The silliest reasons I've heard for the Democrats to avoid passing the Senate health care bill is that the Nebraska medicaid thing makes the whole bill toxic. If that is indeed what is motivating Democrats to find convoluted alternatives to pass-and-patch (that is, pass the Senate bill, and then pass a reconciliation bill to patch pieces that they don't like), then they're making a serious political error. It's actually an error that arises repeatedly -- the idea that Democrats can avoid attacks from Republicans by being careful about their actions.
This is not true. Democrats can be assured that Republicans will attack them, regardless of what they do. Democrats could eliminate the estate tax permanently, slash the capital gains tax, repeal the Clean Air and Clean Water Acts, invade Iran, and pass a Constitutional Amendment outlawing abortion, and Republicans would still attack them -- with exactly the same vehemence and vigor that Republicans have now. That's politics. It's how partisan politics is played. It is absolutely impossible to avoid attacks from one's opponents; nothing you do gives them license to attack, because they will attack whatever you do. Oh, and this isn't partisan; Democrats are going to attack Republicans, whatever the Republicans do.
Don't believe me? Republicans are attacking Democrats for taking away people's guns, even though the Democrats basically surrendered on that issue fifteen years ago. They are attacking Democrats for cutting Medicare and for allowing Medicare to grow so fast that it'll bankrupt the nation -- sometimes in the very same speech (I've seen it in the same paragraph). Republicans have, repeatedly, attacked Barack Obama for not using a word he uses all the time. Last I heard, they were still attacking the Democrats for bringing back the Fairness Doctrine, something that as far as I know not a single elected Democrat has any interest in doing. No, it didn't make sense, but if they don't have attacks ready that make sense, they'll use ones that don't.
The trick is to avoid doing things that voters don't like that really matter to voters. Chief among these are things that make the economy tank. It's not a good idea to do those sorts of things. It's also not a good idea to fight wars, in general, but especially wars that don't go well. Other things are much smaller, even something as big as health care. Provisions within health care just aren't going to do the trick. Oh, Republicans will no doubt attack Democrats over the Nebraska provision should it go into law; I have no doubt that polls would confirm that it's an unpopular provision. But what those polls don't tell you is that it just doesn't matter very much. By November, it will be just part of the partisan background noise. No one who was otherwise intending to vote for the Democrats is going to vote for the Republicans because they passed that damn Nebraska giveaway.
My advice to Democrats unsure about what to do is this: think about the actual bill, and what its effects would be if it became law. If in your judgment those effects would be bad for your constituents, then odds are they will dislike it, blame you for it, and you'll be in trouble. If those effects would be good for your constituents, then vote for it. Then figure out how you're going to sell the thing and yourself, based on that vote. But don't back off of it because you think it will open you up to attacks; you're wide open right now, and you'll remain wide open regardless of what you do.