Comments from President Obama’s budget director may signal a complicated parliamentary showdown over health care in the Senate later this year. At stake is whether the White House needs 60 or only 50 votes in the Senate to pass its reform of the nation’s health insurance system.

And the Senate Parliamentarian, an unelected, non-partisan official who is already considered a crucial figure in the health care debate, could find himself with even more questions to tackle than originally expected.