthinkable happened Tuesday. Democrats lost Edward M. Kennedy’s seat to a Republican upstart, and with it faced the prospect of not being able to pass the legislation that was Kennedy’s dream.

Democrats don’t appear to have enough time to resolve differences between the House and Senate bills — and get cost and coverage estimates back from the Congressional Budget Office — before Brown is sworn in. That leaves House Democrats with the unpalatable option of passing a Senate bill that many of them profoundly disagree with.

“How do we do it with 59?” lamented liberal Rep. Anthony Weiner, D-N.Y.

Independents turned against the sweeping health care legislation and the Democratic base lost its enthusiasm, Weiner continued. Democratic lawmakers must show they got the message by regrouping, considering a time-out on health care and perhaps passing a more modest bill, he argued.

Others said they feel the need to act even more urgently.

“There is only one guarantee — that if we don’t pass something the notion of trying to put Humpty Dumpty together again is a real long shot,” said Rep. Patrick Kennedy, D-R.I., son of the late senator. “If you understand the legislative process, it’s a lot easier to pass something and fix it later.”

The defeat of Massachusetts Attorney General Martha Coakley leaves Obama and Democratic leaders facing a series of wrenching decisions fraught with escalating political risk. Significant disputes between the House and Senate would have to be settled by presidential fiat, and Democratic lawmakers would have to move in virtual lockstep to enact the bill, even as Republican opposition intensifies.

That could be too much to ask from rank-and-file Democrats demoralized by losing a seat held in an almost unbroken line by a Kennedy since 1953. Efforts to woo a Republican convert could increase. But with polls showing voters souring on health care overhaul the president could be abandoned by lawmakers of his own party.

The cleanest option calls for the House to quickly pass the Senate bill and send it to Obama for his signature. But that ignores at least two significant problems. Labor unions are adamantly opposed to an insurance tax in the Senate bill, and they successfully negotiated with Obama last week to weaken it in key respects. Second, a core group of anti-abortion Democrats says the Senate bill’s provisions on restricting taxpayer funding for abortion are too weak.

On top of that, many House Democrats do not believe the Senate bill provides enough aid to make health insurance affordable.

“The Senate bill clearly is better than nothing,” said House Majority Leader Steny Hoyer, D-Md. He refused to speculate on whether House Democrats could be cajoled into voting for it without changes.

Before Tuesday’s election results were in, rank-and-file Democrats were sending mixed signals on whether the House should try to pass the Senate bill, but only a handful rejected the idea outright.

“I think it’s important for us to pass legislation. I haven’t completely analyzed it myself, but if that’s the only option in town, then maybe that’s what we ought to do,” said Rep. Baron Hill, D-Ind., who represents a swing state district.

But Rep. Bart Stupak, D-Mich., sponsor of a House-passed provision restricting taxpayer funding for abortion, said he could not back the Senate bill.

House objections have led to a second fallback option: getting the Senate to accept changes to its bill as a condition for House passage. It involves a complicated legislative choreography that could take several weeks to play out.

Without 60 votes needed to overcome Republican delaying tactics, that strategy would require Senate Democratic leaders to use a special budget-related procedure to pass the changes with only 51 votes. It’s guaranteed to enrage Republicans, and it’s not clear that Senate Democratic leaders have political support to pull it off.

To complicate matters, additional legislation may be required to resolve disputes about abortion funding and illegal immigrants. In the meantime, the drumbeat from opponents of the legislation could be deafening.

Even more uncertain are the chances for persuading Maine Republican Sen. Olympia Snowe to come along, since she opposed the Senate version. Snowe, who supported a version of the Senate bill in committee, remains an intriguing figure in the endgame.

Obama called Snowe on Friday to discuss health care. They have spoken regularly and Gibbs said Obama continues trying to win her over.

Democratic congressional leaders put on a show of resolve. In 1994, Democrats failed to act on President Bill Clinton’s health care package and lost control of Congress.

“Our goals remain the same,” Rep. John Larson, D-Conn., said. “Our strategy may vary but our goals remain the same.”