"House Speaker Nancy Pelosi said Thursday that she doesn't have the votes to pass the Senate's health reform bill as some rank-and-file Democrats signaled support for a scaled-down measure - one that deletes parts of both bills or breaks them into pieces, such as insurance industry reforms and Medicaid expansion. The comment marks a serious setback in efforts to pass President Obama's top legislative priority now that Democrats are one vote shy of enough to overcome a Republican filibuster in the Senate. Senate Democrats were hoping that the House would merely pass its bill to prevent the Senate from having to take another vote. While both chambers have passed health bills, the two pieces of legislation have to be merged before moving to the president's desk. ""In its present form without any changes, I don't think it's possible to pass the Senate bill in the House,"" Mrs. Pelosi told reporters shortly after a meeting of House Democrats. ""I don't see the votes for it at this time."