WASHINGTON — As its opening move in the newly convened Congress, the House voted Wednesday to repeal the Affordable Care Act, the 62nd such vote but the first time that a bill will make it to President Barack Obama's desk, forcing a rare veto to protect his signature domestic achievement.
The measure passed easily, 240-181.
While Democrats dismissed the bill — which would also remove funding for Planned Parenthood — as another ploy in the partisan drama that has played out in the Capitol since the law was enacted in 2010, the vote proved that a Republican congressional majority could deliver a measure that repeals the health law, even in the face of united opposition from Democrats.
It also shows that nearly six years after its enactment, the law remains a divisive political issue not only because it is associated with Obama, but because for much of the middle class, it is at least perceived as costly and lessening consumer choice, polls show.
"This is a big deal," said Bill Hoagland, senior vice president of the Bipartisan Policy Center in Washington and a former longtime Republican staff member on the Senate Budget Committee. "This vote sends the signal to the president and the American people there are changes that need to be made in this law."
Even among Republicans, Hoagland said, "there is a recognition that you may not do away with a number of the provisions that are popular." But, he added, "if you can push away the politics of it, you will find there are a number of provisions that Democrats would agree could be changed," no matter who is president.
Obama's promised veto, only the eighth of his presidency, will be the most consequential so far. Republicans do not have sufficient votes to override the president. The White House and its allies had long expected that the antipathy for the health care law would wane as coverage increased and other policy fights arose.
Indeed, government surveys suggest that more than 17 million uninsured people have gained coverage since Congress adopted the health care law in 2010 and many of its components, such as mandatory coverage for pre-existing conditions and the ability for insured to cover young adult children, are very popular.
"We are in the final weeks of Open Enrollment for 2016 under the Affordable Care Act and saw unprecedented demand for January 2016 coverage," Sylvia Mathews Burwell, the secretary of Health and Human Services, said in a statement. "Yet at the same time, we continue to see efforts to repeal the ACA and turn back the clock."
Democrats in Congress were quick to criticize the vote.
"This is a sad and shameful way to begin the new year," Rep. Chris Van Hollen, D-Md., said on the House floor Wednesday. "With all the pressing issues we face at home and abroad," he said, Republicans chose "to take away access to affordable care to 22 million Americans."
Yet public opposition to the law has ticked up again in recent months, in part because the cost of coverage from the law's insurance exchanges is rising in many states for 2016. The most
recent Kaiser Family Foundation tracking poll found 46 percent of Americans had an unfavorable opinion of the law, compared with 40 percent who viewed it favorably. This has left the law a weapon of choice for Republicans in Congress, particularly in an election year in which Speaker Paul A. Ryan is seeking to set the policy agenda.
"A lot of what members on my side of the aisle predicted has come to pass," said Sen. Susan Collins, R-Maine, citing increased premiums, higher deductibles and confusion among employers as to what constitutes full-time work. "A lot of the issues that directly affect people's pocket books have turned out to be negative. I continue to believe, however, that our party must have a plan for replacing and fixing Obamacare and not just repealing it."
Republicans concede that if they win the White House, simply repealing the law will no longer be sufficient. Republicans in Congress have yet to offer a comprehensive replacement for the law. Instead, much of their focus, beyond the health care law, has been on attacking Planned Parenthood.
"We were elected on a pledge to try and repeal Obamacare," said Rep. David Jolly, R-Fla. "If we are unsuccessful in a veto override, I think we should turn out attention to other matters like national security. But if we get a Republican in the White House, then we need to turn to solutions. The focus can't be just on repealing Obamacare. It has to be, 'What is our health care plan?'"
Republicans say that the health law remains potent for them in part because some of its flaws, like rising premium costs, have only begun to be revealed, even as many of its more popular provisions were quickly clear.
"Even though the law was passed many years ago, the rollout is much more recent, and some components haven't even been implemented," said Rep. Lee Zeldin, R-N.Y. "For a few years the debate over Obamacare was one about how it was going to impact individuals, families and businesses in the future. And when it actually started, the debate shifted and people had their own personal stories to tell."
"I would say constituents have been very upset with the failure of the New York co-op," he said, referring to the Health Republic Insurance of New York.
But for Republicans to succeed in dismantling the law, they need to maintain control of the Senate, as well as win the White House. Their majority in the Senate enabled them to pass the repeal measure through a budget procedure called reconciliation, which requires only a simple majority vote and avoids a filibuster, which would require 60 votes.
While the House at first struggled to make that process work, Sen. Mitch McConnell, R-Ky., the majority leader, used his parliamentary skills to make it work and also attack Planned Parenthood.
"The Senate was never able to muster the votes required to send the legislation to the president's desk," Zeldin said. "So this moment in time is unique compared to the past history."
Although Republicans will almost certainly fail in this latest bid, the issue is all but certain to animate the race for the White House and in Senate and House contests.
"I can assure you this is not the end," Hoagland said. "We will continue to have the discussion about health care, its costs and how to it to the American public at the least cost with the best care."