Speaker Nancy Pelosi received a standing ovation from San Francisco health providers in her first appearance on home turf since the narrow passage of the House health care bill.

Doctors, community clinic directors and others with a stake in health care reform interrupted Pelosi with applause Tuesday. She described Saturday's vote as the biggest step in the direction of health care for all Americans since Teddy Roosevelt first mentioned it as a goal about a century ago.

The bill included language that banned government-funded insurance from covering abortions - a provision that roiled many liberals. She described the concession as necessary, but said she didn't support it.

Pelosi said she was confident that a bill would be signed by the end of the year.