The House voted Wednesday to repeal all of President Obama's health care law, acting where the Supreme Court declined to, in a vote that both sides said is doomed to fail in the Senate but was designed to lay the groundwork for voters to have a final say in November's elections.
The vote forced some Democrats to choose between their support for Mr. Obama and a lingering opposition to the law in their home districts, and five Democrats joined the GOP in the 244-185 vote in favor of a repeal.
It marks the 33rd time that the House has tried a full or partial repeal of the sweeping law, which Democrats powered through Congress in 2010 without a single GOP vote, and which has become both the defining domestic achievement of Mr. Obama's tenure and the political rallying cry for his opponents.
"[Americans] certainly didn't ask for this government takeover of their health care system," said House Speaker John A. Boehner, Ohio Republican. "We're giving our colleagues in the Senate another chance to heed the will of the American people."
The Senate has blocked nearly every one of the previous repeal efforts, with only a few tweaks to the law's financing having made it through in the two years since the law was adopted.
Democrats said this time will be no different.
"We know job creation is the most important thing right now and that's why we're very concerned about the waste of time on the floor of the House on something that's never going to happen, but just is a manifestation of the fact that Republicans are the handmaiden of the health insurance industry," said House Minority Leader Nancy Pelosi, California Democrat.
The Supreme Court upheld most of the Affordable Care Act in a 5-4 decision last month, ruling that Congress' taxing powers were broad enough to grant it authority to require all Americans to obtain insurance.
House Republicans immediately promised to try a repeal again, while Democrats said it was a distraction. Both parties tailored their arguments to the top issue that voters say they care about: jobs and the economy.
White House spokesman Jay Carney accused the GOP of engaging in "a quixotic effort to try and score political points."
"We do not need to refight the battles of two years ago, three years ago," Mr. Carney said. "We need to help the American economy now."
The full law doesn't go into effect until 2014, and the court's decision has left some holes in it. A number of states where Republicans are in control have said they will opt out of expanding Medicaid coverage - an option the high court opened up in its ruling. Some states also said they would forgo setting up insurance exchanges.
Health and Human Services Secretary Kathleen Sebelius said Wednesday that a dozen states, representing nearly a third of all Americans, have sent letters officially saying that they would create exchanges.
The deadline for states to decide is Nov. 16.
Wednesday's repeal vote was a test for Democrats from conservative-leaning districts.
As lawmakers milled around the House floor Wednesday afternoon, seated shoulder to shoulder in a row near the back were Reps. Collin C. Peterson of Minnesota, Larry Kissell and Heath Shuler of North Carolina, Jason Altmire of Pennsylvania, Dan Boren of Oklahoma and Ben Chandler of Kentucky - all lawmakers who originally voted against enacting the law.
When it came time for them to vote, Mr. Boren and Mr. Kissell bucked their party again, along with Reps. Mike McIntyre of North Carolina, Dennis Ross of Florida and Jim Matheson, who voted against the law initially. Mr. Boren, Mr. McIntyre and Mr. Ross also had voted for repeal.
Mr. Shuler said he can't stomach taking away benefits already flowing to millions of Americans.
"It's true that I did not support the Affordable Care Act, but my strong pro-life philosophy cannot reconcile or justify how we pull the rug out from beneath these individuals now," he said.
Just before the vote, Democrats held a news conference and showcased five Americans who described how the law has helped them.
Senior Bill Cea said he didn't have to pay for a wellness visit to his doctor now that Medicare offers the benefit once a year.
Christine Haight Farley, a mother whose son has cystic fibrosis, and Emily Schlichting, a young adult with a rare autoimmune disease, said they don't have to worry about finding insurance because children can stay on parental plans until age 26 and insurers can't discriminate against them after that.
Jamal Lee, owner of a small audio production company, said he is able to provide insurance coverage for his employees with help from the law's small-business tax credits.
Aracely Rodriguez, who works for Planned Parenthood in San Diego, said the law's provisions to expand health coverage are crucial to Hispanic women, who lack insurance more than any other female group in the country.
Mrs. Pelosi said their stories should send a message to Republicans - and to voters in November.
"Really, we just want people to know what they have and what will be taken away, and they'll make their political judgment about that," she said.
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