WASHINGTON — Confronting President Barack Obama, the new Republican-led House took a first step Friday toward a symbolic vote to repeal his landmark health care overhaul law, which would provide coverage to more than 30 million now uninsured.
The 236-181 largely party-line vote set the stage for what is likely to amount to no more than a political message, because Democrats who still run the Senate have promised to block efforts to scrap the law and Obama has veto power.
The House action set the rules for a debate next week that will culminate in a simple up-or-down vote on repeal, scheduled for Wednesday. The House will also instruct several committees to come up with more modest replacement health care legislation, a process that could take months even if successful.
Obama made history last year when Congress finally passed the law after months of contentious debate, closing in on a goal of coverage for all that Democrats had pursued for generations. Republicans say they changed history by taking back the House in the midterm elections, partly on the strength of their pledge to tea partyers and other conservative backers to undo the divisive law, whose complexities, costs and consequences remain largely unknown.
"Today we are taking the first step in fulfilling a key promise to the American people," said Rep. David Dreier, R-Calif., who led the GOP side in the debate. "We are setting in motion a process to repeal President Obama's job-killing healthcare bill and replace it with real solutions."
During last year's election campaign, many Democrats kept silent about the health care law. On the House floor, they mounted a full-throated defense, accusing Republicans of trying to take away benefits that many people are already receiving, from lower prescription costs for Medicare recipients to extended coverage for young adults on their parents' plan and newly available insurance for people with serious medical problems.
"Repeal this bill, and you're going to find more Americans dying," said Rep. John Garamendi, D-Calif.
Polls show the public remains divided over the underlying law as well as the question of whether it should be repealed, scaled back, or added to.
Senate Democrats say what the House does matters little, because they will derail any repeal legislation when it reaches the other side of the Capitol.
That leaves House Republicans with few clear options. They could try to deny the administration money to carry out the law, but that may not work either. Major elements, such as tax credits to help make health insurance more affordable, were written as entitlements, meaning that they will be automatically funded. And if a drive to deny funding threatens to shut down the government, it could backfire politically.
Leading proponents of repeal acknowledge it may take the election of a Republican president to accomplish the goal. That means both parties will likely take the major issues in the healthcare debate to the voters in 2012, when Obama is expected to run for a second term and the House and Senate will again be up for grabs.
The drive to repeal has opened Republicans up to charges that they would increase the federal deficit. The Congressional Budget Office, the nonpartisan budget referee, says the legislation would increase deficits by $230 billion from 2012 to 2021. That's because spending cuts and new taxes more than offset the cost of expanding coverage.
Republicans counter that, even if that's technically true, it would save money in the long run to repeal a big new program before it gets off the ground.
The law would provide coverage to more than 30 million now uninsured, expanding Medicaid to pick up more low-income Americans and offering tax credits to help the middle class buy coverage. Most Americans would be required to carry health insurance, either through an employer, a government program or by purchasing their own policy. A legal challenge to that mandate is expected to go all the way to the Supreme Court.
Voting with the Republicans were four Democrats who had opposed the law last year — Reps. Dan Boren of Oklahoma, Mike McIntyre, and Larry Kissell of North Carolina, and Mike Ross of Arkansas.
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