ST. CHARLES, Mo. -- President Barack Obama on Wednesday made an impassioned case for his health care proposal, delivering a folksy, partisan argument for reform as industry groups prepare a multimillion-dollar advertising campaign to defeat it.

Stripping off his suit jacket and pushing up his sleeves within minutes of entering a stuffy high school gym in this St. Louis suburb, Mr. Obama criticized his Republican opposition, Washington's wasteful spending and rising insurance premiums. He spoke with evident anger about "political gamesmanship" in Washington leading to "terrible consequences," as he evoked the outsider's message he delivered successfully in his 2008 presidential campaign.

"Congress owes America an up-or-down vote," he said over raucous applause, which greeted his remarks at several points. "The time for talk is over. It's time to vote."

Mr. Obama's appearance at St. Charles High School was the most visible element of his endgame strategy to push through health care legislation. Unfolding inside and outside the Capital Beltway, the effort is designed to revive the sense that passage is inevitable -- a feeling that evaporated when Democrats lost their filibuster-proof Senate majority in January.

Mr. Obama is visiting media markets that touch multiple congressional districts, particularly in swing states such as Missouri and Pennsylvania, which he visited earlier this week. He might head to Cleveland early next week for a town hall-style appearance to discuss health care, White House aides said Wednesday.

The president is delivering to his audiences a sharply populist warning that doing nothing about the health care system would reward the insurance industry and Wall Street investors, easy targets in communities anxious about the economy. He is also calling on the public to make its opinion known to members of Congress as he works to secure enough House votes to pass the measure before he leaves on an Asian trip late next week.

Mr. Obama intends to lobby wavering House Democrats to vote for a Senate version of the legislation and then to support the subsequent reconciliation process, which Republicans have characterized as an unjustified use of majority power.

Meanwhile Wednesday on Capitol Hill, lawmakers were hearing directly from some constituents. Pennsylvania's Rep. Jason Altmire, D-McCandless, who voted against the House bill and remains a coveted swing vote, met for an 1 1/2 hours with about 50 members of a "tea party" group that traveled via bus from the North Hills and Monroeville.

That group was steadfastly against the bill, although Mr. Altmire would not say which way he will vote the next time. He met earlier Wednesday with smaller pro-health reform groups, and is in the process of surveying his constituents about the issue.

Mr. Altmire's attempts to explain why the Senate bill combined with the reconciliation proposal is "a better bill" were not greeted warmly by the tea partyers. "Respect our intelligence and don't talk to us as if we came here to listen to you talk about specific things that were taken out of the bill," said Charlie Robinson, 69, of Middlesex, Butler County. "Kill the bill!"

Among the rewards Mr. Obama is ready to offer those who side with him, White House officials said, are election-year visits to competitive congressional districts, where a presidential appearance can bring in hundreds of thousands of dollars in campaign funds.

"The president has breathed some new life into this effort," said White House Communications Director Dan Pfeiffer. "The opportunity to get this done exists, but it won't last forever."

For much of the past year, the White House health care strategy revolved around maintaining momentum behind the politically vulnerable initiative. The effort faltered, though, as GOP critics convinced more and more Americans that it was an unwieldy and expensive government intrusion.

Mr. Obama planned to meet at the White House today with the Congressional Black Caucus and the Congressional Hispanic Caucus in separate sessions on health care legislation.

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