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Until Scott Brown's election to the Senate in January 2010, the Nelson Amendment was viewed by the pro-choice leadership of the Democratic party as one of the big hurdles in passing legislation, along with other significant issues such as the public option.
Howard Dean and other Democrats have criticized abandoning the idea of a federally run, statewide, public option in favor of co-ops, questioning whether the co-ops would have enough negotiating power to compete with private health insurers.