House leaders race to finish health care bill

House leaders struggled Thursday to settle differences over illegal immigration and taxpayer-funded abortion in time to pass expansive health care reform Saturday, looking for political momentum from last-minute endorsements by the American Medical Association and AARP as well as a planned Capitol Hill visit from President Obama.

The push to garner the 218 votes needed for passage came as congressional Republicans and thousands of conservative activists gathered on the West Lawn of the Capitol — just below the steps where Democrats released their bill last week — to protest what they call a government takeover of health care that will lead to extraordinary new taxes.

“Kill the bill!” the crowd chanted repeatedly as GOP lawmakers denounced the bill and the Democrats’ push for quick passage.

Mr. Obama is expected to pay a rare visit to Capitol Hill on Friday for a last-minute appeal to House Democrats to support the 10-year, $1.2 trillion legislation, just a day before leaders plan to start voting. His argument for reform was buoyed by endorsements from the AMA, which represents the nation’s physicians, and the AARP, a powerful lobby group that represents seniors.

But the endorsements did nothing to ease the concerns of House Republicans or conservative protesters who descended on the Capitol grounds Thursday to denounce the nearly 2,000-page bill.

“House Republicans are here to deliver a simple message to Speaker Nancy Pelosi and to the American people,” said House Republican Conference Chairman Mike Pence of Indiana. “Madame Speaker, we the people are tired of runaway federal spending in Washington, D.C. And we the people want health care reform that lowers the cost of health insurance, not grows the size of government.”

Thousands carried posters reading “Don’t Tread on Me” amid accusations by some in the crowd that Democrats are promoting a health care system that would resemble that of Nazi Germany.

Inside the Capitol, intense negotiations continued on the specifics of the bill. Democratic leaders said they would have enough support by the time the voting starts, but didn’t appear to have them as of late Thursday. When asked whether she has the votes, Mrs. Pelosi said only, “We will.”

Members of the Congressional Hispanic Caucus tried to fight off last-minute changes to the legislation that would ban illegal immigrants from having access to the bill’s insurance exchanges — clearinghouses that will be the only place people can buy public or private health insurance.

Caucus Chairman Nydia M. Velazquez, New York Democrat, and Vice Chairman Charlie Gonzalez, Texas Democrat, said they did not know who was trying to insert the language. The most prominent Democrat who has publicly called for it is Mr. Obama, who met with members of the caucus Thursday.

White House press secretary Robert Gibbs confirmed the White House’s position, but declined to say whether Mr. Obama was lobbying for its inclusion.

“I know there’s stuff that’s ongoing on Capitol Hill that I don’t want to interject myself into,” Mr. Gibbs told reporters before the meeting.

Mr. Obama, who met privately with Ms. Velazquez and other Hispanic lawmakers at the White House on Thursday afternoon, said the AARP and AMA endorsements would provide a major boost to the reform’s prospects.

“Now that the doctors and medical professionals of America are standing with us, now that the organization charged with looking out for the interests of seniors is with us, we are even closer” to passing a bill, he told reporters in an unscheduled visit to the White House briefing room.

The immigration issue has already proven to be inflammatory. When the president said the bill would bar illegal immigrants access during an address to a joint session of Congress in September, Rep. Joe Wilson, South Carolina Republican, ignited passions by shouting, “You lie!”

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