I get the impression it's a life and death issue for someone. I have never seen either party fight this hard for ANY bill to be passed in my entire life and I am old as dirt.
Obama has made a pile of the last of his political capital and is watching the roulette table slow down.
Reid realizes that he is gone anyway.
Pelosi, ironically, will continue in Congress until she wants to leave (she does represent her district fairly well), but she is serving her last 9 months in any place in leadership no matter what happens.
So the two big worriers on the Dem side are Obama, whose entire Presidential legacy can be destroyed in the next few weeks, and Steny Hoyer, who would love to be Speaker of the House rather than Minority Leader.