Prior to today, momentum seemed to be on the side of passing a comprehensive health care bill. But Eric Cantor’s inconvenient memo refocused attention on the fact that the House may not have the votes to pass any kind of health care bill. Cantor may be a dim bulb, but it’s hard to argue with his figures, which just recapitulate what we’ve known all along – there are three less Yes votes in the House than there were in November, and around a dozen or so members are candidates to vote no the second time around, particularly Bart Stupak and the anti-choice crew. Cantor acknowledges that a few no votes could flip to yes this time, particularly retiring members Brian Baird (D-WA), John Tanner (D-TN) and Bart Gordon (D-TN), but nobody has yet counted to 217. Cantor helpfully provided a list of possible anti-choice flips from yes to no:

1. Cao, Anh (R-LA)
2. Costello, Jerry (IL)
3. Dahlkemper, Kathy (PA)
4. Donnelly, Joe (IN)
5. Driehaus, Steve (OH)
6. Ellsworth, Brad (IN)
7. Kaptur, Marcy (OH)
8. Kildee, Dale (MI)
9. Lipinski, Dan (IL)
10. Oberstar, Jim (MN)
11. Stupak, Bart (MI)
12. Wilson, Charlie (OH)

Cantor later flags Earl Pomeroy, Nick Rahall, Alan Mollohan and Baron Hill as possible yes-no flips as well. Again, it’s hard to argue with this list, though it does provide a target list for anyone who wants this bill to pass.

Throwing more cold water on efforts to pass the bill, Kent Conrad, the chair of the Budget Committee who would nominally be in control of a reconciliation process, said that such a tactic was impossible unless the House passes the Senate bill first, which simply cannot happen (and I would submit Conrad knows that).

“The only way this works is for the House to pass the Senate bill and then, depending on what the package is, the reconciliation provision that moves first through the House and then comes here,” said Sen. Kent Conrad (D-ND) outside the upper chamber this morning. “That’s the only way that works.”

I pointed out that House leadership, including Speaker Nancy Pelosi, has repeatedly insisted they won’t take a flier on a reconciliation package–that they will only pass the Senate bill after the smaller side-car reconciliation bill has been all wrapped up.

“Fine, then it’s dead,” Conrad said.

This is the usual House/Senate wrangling. Neither chamber trusts the other, and this stance could put a quick end to any efforts at passage.

Blanche Lincoln is already lining up the fallback bill – essentially another tax break for small businesses.

A duo of key centrist senators urged their colleagues today to set down comprehensive healthcare reform temporarily and instead start with reforms for small businesses.

Sens. Olympia Snowe (R-Maine) and Blanche Lincoln (D-Ark.) said the Senate could “breathe bipartisan life” into the healthcare debate if they passed the Small Business Health Options (SHOP) Act.

The bill, which was included in the comprehensive Senate Finance Committee legislation, would give tax credits to small businesses to buy coverage, establish an exchange for small businesses to compare plans, and allow national plans to be sold across state lines.

“Our SHOP legislation is an essential building block that we believe can serve as the foundation of health care reform moving forward,” Snowe and Lincoln said in a joint statement.

That’s a conservative wish list – interstate insurance to gut state-based regulation, a bunch of tax credits, and nothing else (the exchange in question here is nothing more than a comparison-shopping website). Lincoln and Snowe obviously would get shut out of a reconciliation process, and they’re just bargaining for a role and positioning themselves for a fallback. It’s Conrad’s intonation that the House has to eat the Senate bill and hope that reconciliation will get used to change it which will put a swift end to the hopes of passage.

Nothing like reality to temper optimism.