Republican Scott Brown’s upset win in Massachusetts Tuesday threatened to derail any hopes of passing a health reform bill this year, as the White House and Democratic leaders faced growing resistance from rank-and-file members to pressing ahead with a bill following the Bay State backlash.

White House senior adviser David Axelrod told POLITICO: “I think that it would a terrible mistake to walk away now. If we don’t pass the bill, all we have is the stigma of a caricature that was put on it. That would be the worst result for everybody who has supported this bill.” He said the administration will work with Capitol Hill to figure out how.

Obama's former campaign manager, David Plouffe, added on ABC's "Good Morning America": "I'm very confident we can pass health-care reform."

Democratic leaders insisted they planned to press ahead with health reform, and met late into Tuesday night in Speaker Nancy Pelosi’s office. But they made no decisions about how to proceed, now that Brown has swept away the Democrats’ filibuster-proof 60-vote majority in the Senate.

Their options are few, and extremely complex, mostly involving legislative tactics that would be difficult to pull off in the best of circumstances, let alone at a time when members are worried they could be the next Martha Coakley – a seeming Democratic shoo-in laid low, in part, by health reform.

And already Tuesday night, Democrats were being forced to come to terms with the prospect that their decades-long goal of health reform might once again fall short, despite getting closer to becoming law than ever before.

Pelosi insisted Democrats could still make it happen. "We will get the job done. I am confident of that. I have always been confident of that," she told reporters as she left the Capitol at 11:30 p.m.

"Massachusetts has health care and so the rest of the country would like to have that too," Pelosi said, referring to the state’s health care program. "So we don't [think] a state that already has health care should determine whether the rest of the country should."

But it wasn’t clear last night how Democrats could do it, or how hard the White House is prepared to push. A statement by Press Secretary Robert Gibbs announcing that President Barack Obama called Coakley and Brown made no mention of health reform.

The White House’s preferred option is for the House to approve the already-passed Senate version of health reform, to avoid the need for another vote in the Senate. But several House members said last night they’re not prepared to pass the Senate bill alone – even if it means health care reform would die.

In fact, early signs of split emerged as the polls closed in Massachusetts – between leaders like House Majority Leader Steny Hoyer who said “the Senate bill is better than nothing,” and individual members who refused to swallow the Senate’s version of health reform whole.

And with the winning majority for a health reform bill in the House so thin, almost any defections at this point would be fatal to reform’s prospects.

"I've maintained for months now that incremental reform in the health care package would make much more sense from my perspective," said California Rep. Jim Costa, one of the last Democrats to vote "yes" on the House bill.

He said he'd like to see Obama tell voters that "we may have been overreaching" and then push for a scaled-back bill that focuses on things more people can agree on, like insurance reforms. He said it's not just a question of the House bill versus the Senate bill. "For me, it's broader than that," Costa said.

Rep. Anthony Weiner (D-N.Y.), one of the leading advocates for health reform in the House, urged fellow Democrats to heed the message of Massachusetts and pivot toward creating jobs, perhaps with a health-care component added in.