There is one way to pass the bill, even without 60 votes in the Senate, that's getting a lot of attention now. But Pelosi probably won't like it, and neither will a fair amount of her members.
The procedure in question would involve simply having the House vote on the bill that the Senate has already passed. That would mean avoiding yet another cloture vote in the Senate, one Democrats would be likely to lose if their caucus is down to 59 members after the special election in Massachusetts on Tuesday.
House liberals will be upset about this idea, and progressive activists would likely be angry as well, but it may well be the only option left, and Democrats are reportedly leaning towards it. On Monday night, the New York Times reported: "The White House and Democratic Congressional leaders, scrambling for a backup plan to rescue their health care legislation if Republicans win the special election in Massachusetts on Tuesday, are preparing to ask House Democrats to approve the Senate version of the bill, which would send the measure directly to President Obama for his signature."