Roiled by the GOP's victory in the Massachusetts Senate race, Democratic leaders in Congress continue to send mixed messages about what their next move on health reform might be.

And though the White House remains committed to passing health-reform legislation this year, the path forward remains indefinite.

In an appearance Jan. 31 on the CNN program "State of the Union," White House Press Secretary Robert Gibbs said the administration does not yet know what the process will be for moving health-reform legislation -- only that the process will take place.

"Reading the tea leaves on this one is pretty close to impossible," conceded Bob Doherty, senior vice president of government affairs and public policy for the American College of Physicians.

House Speaker Nancy Pelosi (D-Calif.) told journalists recently that she thought she could get the votes to move comprehensive health-reform legislation if the Senate first passes a set of amendments through the reconciliation process. Such legislation would require only a simple majority of 51 votes.

And at a press conference Jan. 28, Pelosi said that House Democrats had begun to consider moving pieces of the comprehensive health-reform measure through several smaller bills.

Sen. Majority Leader Harry Reid (D-Nev.), however, has offered even fewer specifics about how health reform might advance in that chamber.

President Barack Obama, in his State of the Union address Jan. 27, affirmed his ongoing commitment to health reform but offered no details on strategy or timing.

"I think a lot of people are waiting for the administration to step up and be much clearer in how the president wants to see things move forward," Doherty said.

He also questioned the viability of breaking the legislation into smaller bills. "You could end up with a 'Swiss cheese' health-reform product that just isn't going to work" because the various provisions are interdependent, he said.

For example, many Americans appear to favor legislation to prohibit health plans from denying people coverage because of pre-existing health conditions. That means insurers would have to accept anyone, regardless of their health status. But unless people are required to buy insurance, some people will undoubtedly wait until they're sick, "and then the whole concept of risk-sharing doesn't work," Doherty explained. And if you require people to buy coverage, he said, then you have to help subsidize those who cannot afford it.

In a raucous exchange with House Republicans on Jan. 29, Obama insisted that he welcomes ideas from the GOP and is "absolutely committed" to working with its members to advance health reform, "but it can't just be political assertions that aren't substantiated when it comes to the actual details of policy," he said.

As an example, the president cited tort reform, which he indicated he would be willing to work on with House Republicans. He added, though, that if experts say it won't bend the cost curve long term, "then you can't make the claim that that's the only thing that we have to do."

Though the White House is now focused on moving a jobs bill through Congress, that should not interfere with health reform, Doherty observed. "Most of us multi-task in our jobs," he said. "I don't know that it's impossible for the Congress to multi-task and handle more than one priority at a time."

Amid the uncertainty about the procedural process that will take shape, however, ACP's advocacy agenda remains unchanged.

In a letter to key House and Senate legislative leaders dated Jan. 28, ACP reaffirmed its commitment to helping Congress move comprehensive legislation that creates a pathway to affordable coverage for all Americans, ensures a sufficient supply of primary-care physicians, supports alternatives to the current medical liability system and ends the annual cycle of Medicare payment cuts caused by the "sustainable growth rate" system currently in place.

"The rationale for those reforms was true a year ago, was true the day before the Massachusetts special election and is still true today, and so we are going to continue to push those four agenda items," Doherty said.