NYTIMES | WASHINGTON — The House voted Wednesday to repeal the Democrats’ landmark health care overhaul, marking what the new Republican majority in the chamber hailed as the fulfillment of a campaign promise and the start of an all-out effort to dismantle President Obama’s signature domestic policy achievement.
The vote was 245 to 189, with 3 Democrats joining all 242 Republicans in support of the repeal.
Leaders of the Democratic-controlled Senate have said that they will not act on the repeal measure, effectively scuttling it.
While conceding that reality, House Republicans said they would press ahead with their “repeal and replace” strategy. But the next steps will be much more difficult, as they try to forge consensus on alternatives emphasizing “free market solutions” to control health costs and expand coverage.
Even as four House committees begin drafting legislation, Republicans said they would seek other ways to stop the overhaul, by choking off money needed to carry it out and by pursuing legislation to undo specific provisions, like a requirement for most Americans to carry health insurance or face penalties. The law is also under challenge in the federal courts, with the individual coverage requirements fueling a constitutional battle likely to be decided by the Supreme Court.
The House vote was the first stage of a Republican plan to use the party’s momentum coming out of the midterm elections to keep the White House on the defensive, and will be followed by a push to scale back federal spending. In response, the administration struck a more aggressive posture than it had during the campaign to sell the health care law to the public. With many House Democrats from swing districts having lost their seats in November, the remaining Democrats held overwhelmingly together in opposition to the repeal.
On the House floor, the resulting debate was a striking reprise of the one that engulfed Capitol Hill from the spring of 2009 until March 2010, when Mr. Obama signed the health care law.
And while the tone was slightly subdued in the aftermath of the attempted assassination of Representative Gabrielle Giffords in Arizona, the debate showed that the divisions over the law remained as deep as ever.
The three Democrats who crossed the aisle to support the repeal were Representatives Dan Boren of Oklahoma, Mike McIntyre of North Carolina, and Mike Ross of Arkansas, all of whom opposed the law last year.
Ms. Giffords, who had supported the law, remains hospitalized in Arizona and was the only House member who did not vote.
Republicans denounced the law as an intrusion by the government that would prompt employers to eliminate jobs, create an unsustainable entitlement program, saddle states and the federal government with unmanageable costs, and interfere with the doctor-patient relationship. Republicans also said the law would exacerbate the steep rise in the cost of medical services.
“Repeal means paving the way for better solutions that will lower the cost without destroying jobs or bankrupting our government,” the House speaker, John A. Boehner of Ohio, said. “Repeal means keeping a promise. This is what we said we would do.”
Democrats, eager for a second chance to sell the law, trumpeted the benefits that have already taken effect. These include protections for people who would otherwise be denied insurance coverage based on a pre-existing medical condition, the ability for children to stay on their parents’ policy until age 26, and new tax breaks for small businesses that provide health coverage to their workers.
Representative John Lewis, Democrat of Georgia, said, “It is unbelievable that with so many people out of work and millions of people uninsured, the first act of this new Congress is to take health care away from people who just got coverage.”
The health care law, which Congress approved last year without a single Republican in favor, seeks to extend insurance to more than 30 million people by expanding Medicaid and providing federal subsidies to help lower and middle-income Americans buy private coverage.
Republican leaders said they had not set any timetable for the four committees drafting alternatives to the law. “I don’t know that we need artificial deadlines for the committees to act,” Mr. Boehner said. “We expect them to act in an efficient way.”
Republicans said their package would probably include proposals to allow sales of health insurance across state lines; to help small businesses band together and buy insurance; to limit damages in medical malpractice suits; and to promote the use of health savings accounts, in combination with high-deductible insurance policies.
Republicans also want to help states expand insurance pools for people with serious illnesses. The new law includes such pools, as an interim step until broader insurance coverage provisions take effect in 2014, but enrollment has fallen short of expectations.
Representative Paul Broun, Republican of Georgia, said that allowing people to buy insurance across state lines would “expand choice and competition.” And he said businesses could negotiate better insurance rates if they could join together in “association health plans,” sponsored by trade and professional groups.
But state insurance officials have resisted such proposals, on the ground that they would weaken state authority to regulate insurance and to enforce consumer protections -- a concern shared by Congressional Democrats.
Some Republicans seemed sensitive to accusations that repeal would strip away new patient protections and leave millions of Americans without insurance.
Representative Joe Heck, Republican of Nevada and a physician, said he supported some goals of the new law: “making sure people don’t lose their coverage once they get sick; letting dependent children stay on their parents’ insurance until they turn 26; making sure anyone who wants to buy insurance can purchase a policy, regardless of pre-existing conditions.”
Representative Joe L. Barton, Republican of Texas, said, “There are some things in the new law that we think are worth keeping,” including a procedure for approval of generic versions of expensive biotechnology drugs.
But Mr. Barton and other Republicans returned to a core objection to the law, which they said extends the reach of government too far.
“We believe that you shouldn’t have the federal government mandate that an individual has to have health insurance, whether he or she wants it,” Mr. Barton said. “We want to repeal today so that we can begin to replace tomorrow.”
Representative Allyson Y. Schwartz, Democrat of Pennsylvania, said she doubted that the Republican alternatives would be effective in expanding coverage or controlling costs.
“Many Republicans want to repeal the law, but are not serious about replacing it,” Ms. Schwartz said.