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Democratic leaders have set the course for a climactic vote on comprehensive health reform, but success hinges on convincing some of their more conservative colleagues to back an effort they previously opposed.

One of their likely targets is Utah Democratic Rep. Jim Matheson, who voted against health reform twice but says he hasn't ruled out supporting a compromise package this go around.

"We haven't seen what this last bill is going to look like now," he said. "I think it is important to look at this bill."

That said, Matheson criticized the process and the potential cost of this last-ditch attempt in an interview Thursday with The Salt Lake Tribune .

"I do have concerns about the overall cost of the bill, which sounds like it is going up," he said. And he isn't a fan of using of the Senate's reconciliation process to bypass Republican stall tactics and force a final vote.

"I don't think it is the cleanest way to go about it," he said.

But Democrats have little choice unless they want to seriously downsize their proposal. It takes 60 senators to overcome a filibuster and the Democrats only have 59. That means the White House is encouraging the House to pass the Senate's version of health reform and then a second bill of negotiated fixes. Once that is done, it would only take 51 senators to pass the changes under reconciliation.

The vote in the House is far from certain with some members critical of abortion language and Blue Dogs like Matheson wary about the fiscal implications of the bill.

Utah's lone Democratic House member, Matheson has said he supports the need for health reform that lowers medical inflation and expands coverage to the uninsured, but he has criticized components of the massive bills throughout the last year.

Like other Blue Dog Democrats, he has complained that Democratic bills do too little to contain costs, centralize too much power in Washington and fail to reform medical malpractice laws or support health savings accounts.

In announcing his vote against the House bill last year, Matheson used political talking points often used by Republicans.

"A one-size fits all, nationally run plan that doesn't acknowledge the different health demographics in the states isn't the answer," he said.

President Barack Obama has released a list of changes he wants to see, some of which go directly to the concerns mentioned by Matheson, including more funding for medical malpractice reform proposals on the state level and a proposal that could make health savings accounts more enticing.

Matheson said he has yet to review the president's proposal. He did credit Obama for hosting a seven-hour health care summit with leading Republicans last week and isn't ready to give up on bipartisan talks.

But the president said he saw no point in further negotiations, citing an honest difference of opinion between the two political parties.

Kirk Jowers, director of the University of Utah's Hinckley Institute of Politics, says Matheson is "caught in a vise." Leading Democrats are pressuring him to support the bill, while Republicans are attacking him for simply being undecided.

Jowers, who credits Matheson for being attuned to the wishes of his Republican-leaning district, said it "could be disastrous for his constituent relationships" if Matheson were to switch his vote on such a controversial proposal.

Complicating matters further are recent rumors that Obama appointed Matheson's brother Scott to the U.S. 10th Circuit Court of Appeals in a bid to win him over on health reform. The rumors are baseless, since Scott Matheson is a consensus appointee backed by Sen. Orrin Hatch, R-Utah, but Jowers said they may have an impact nonetheless.

"These rumors make it even less likely that Matheson would ever change his vote," Jowers said. Matheson, who calls the rumors "absurd," said they would not have any impact on his decision.

"I think people back home know who I am," he said, promising to vote based on the merits of the bill.

Health care partisanship

Utah's four GOP lawmakers, like most Republicans in Congress, remain opposed to the legislation and plan to vote against it when Democrats bring up the compromise bill in the next few weeks.