As Senate Democrats assess the political landscape of health care reform, their options for bringing up a comprehensive bill appear to be narrowing with the gradual realization that — no matter what they do —they’re probably going to need 60 votes to pass it.

Democrats gave themselves a choice this year between keeping the bill open to filibuster — which requires 60 votes to overcome — or using fast-track budget rules, known as reconciliation, to push a measure through with a simple, 51-vote majority.

But the rules governing reconciliation are so complex and restrictive that the Senate Democratic leaders’ backup reconciliation plan could become mired in the same 60-vote problem they currently face as liberals, centrists and a handful of Republicans battle it out over the direction of a final Senate bill.

“At some point in the process, they’re going to need 60, if they go with reconciliation, to do a complete bill,— said Martin Paone, a former Democratic leadership aide who now works for Timmons and Co.

Paone and others on and off the Hill said Democrats could find themselves in a position of having to pass two separate bills — one under reconciliation and another under “regular order.— Alternatively, Democrats could try to amend a reconciliation bill with provisions that also need to overcome the 60-vote hurdle, Paone said.

Senate Majority Leader Harry Reid (D-Nev.) insisted last week that reconciliation is still a viable option and that he believes Democrats have a way to craft a public health insurance plan using such rules. However, Reid was careful to note that he is not planning on pursuing that path at this point given the difficulties it presents.

Reid said if he cannot find 60 votes for a health care bill, “then we’ll consider reconciliation, but at this stage, that’s not something that we are in the process of putting together. I have spent some time over the last couple of months understanding reconciliation. I understand much better than I did, and we have people working on what can be done and what can’t be done in reconciliation. But we’re not there. … My goal is to work with the House and have a bipartisan bill.—

One Senate Democratic aide said Reid is largely keeping the reconciliation option open because he is unsure of — and impatient with — the pace of Senate Finance Chairman Max Baucus’ (D-Mont.) bipartisan negotiations, which have gone on for more than a month.

“There was a general agreement … at the White House that he would release a bill by the end of— last week, the aide said. “The goal is to get a bipartisan bill done, but we need to reach an agreement as soon as possible.—

As for any two-bill strategy, however, one senior Senate Democratic aide downplayed that as an option.

“How can we do a two-bill strategy if we can’t do one bill?— the aide asked.

Of course, at this point, Democrats do not yet have a complete bill to bring to the floor, even though Reid continues to insist he will bring up a measure and pass it before Senators leave for the August recess.

While the Health, Education, Labor and Pensions Committee passed a bill creating a public insurance plan last week, the Finance panel continues to work on a bipartisan package. Finance is looking at establishing a nonprofit health insurance cooperative that would get its seed money from the government.

Those two bills are set to be merged before any floor debate this month. This year’s budget resolution gave both Finance and HELP until Oct. 15 to write bills under reconciliation, but Reid is under no obligation to bring up such a measure for debate.

Under reconciliation, anything that does not have a budgetary impact — either by cost or savings — would be eliminated from the bill unless leaders could muster 60 votes to keep it. That means mere policy and regulatory changes that would be central to the creation of a public health insurance plan, for example, might not make it into the bill.

The senior Senate Democratic aide said Reid and other leaders believe that “there are ways to structure it and get as much as you can in it and avoid— budget points of order.

But when it comes to writing a bill to meet reconciliation rules, Senate Budget Chairman Kent Conrad (D-N.D.) could be less than helpful, one Democratic aide warned. Conrad, who has been a key player in talks to forge a bipartisan deal, opposes the use of reconciliation for any health care bill, even though he relented to his leaders’ demands earlier this year and put those instructions in his fiscal 2010 budget.

Bill Hoagland, a former Senate budget expert who currently works in government relations for health insurance giant CIGNA, said there are already provisions of the HELP bill that could fall to points of order. For example, the public health insurance option in the bill would set rates equivalent to private company averages, and that provision has been scored as budget-neutral, he said.

Without that provision, Hoagland said, “You wouldn’t have a public option.—

Hoagland also said Baucus’ co-op proposal could be affected. Any authorization to appropriate money for a co-op could be ruled out of order, Hoagland posited.

All of those decisions on what makes the cut and what doesn’t would be made by the Senate Parliamentarian’s office, and aides who have dealt with amendments being ruled out of order in the past said it is often a tough sell to get them to change their minds.

“They kind of lean toward No.’ That’s their natural predisposition,— said another Senate Democratic aide.

And Republicans — most of whom have expressed opposition to the Democratic proposals — are likely to take full advantage.

“There are some Republicans who say, Great, let’s do reconciliation,’ because they think they can make mincemeat out of it,— said one former Senate GOP aide.

Of course, the reconciliation process also might open up Democrats to more charges that they are rushing the bill through Congress, considering debate on reconciliation bills is limited to 20 hours.

But Democrats would have an advantage in that they would not have to force all 60 Members of the majority to vote for the bill. Still, the measure would likely only pass with Democratic votes given a threshold of 51.

“If you go that route, you telegraph to the world that this is going to be a partisan bill,— Hoagland said.

Of course, Democratic leaders, with a 60-member Conference, are already exploring ways to keep Democrats together on health care, just in case all 40 Republicans end up opposing it.

But many centrist Democrats have expressed concerns about passing a measure with only Democratic votes because they feel they could be tagged as too partisan.

Reid and Obama have seemed to have gone back and forth on what they would like to do and appear to be working both the partisan unity and bipartisan angles.