WASHINGTON - Swiftly honoring a campaign pledge, newly empowered Republicans pushed legislation to repeal the nation's year-old health care overhaul through the House Wednesday night, brushing aside implacable opposition in the Senate and a veto threat from President Barack Obama.
The 245-189 vote was largely along party lines, and cleared the way for the second phase of the "repeal and replace" promise that victorious Republicans made to the voters last fall. GOP officials said that in the coming months, congressional committees will propose changes to the existing legislation, calling for elimination of a requirement for individuals to purchase coverage, for example, and recommending curbs on medical malpractice lawsuits.
Republicans also intend to try to reverse many of the changes Democrats made to Medicare Advantage, the private alternative to the traditional government-run health care program for seniors.
Like the repeal bill itself, these other measures will require Senate approval and a presidential signature to take effect, and the prospect is for months of maneuvering on the issue.
Debate across two days leading to the vote was markedly restrained, as lawmakers in both political parties observed self-imposed vows of civility in the wake of the shooting rampage in Arizona that left six dead and Rep. Gabrielle Giffords wounded.
But there was no mistaking the significance many first-term Republican lawmakers attached to a day they had long waited for, finally getting a chance to speak and then vote on the House floor against a law they had campaigned for months to repeal.
Rep. Jeff Duncan, R-S.C. said the legislation produced by Obama and congressional Democrats was a "job-killing, socialistic" approach to health care. Rep. Frank Guinta of New Hampshire, who defeated a Democratic incumbent last fall, said it was misguided, needing repeal.
"The American people have soundly, soundly rejected the Democrats' government takeover of health care," said Rep. Sandy Adams of Florida.
Rep. Steve Southerland, also of Florida, said the law imposes a crushing tax burden on businesses, and he predicted "1.6 million jobs will be lost by 2014 due to this mandate" to require many businesses to provide coverage for employees.
Both Floridians won their seats by turning out Democratic incumbents.
"This is not symbolic. This is why we were sent here," added Rep. Michelle Bachman, of Minnesota, a third-term conservative with strong support among tea party activists.
On the short end of the vote, Democrats challenged Republican claims and highlighted politically popular elements of the bill that would be wiped out if repeal took effect.
In one of the most animated speeches of two days of debate, Rep. George Miller, D-Calif., said repeal would return power to insurance companies. "Has anybody, any family in America, any single mother, any spouse, any child, any grandparent met a more bureaucratic system than the American health insurance system? There is no more bureaucratic system."
Three Democrats voted with Republicans on the repeal measure: Dan Boren of Oklahoma, Mike McIntyre of North Carolina and Mike Ross of Arkansas.
Senate Majority Leader Harry Reid has said the legislation will not see the light of day there, but the GOP leader, Sen. Mitch McConnell of Kentucky, said bluntly, "I assure you we will" have a vote on it. He did not predict the repeal would pass, but even a vote could present a difficult choice for Democrats facing re-election campaigns in swing states in 2012.
Separately, Republicans are expected to try to cut off the flow of funds needed to implement provisions on the bill.
The law faces another challenge, well beyond the reach of Obama's veto pen. More than half the states have filed suits against it, and while some judges have upheld the legislation, one recently ruled it was unconstitutional to require individuals to purchase insurance. The Supreme Court is widely expected to have the final word.
The Obama administration has made a major effort in recent days to emphasize parts of the bill that have met with public approval, including one that permits children to age 26 to remain on their parents' policies if they do not have on-the-job coverage of their own. Democrats also argue that repeal would short-circuit other changes yet to take effect, including a ban on the insurance industry's practice of denying coverage or charging sharply higher premiums on the basis of a pre-existing medical condition.
Republicans intend to address the same issues with legislation they say they will bring to the House floor in the coming months, according to officials who have been involved in discussions on the issue, but no details were immediately available.
Last year, for example, the Republicans proposed a 10-year, $25 billion program to help states fund programs in which high-risk individuals could receive affordable coverage.
GOP leaders are working on the assumption that the repeal legislation will not become law, and they intend to draft future bills as changes to the structure that Obama and Democrats put into place.
On one point, they conceded no change was warranted. Majority Leader Eric Cantor, R-Va., told reporters on Tuesday seniors would be permitted to keep the $250 they have been promised to help defray the cost of drugs under the Medicare prescription benefit.
The legislation Obama signed last year was sweeping in its scope.
The Congressional Budget Office said at the time that when fully enacted, it would spread coverage to tens of millions who now lack it and - in a forecast rejected by Republicans - reduce federal deficits over the next decade.
Beginning in 2014, millions of Americans would be required to carry health insurance, whether through an employer, a government program, or their own purchase. New insurance marketplaces called exchanges would open in each state, enabling individuals and small businesses to pick from menus of private plans that met government standards. Federal subsidies would help defray the costs.