PITTSBURGH — Democratic congressman Jason Altmire might have drawn the quickest and loudest criticism in Pennsylvania after saying he would vote against federal health care reform, but there are two other Democrats in the state who could face a bigger challenge at the polls because of their support of the bill.

Kathy Dahlkemper and Christopher Carney represent largely conservative districts — Dahlkemper in northwestern Pennsylvania and Carney in the northeastern part of the state. Both voted for the historic health care reform bill that was approved late Sunday by the U.S. House.

"Out of all the Democrats that I would think that would be in a position that this vote could really come back to haunt them in November, those two stood out," said Christopher Borick, a political science professor and pollster at Muhlenberg College in Allentown.

Dahlkemper and Carney are members of the fiscally conservative "Blue Dog" faction, along with fellow Pennsylvania Democrats Altmire and Tim Holden, who voted against the bill. The state's seven Republican House members all voted "no."

Tom Baldino, a political science professor at Wilkes University in Wilkes-Barre, said being a part of that faction can also explain why Carney and Dahlkemper voted the way they did.

"As Blue Dog Democrats, they can argue that they did what they promised to do, which was not to vote for something that would raise the deficit," Baldino said.

The nonpartisan Congressional Budget Office said the legislation would cut deficits by an estimated $143 billion over a decade. Also, President Barack Obama signed an executive order affirming current law and provisions in the legislation banning federal funding for abortions except in cases of rape, incest or danger to the life of the mother.

Dahlkemper, an abortion opponent, said she was undecided until the executive order was secured. Speaking Monday morning in a telephone conference with district reporters, Dahlkemper said she expected Obama's executive order to stand up in court.

She did say, however that she and other anti-abortion Democrats will continue to work during the next four years to make the abortion amendment a statute.

She said the bill's passage would mean that 20,000 uninsured district residents would have insurance.

There is nothing in the bill's language that supports stopping care for critically ill patients to cut costs, and premium rates are expected to go down as a result of the legislation, she said.

The bill also allows 51,000 young adults in the 3rd District to stay on their parents' insurance through age 26 if need be, Dahlkemper said.

The bill is expected to create a $130 billion reduction in the deficit over 10 years, and is projected to save the United States $1 trillion over 20 years, Dahlkemper said.

She said she expects a challenging campaign, regardless of her health care vote, as she seeks her second term in a district that was held by Republicans for 32 years.

Her office had gotten calls Monday from constituents both pleased and displeased with her vote, she said, but no one was keeping a tally.

On Saturday, picketers upset with Altmire's decision to vote against the legislation demonstrated outside his suburban Pittsburgh home and one of his district offices.

Altmire said an overwhelming number of his constituents opposed the bill. Altmire has 135,000 Medicare recipients in his district, and more Medicare Advantage recipients than any of the 435 congressional districts across the country. He said cuts to those programs will "hurt my district worse than anybody else."

Susan Hansen, a political science professor at the University of Pittsburgh, said she expects Altmire to face some campaign fallout.

"He was going to be in trouble both ways, but probably in more trouble this way because he ticked off Democratic supporters," she said. "They may not vote for his opponent, but they may just stay home."

Still, the public's main concern is the economy, and Dahlkemper and Altmire might be able to counter fallout from their votes if they've brought stimulus money into their districts, Hansen said.

Borick, who directs Muhlenberg's polling center, said his last poll found Pennsylvanians preferred that Congress start over on health care reform.

"That being said, the real campaign is going to begin now for a lot of individuals to make the case that this was the right call," he said.

Eagle staff writer Craig Keener contributed to this report.