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Nancy Pelosi puts her stamp on the House

Nancy Pelosi is a master tactician and the most powerful speaker in a half century. Behind her personal brand of power politics – and whether she will still be speaker after the midterm elections.

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Mr. Stupak was stunned. "We had never heard of these nuns before," he says.

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At the climactic hour, Pelosi offered Stupak and other holdouts a sweetener: The White House would issue an executive order clarifying that public funds would not be used to fund abortion. This agreement, as well as the public backing of the Catholic churchwomen, gave anti-abortion Democrats cover for backing the Senate bill – and gave Pelosi her last critical votes for passing the Senate health-care bill. "Three or four in the Stupak coalition went over to the other side explicitly saying they [were] moved by the nuns...," says Deal Hudson, president of the Catholic Advocate, an anti-abortion advocacy group. "So it was a very powerful move at that moment in time."

On the other side, abortion-rights groups swallowed an executive order they found repellent because they trusted her assurances that this course was the only way to get a bill. "Without Pelosi, this bill would not have passed," says Congresswoman DeGette.

In the end, the maneuvering on the abortion roadblock and the entire health-care issue was vintage Pelosi: It demonstrated a mastery of the legislative process, an instinct for providing vulnerable members adequate political cover – and no rapprochement with Republicans.

On a warm spring night, many Democratic Party activists at the annual Midland County Democratic Smorgasbord in Industry, Pa., arrive at the same time, straight from Saturday evening mass. Despite hard economic times, cultural issues – church and family, gun rights, education, opposition to abortion – count here in western Pennsylvania's old industrial heartland, along the Ohio River, and the image of Pelosi as San Francisco liberal doesn't sit well, even among many party regulars.

"She fails to represent what I believe in," says Terry Colatriano, a former steelworker. "Obviously she thinks she's the face of the Democratic Party. She's too far left."

Others say they don't like her because she has a phony grin, can't be trusted, plays a game too big for her, or likes the spotlight too much.

Howard McDonald, a retired railroad worker and lifelong Democrat sitting at the next table, quietly dissents. "People don't like her because she's strong," he says. "She's a tough chick."

The unequivocal views show how visible Pelosi is outside the marbled halls of Washington – and how big of an issue she will be in the midterm elections. The congresswoman remains a target across the country like few speakers before her. That's in part because she's serving in highly polarized times. It may also stem from her gender and almost certainly is rooted in the caricature of her, conveyed incessantly in the conservative blogosphere and in cable-TV land, as a vacuous yet somehow omnipotent San Francisco lefty.

Health care is a factor, too. Next to President Obama, no one is as identified with the passage of the legislation more than Pelosi, and its reception on Main Street will help decide the Democrats' fate.

"The first woman speaker is always going to have a higher profile, but she sought out an even higher profile, and it's not been helpful to the party," says Charlie Cook of the Cook Political Report, who predicts there's at least a 50-50 chance the Democrats will not retain their majority.

In national polls, only 36 percent of Americans hold a favorable view of Pelosi – nearly as low as one other lightning-rod speaker, Mr. Gingrich, who bottomed out at 25 percent approval rating in March 1997.