WASHINGTON — Democrats defended plans to push massive health care 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.

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.

“It’s more insider and process-oriented than most people want to know, but I like it because people don’t have to vote on the Senate bill,” she said of the approach.

Both parties have used the strategy in the House to create a distance between lawmakers and politically unpopular votes such as raising the debt ceiling. However some moderate rank-and-file Democrats voiced discomfort.

“I’m getting a lot of comments about the process, and a lot of unease,” Rep. Jason Altmire, D-Pa., said in an interview Monday.

The back-and-forth came as a couple hundred tea party activists descended on Capitol Hill to meet with lawmakers and voice opposition to the legislation. Protesters carried signs that read, “God heals, Obamacare steals,” at a rally with Republican lawmakers.

Rep. Michele Bachmann, R-Minn., urged activists to make phone calls, send e-mails and go to congressional district offices by the carload to stop the health care measure from being passed. Bachmann said they should keep up the fight until Sunday and give Obama “a farewell party” ahead of his Asian trip.

She said Democrats want people to believe that health care is a done deal, but “they’ve got another thing coming.”

Obama has turned up the pressure, as only presidents can, and Democratic leaders are immersed in a desperate scramble for votes.

Obama said in an interview with ABC News: “I believe we’re going to get the votes. We’re going to make this happen.”

The president is wooing freshman Democrats in the Oval Office, holding at least two one-on-one sessions in the past few days that never appeared on his official schedule, according to aides to two lawmakers invited, Reps. Scott Murphy, D-N.Y., and Suzanne Kosmas, D-Fla.

Both voted “no” when the legislation passed the House on the first go-round last year, but now they’re not ruling out siding with the president and Democratic leaders on what’s expected to be a cliffhanger vote in the House later this week, before Obama leaves for an overseas trip. The White House hopes for final action by the Senate the following week, prior to Congress’ Easter break, though the outcome is anything but assured.

Another lawmaker who opposed the legislation last year, Rep. Dennis Kucinich, D-Ohio, flew with Obama on Air Force One to an Obama appearance in Kucinich’s district Monday. Kucinich, who was against the bill because he wants a larger government role in health care, also is not ruling out voting “yes” this time.

With a number of anti-abortion Democrats expected to defect over provisions they contend allow federal funding of abortion, every vote will count for Democratic leaders, who need to win over lawmakers who opposed the legislation the first time — and keep reluctant supporters on board in the face of escalating attacks. Sweetening the pot, those who vote with the president may get more help from him in the future: Party officials said that in determining how to allocate Obama’s time for campaign stops or other events, a vote on something like health care would be a consideration.

House Democrats triggered the countdown Monday for the climactic vote, with the House Budget Committee agreeing 21-16 to fast-track rules for the health bill, a necessary first step before floor action. Even so, the legislation remained incomplete. House Democrats caucused Tuesday still without final legislative language or a cost estimate from the Congressional Budget Office.