"If anybody's going to apologize, everybody should apologize," she said when asked Thursday about Rep. Alan Grayson's comments on the House floor earlier this week.
Pelosi's response reflects what Democratic aides have said privately since Grayson's remarks sparked an uproar: that Republicans have routinely said with impunity that Democrats want to "pull the plug on grandma" or create "death panels" to decide who deserves care and who doesn't.
"Apparently Republicans are holding Democrats to a higher level than they are holding their own members," Pelosi, D-Calif., said of Republican calls for Grayson to rescind his comments.
But she also cautioned against inflammatory rhetoric, saying it shouldn't get in the way of the complex job of overhauling the health care system.
Republicans said they would continue withholding a resolution putting the House on record as disapproving of Grayson's remarks in hopes that Grayson will apologize.
"It is the job of the speaker to ensure the House runs with proper decorum," said Brendan Buck, a spokesman for Rep. Tom Price, the Georgia Republican who drafted the resolution this week. "Any future decision on a resolution will rest on the ability of the speaker to control her members."
Grayson, a first term congressman from Orlando, has stood firmly behind his remarks, saying his speech Tuesday night was an accurate description of how Republican health care proposals would treat thousands of Americans who go without care because they don't have insurance. He has cited a study showing that nearly 45,000 people die each year for lack of insurance.
He has mocked Republican calls for an apology, calling the GOP "foot-dragging, knuckle-dragging Neanderthals" and saying he violated no House rules. He said Democratic leaders have not asked him to apologize.
With the Grayson uproar, Republicans are seeking payback from a Democratic-led reprimand of Republican Rep. Joe Wilson of South Carolina, who last month shouted "You lie!" at President Barack Obama during his speech to a joint session of Congress.
More Grayson coverage: