WASHINGTON — As the office phones buzzed, party leaders hectored and protesters outside roared, several undecided House Democrats this weekend faced an unpleasant and all-too-realistic prospect: that voting for the health care overhaul could doom their careers.

Some bit their lips and went ahead — perhaps saying a silent prayer along the way. But others begged off, declining to support the bill for a number of reasons, including its effect on state Medicaid budgets and concerns about its effect on seniors. But all had to have one eye on polls that continue to show the legislation unpopular with a large chunk of the electorate.

"Every time you have a midterm election, you risk the chance of losing members," Rep. John B. Larson, D-Conn., the chairman of the House Democratic Caucus, said yesterday on ABC News' "This Week." "But it isn't about how many members are going to lose their seat. . . . It's about this moment, it's about the truth, it's every reason why you were elected to come and serve in Congress."

Perhaps the most reliable chronicler of Democratic "yes" votes was the National Republican Congressional Committee, which supports GOP House candidates. Each time another Democrat declared support for the bill, the committee gleefully blasted out a news release in the manner of a grim reaper counting souls: Earl Pomeroy, a moderate from North Dakota, was said to have made a "career-ending decision." Harry E. Mitchell, a second-term member from Arizona, would "begin a new job search soon." And Betsy Markey, another freshman from Colorado, had declared herself a "Washington short-timer."

Mike Pence of Indiana, a House GOP leader, pledged Saturday that Republicans would regain control of the chamber because of the health care vote. "I don't know if our victory will come on the third Sunday in March or on the first Tuesday in November, but I know our victory will come," he told protesters on the Capitol lawn.

And although antiabortion Democrat Bart Stupak of Michigan made the largest headlines for throwing his support behind the bill Sunday, he wasn't taking the largest political risk. Democrats such as Pomeroy, Mitchell, and Markey, representing districts that favored John McCain over Barack Obama in 2008, held that distinction.

Markey was also among a small group of Democrats who switched to declaring support for the bill after voting against similar legislation last November. Other Democrats in that camp included Rep. John Boccieri, an Ohio freshman, and Suzanne Kosmas, a first-termer from Florida's east coast, both of whom hail from districts that went for McCain; and Scott Murphy, who won a special election last year in an upstate New York swing district by just 700 votes.

"A lot of people are telling me this decision could cost me my job," Boccieri said at a news conference Friday.

President Obama, in fact, mentioned Boccieri and Markey by name in remarks to House Democrats on Saturday, saying both represent "tough" districts.

"I know this is a tough vote," Obama said to the Democrats. "And I am actually confident — I've talked to some of you individually — that it will end up being the smart thing to do politically, because I believe that good policy is good politics."

But not everyone in the crowd, it appears, believed him. A number of first-term and second-term Democrats — some handpicked for their seats by White House Chief of Staff Rahm Emanuel and the chairman of the Democratic Congressional Campaign Committee, Chris Van Hollen of Maryland — declined to back the legislation.

They included Jason Altmire of Pennslyvania, Michael Arcuri and Michael E. McMahon of New York, Frank Kratovil Jr. of Maryland, Harry Teague of New Mexico, and Zack Space of Ohio. All are expected to face difficult races later this year, regardless of their health care vote.

Unions were so angry with Altmire that members of the United Steelworkers staged a sit-in Saturday at his district office. But McCain won Altmire's district by 11 percentage points in 2008.

Arcuri said he spoke to Obama on Thursday for 20 minutes, but he still believed the bill was unacceptable to his constituents.

"I think the president knows how things are," Arcuri told his hometown newspaper.

in Rochester, N.Y. "The No. 1 rule up here is you have to do what's best for your district."

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(c) 2010, Tribune Co.

Distributed by McClatchy-Tribune Information Services.

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GRAPHICS (from MCT Graphics, 202-383-6064): HEALTH

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