"You know she is viewed across the country as an ideological figure, her unfavorable rating is usually in the high 40's to low 50's, which, for a speaker of the House is really, really extraordinary," said Nelson. "I mean Speakers of the House tend to be, they are obviously important figures, but they tend not to be extraordinarily well-known across the country. With Nancy Pelosi, a lot of people know who she is and they have strong feelings about her."

Fighting for others

Pelosi makes no secret of her feelings about issues that come before Congress.

She has long been an advocate for human rights around the world. She fought to improve China's human rights record, attempting to link trade to human rights standards. She's also been a leader in efforts to win autonomy for the people of Tibet.

Some analysts say that Speaker Pelosi and President Barack Obama complement each other, with her tough, behind-the-scenes way of getting things done, and his gift for inspiring public speeches. The two still have a lot more they want to accomplish together, including financial reform, immigration reform and climate change legislation.

But first, Pelosi must try to hold on to the Democrats' current majority in the House of Representatives.

Voters will cast ballots for all 435 seats this November. If Republicans do win back a majority, Pelosi will no longer be Speaker, but her place in history will be secure as the first female speaker, and the one who helped push health care legislation through Congress.