When Massachusetts elected Republican Scott Brown to fill the Senate seat of the late Edward Kennedy, health care reform seemed doomed.

In truth, it was an opportunity, say the Democratic leaders who led the successful effort to pass the bill Sunday.

Before that moment, the entire process had focused on “getting to 60” – crafting a bill that could get 60 votes in the Senate. After a snowy January Tuesday in Massachusetts, however, a new strategy was born:

Pass the Senate bill in the House, then fix it. If passing the fixes meant using the contentious and time-consuming process of reconciliation – which requires only a simple majority – so be it.

IN PICTURES: Health care reform passed: who Nancy Pelosi won and lost

“Scott Brown’s election was a turning point,” says House majority whip James Clyburn (D) of South Carolina. “Losing 60 votes [in the Senate] got us to a more realistic place: that the number for health care had to be 50 plus one, not 60.”

“I never thought the things we had to do to get to 60 could produce a good plan that the House would agree to,” he added, citing the now-notorious deals included in the Senate bill to win over holdouts needed to get to 60 votes.

But that first step – getting 216 House Democrats to pass what many thought was an odious Senate health care bill – was a formidable one.

Thirty-seven sitting Democrats had voted against the House version of health care reform in November 2009, and many found the Senate version even more objectionable. With no GOP support, House Speaker Nancy Pelosi had almost no room for error.

Here’s a glimpse at how Speaker Pelosi and President Obama worked a diverse caucus to get to Sunday’s 219-to-212 vote victory:

Congressman Kucinich opposed the House bill because its public option was not strong enough. The Senate version is weaker still. But hours of discussion with Mr. Obama – including a trip to Cleveland on Air Force One on March 15 – helped change his mind and shift momentum toward Democrats.

“When I realized I couldn’t get everything I wanted, the choice was: Do you accept the bill as it is or just kill the bill – and with it, any chance of a serious discussion – because people won’t want to go there again,” he said.

Kucinich says that what moved him wasn’t any special deal for Cleveland, but concern for the impact of a defeat of health care to the Obama presidency.

“I saw how he was really putting his presidency on the line,” he added.

On Sunday night, he voted for the bill.

Congressman Stupak said he would oppose the Senate health care bill unless House leaders allowed a stand-alone vote to strengthen language in the Senate bill banning public funding of abortion services.

IN PICTURES: Health care reform passed: who Nancy Pelosi won and lost

But after talks with Speaker Pelosi and the White House, Stupak accepted the compromise of a new executive order reaffirming the principle that taxpayer dollars not fund abortion services in the new system.

“Although this legislation is not perfect and does not do everything I believe is necessary to reform our health insurance industry, it is a tremendous step forward for northern Michigan residents and for our nation,” he said in a statement after the vote.

Stupak backed the bill Sunday.

A former consumer activist in Chicago who organized one 1989 protest that featured seniors chasing then-Rep. Dan Rostenkowski (D) of Illinois down the street, Congresswoman Schakowsky was a strong yes for health care reform.

But she was outraged by Stupak’s proposal and told Pelosi that she and some 50 others would vote down the bill if Stupak were given the option of a stand-alone vote to strengthen anti-abortion language.

“We have said from Day 1 that we are not going to allow this bill to set back women’s access to abortion,” she said.

Pelosi told the group that she was suspending talks with Stupak. Pelosi’s response “made many of us feel much more reassured,” Schakowsky said.

Schakowsky voted to pass the bill Sunday.

A lifelong liberal, Kaptur also strongly opposes public funding of abortions and lined up with Stupak. “I’m trying to be constructive in this,” she said. “We have to find a way to reaffirm the House language before the vote on the bill.”

But at the same time, the plight of the uninsured has troubled her ever since her father had to give up his own grocery to take a job in a factory that ensured his family health coverage.

“It was gut wrenching,” she said. “I’ll never forget what I felt for him to give up his life’s dream.”

She praised round-the-clock efforts by both House leadership and the White House to resolve this issue.

On Sunday, she voted yes.

A second revolt broke out in Democratic ranks after the Senate parliamentarian – who is seen as the authority on what provisions can be passed by reconciliation – said last week that geographic disparities that disadvantaged Wisconsin and 16 others could not be “fixed” under Senate rules for reconciliation.

“Wisconsin has some of the highest quality outcome areas in the country, but among the lowest reimbursement rates, because we are not practicing volume medicine,” he says.

Asked on Friday whether the group would actually vote down health care reform over this dispute, he said: “Many of us are of the belief that this is the time. This is it.... A lot of votes are hinging on it.”

Congressman Kind says that savings expected to come from wellness programs or improved quality of care are under-scored by the CBO. “The US is spending $80 billion a year on tests and procedures that don’t work.”

IN PICTURES: Health care reform passed: who Nancy Pelosi won and lost

In response to these concerns, the White House agreed to step up efforts to educate the public on quality medicine as an alternative to fee-for-service. The president also pledged to hold a summit on the issue in Washington.

Kind voted yes on healthcare Sunday.

Rep. Paul Hodes (D) of New Hampshire

Currently in a tough race for US Senate, Congressman Hodes told his constituents that he would carefully read the health care bill before committing to vote for it. Like Kind, he is concerned about regional disparities in Medicare payments that disadvantage his state. But the Live Free or Die state is also famously independent and distrustful of anything that smacks of big government.

“I studied the bill carefully in its final form – all 2,407 pages of the bill and 154 pages of the reconciliation bill,” he says.

In the end, he voted for the Senate bill and fixes, but analysts say he could pay a price for it at the polls. According to a recent Rasmussen poll, 61 percent of New Hampshire voters think it would be better for the country if most incumbents were defeated in November. Only 44 percent of New Hampshire voters favor national health reform.

“I am confident that when people I represent and the American people fully understand the benefits of this bill whatever public sentiment there may be against it will change,” he says. “This bill is a jobs bill.”

Congressman Marshall is one of 13 members of the Democratic caucus who voted against leadership on the 2009 House health care reform bill, the climate change bill, and the Senate health care bill and fixes. He is also one of the group Pelosi refers to as “majority makers,” whose views must be taken into account.

He is deeply concerned about the growth of federal deficits and says that the health care reform bill does far too little to rein in costs.

“It’s all very well intended, and millions will be helped by this, but how does this bill deal with increasing health care costs? It raises revenues,” he says. “Sixty to 80 percent of our long-term debt problem is involved with health care. We have missed quite an opportunity.”

He voted no on health care reform, again.

A former ironworker with strong union ties, Congressman Lynch stunned Democrats when he announced opposition to the Senate bill: “We’re adding 33 million people to a system that’s still as broken as it was before.”

Lynch opposes a funding mechanism in the Senate bill that taxes high-end insurance plans, including many negotiated in union contracts. He preferred the House measure, which taxed rich families. He also objected to the absence of a public option in the House bill.

In recent days, he has withstood a personal meeting with Obama, an appeal from Vicki Kennedy (Ted’s widow), and a full court press just off the floor of the House from AFL-CIO leader Richard Trumka. “There’s a difference between a compromise and a complete surrender,” he said.

On Sunday night, he voted against the bill.

IN PICTURES: Health care reform passed: who Nancy Pelosi won and lost