Glenside, Pa. - Stirring memories of his campaign for the White House, President Barack Obama made a spirited, shirt-sleeved appeal for passage of long-stalled health care changes Monday as Democratic congressional leaders worked behind the scenes on legislation they hope can quickly gain passage.

"Let's seize reform. It's within our grasp," the president implored his audience at Arcadia University, the first outside-the-Beltway appearance since he vowed last week to do everything in his power to push his health care plan into law.

The president's pitch was part denunciation of insurance companies - "they continue to ration care on the basis of who's sick and who's healthy," he said - and part criticism of his Republican critics. "You had 10 years. What happened? What were you doing?" he taunted members of a party that held the White House for eight years and control of Congress for a dozen.

The outcome could affect almost every American, changing the ways they receive and pay for health care - and extending coverage to tens of millions more people - if the legislation gains final approval.

"I'm kind of fired up," Obama said at the beginning of his remarks, a variation on his oft-stated 2008 refrain, "Fired up. Ready to go." And he included an appeal to his audience - many of whom were students - to help in the same ways they might in a campaign. "So I need you to knock on doors. Talk to your neighbors. Pick up the phone," he urged them.

Obama made his appeal as Democratic leaders in Congress worked on a rescue plan for legislation that once seemed on the cusp of passage, only to run into difficulty when Senate Republicans gained the seat they needed to block action on a final compromise.

The two-step approach now being pursued calls for the House to approve a Senate-passed bill from last year, despite House Democrats' opposition to several of its provisions. Both houses then would follow by approving a companion measure to make changes in that first bill.

In general, Obama wants legislation to expand health care to many millions who lack it, with subsidies to defray the costs for lower income families as well as small businesses. In addition, he has called on Congress to ban insurance industry practices such as denial of coverage because of pre-existing conditions.