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Of the 11 Blue Dogs who voted against the original House bill, six cast “no” votes last week against the final package. All of them were from conservative districts: Bobby Bright and Parker Griffith, both of Alabama, Colin C. Peterson of Minnesota, Gene Taylor of Mississippi, Heath Shuler of North Carolina and Walt Minnick of Idaho.

Mr. Minnick, who offered a scaled-down $200 billion stimulus as an alternative, said the consequences of this bill “will be painful and possibly harsh for those tasked with the burden of paying for what has been passed.”

Minnick spokesman John Foster said the feedback from constituents has been largely positive. “Some folks wanted Walt as a Democrat to show support for the president, but the vast majority of our constituents approved of his decision to vote the district,” he said.

The stakes are especially high for Mr. Kratovil, though most of the five Democrats who switched their votes likely will be on the Republican Party’s hit list in the next election.

Mr. Kratovil, who won election last year by less than a one-percentage-point margin, is the first Democrat in 18 years elected to Congress from the district. It includes parts of three suburban counties - Baltimore, Anne Arundel and Harford - and all of Maryland’s rural Eastern Shore.

Only two of the 12 counties he represents went to Mr. Obama: Baltimore County and Kent County on the Eastern Shore.

Mr. Kratovil points to estimates that the bill will create 8,200 jobs in his district and to spending on programs popular with his constituents, whether it is health care programs that will benefit local hospitals or expanding broadband Internet service to rural communities.

Mr. Kratovil and Rep. Allen Boyd, Florida Democrat and a leader of the fiscally conservative 49-member Blue Dog coalition, issued nearly identical statements explaining their final decisions. Both cited, among other items, the elimination from the bill of $200 million to refurbish the National Mall in Washington, including sod, and $75 million to fight smoking.

Mr. Kratovil also listed cutting $400 million to fight sexually transmitted disease.

However, the anti-smoking and STD programs still could be funded with stimulus money going to the Centers for Disease Control and Prevention. Democratic leaders stripped out many of the specific programs in the bill and replaced them with pools of money for agencies to spend at will.

“That’s not a given,” Kratovil spokesman Kevin Lawlor said of funding anti-smoking and STD programs. He said Mr. Kratovil would rather the money be spent at the discretion of the CDC than be prescribed by Congress.

• Donald Lambro and David Sands contributed to this report.