BAKERSFIELD, Calif. -- The debate over health care reform was front and center Tuesday in central Bakersfield.

Protesters gathered outside Congressman Jim Costa's office at 2700 M St. to urge the Democratic lawmaker to vote in favor of health care reform legislation.

"We know that we need to have national health care for everybody," said protester Dolores Huerta. "Were the only modern country in the world that does not have a national health care system."

Reform opponents also showed up to make their voices heard.

"That's not good health care, that's not American health care," said Jeanette Downs. "America's health care is founded on the idea that you can step forward and your doctor will tell you all of the options, not just the ones that are covered."

Costa hasn't said how he will vote this week if legislation comes before the House.

Meanwhile, in Washington, fellow Democrats defended plans to push the massive legislation through the House without a direct vote, and Republicans assailed the strategy Tuesday as both parties fenced ferociously over the health overhaul end game.

House Majority Leader Steny Hoyer said that no final decision had been made on the complex parliamentary strategy, which would allow House Democrats to pass the Senate's health care legislation without voting on the bill itself. Instead House members, who dislike the Senate bill, would vote on a rule for debate that would deem the bill passed once a smaller package of fixes also had passed.

Hoyer defended the austere procedure, noting that it had been used in the past by both parties, and more often by Republicans, and that regardless of the approach, the House would be passing the Senate legislation.

"We're playing it straight," Hoyer said. "We will vote on it in one form or another."

The Maryland Democrat also said the public didn't care about process but about results, and that the approach Democrats are weighing would result in enactment of President Barack Obama's landmark legislation to extend coverage to tens of millions of uninsured and create new insurance market protections for nearly everybody else.

At the White House, press secretary Robert Gibbs refused to say whether Obama supported the maneuver. Gibbs repeatedly returned to the notion of a vote during his daily meeting with reporters.

"There's going to be a vote on health care reform. You're going to know where people are on health care," Gibbs said.

He would not, however, say whether he wanted the House to vote on the bill or whether he would accept the House Democrats' legislative proposal.

With the House aiming to cast the decisive votes by the weekend, Republicans ramped up their attacks, seizing on the approach under consideration in the House to criticize Democrats and try to sow doubts among wavering moderates. The GOP is unanimously opposed.

"Anyone who endorses this strategy will be forever remembered for trying to claim they didn't vote for something they did," Senate Minority Leader Mitch McConnell of Kentucky said Tuesday. "It will go down as one of the most extraordinary legislative sleights of hand in history."

House Speaker Nancy Pelosi wants to shield lawmakers from having to vote directly on the Senate-passed health care bill because it's unpopular with House Democrats.

"Nobody wanted to vote for the Senate bill," Pelosi, D-Calif., explained in a round-table meeting with liberal bloggers Monday.
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The Associated Press writers Erica Werner, David Espo, Ricardo Alonso-Zaldivar, Alan Fram, Charles Babington, Ann Sanner and Sam Hananel contributed to this story.