For Sen. Blanche Lincoln, the moderate Arkansas Democrat, the nation’s health-care woes may lead to more headaches than any medicine could alleviate.

Lincoln is a pivotal vote on the motion to begin debate on Senate majority leader Harry Reid’s health-care legislation; if the motion passes, she could be the swing vote on the eventual motion to close debate. Her decision isn’t simply a calculation about winning the right number of concessions, as perhaps President Obama and the Democratic leadership hope; it’s about her political survival.

The pressure in Washington may be significant — Lincoln has had sit-down meetings with Obama and Senate majority leader Harry Reid — but so is the pressure back home, where Lincoln is showing clear signs of political weakness heading into her 2010 reelection campaign.

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She is unpopular with a wide range of voters, and that unpopularity directly correlates with the hostility many Arkansans feel toward Democratic policies in Washington, health care included. A recent Zogby International poll of likely Arkansas voters showed that 64 percent oppose the Senate health-care plan and only 29 percent support it.

The stacks of survey data show that more voters disapprove than approve of Lincoln. Her approval rating has consistently hovered in the low 40s, while her disapproval rating has edged up into the high 40s.

So far, seven Republicans are vying for an opportunity to challenge her in the general election. Some of her would-be Republican opponents, though relatively unknown statewide, are within the margin of error in most polls.

According to Zogby, in an initial match-up of Lincoln and possible Republican candidate Gilbert Baker, a state senator, Lincoln holds a narrow 41–39 lead. Against another possible GOP contender, State Senator Kim Hendren, Lincoln holds a more substantial 45–29 lead. But when voters were asked how they would vote in a Lincoln-Baker race if Lincoln were to vote in favor of the pending health-care legislation, the incumbent Democrat fell behind her possible GOP challenger 37–49. In all, 48 percent of likely Arkansas voters said they would be less likely to back Lincoln’s reelection if she supported the health-care bill, and 38 percent said they would be much less likely to back her in that event.