WASHINGTON—Stunned by the outcome of a special election in Massachusetts that ended their filibuster-proof majority in the U.S. Senate and a wide-open road to pass health care reform legislation, top congressional Democrats are regrouping to develop new legislative strategies.

But amid clearly diminished congressional interest in the issue—as well as a shift in focus to reducing unemployment—it isn't clear whether a strategy will be developed, much less whether it will be successful, benefit observers say.

While President Barack Obama remains committed to enacting health care reform, the issue made up only a small portion of last week's State of the Union address, which was dominated by economic issues.

Until Jan. 19, it seemed almost certain that legislators would come to a final agreement on a health care reform bill that would extend coverage to many uninsured U.S. residents and make other sweeping changes.

But that widespread optimism ended when Republican Scott Brown came from behind to capture the Senate seat held by Sen. Edward Kennedy for 47 years until the Massachusetts Democrat's death last August.

The immediate reaction to the change in the balance of political power by top congressional Democrats, who previously had been racing to win final approval of the reform legislation, was to stop the reform drive, at least temporarily.

After the Massachusetts election, Senate Majority Leader Harry Reid, D-Nev., who had kept the chamber in session in until Christmas Eve to ensure passage of the reform bill before year-end, said there no longer was a rush to act on health care.

“Clearly, the pause button has been hit,” said Paul Dennett, senior vp-health care reform with the American Benefits Council in Washington. “Clearly, Sen. Reid is not throwing in the towel, but he also no longer is setting a deadline,” Mr. Dennett added.

“Right now, there is a cooling-off period,” added Frank McArdle, a consultant with Hewitt Associates Inc. in Washington.

That pause, Mr. McArdle and others said, is deliberate as top congressional Democrats try to gauge how much interest remains in Congress for trying to pass comprehensive health care reform legislation.

Already, though, there are signs that other issues, such as boosting the economy and reducing the unemployment rate, is where congressional and presidential legislative interest will be focused in the coming months, with health care reform moving down as a priority.

For example, Sen. Charles Schumer, D-N.Y., said at a news briefing last week that the “three top issues” on the Democratic Party's agenda “are jobs, jobs, jobs.” He did not mention health care reform.

Indeed, Senate Democrats this week are expected to unveil and push—for fast action—a jobs bill. The only health care piece expected to be included in the bill would extend the federal COBRA premium subsidy for the unemployed and possibly lengthen COBRA eligibility for those who lose their jobs.

Still, observers say it is premature to declare health care reform dead. “While health care reform has been clearly surpassed by the need to get the economy going again, that does not mean it is time to write the obituary for health care reform,” Mr. Dennett said.

If fact, observers say top Democrats soon will convene to discuss potential strategies to try to move health care reform legislation forward.

One strategy under discussion by top Democrats is to seek passage of a series of smaller, relatively noncontroversial bills that would, among other things, require group plans to continue coverage for employees' adult children living at home, eliminate annual and lifetime dollar coverage limits, and remove health insurers' limited immunity from antitrust law.

While such measures would be a far cry from the sweeping reform bills previously approved by the House and Senate, they would make “good sound bites” for Democrats to show the public that they scored some victories on health care reform, said Chantel Sheaks, a principal with Buck Consultants L.L.C. in Washington.

“An agreement on a smaller bill is definitely possible,” added Mark Ugoretz, president of the ERISA Industry Committee in Washington.

Yet another strategy—mentioned by House Speaker Nancy Pelosi, D-Calif.—would be for the House to pass the Senate reform bill. Then, the Senate would make changes to the Senate bill that House members are seeking, such as a liberalization of a proposed excise tax on the costliest health insurance plans, through a budget reconciliation bill. The appeal of this approach is that only a simple majority is needed to approve such bills.

But there is skepticism on whether such a strategy would be successful. Ms. Sheaks noted that the House barely passed its own reform bill, raising questions whether there would be enough votes to pass the Senate bill.

In addition, observers say it is uncertain whether enough Senate Democrats would favor such an approach.

The bills previously passed by the House and Senate would make huge changes to the nation's health care financing and delivery system. Among other things, the federal government would subsidize health insurance premiums for the lower-income uninsured while employers would be hit with penalties if they did not offer coverage.

In all, the legislation could enable about 30 million of the nation's 46 million uninsured to obtain coverage, according to congressional estimates.