Pledging anew to replace the federal health law that President Obama signed five years ago, House Republicans passed yet another bill Tuesday to repeal the Affordable Care Act.
The repeal bill, the first of the new Congress, faces an uncertain future in the Senate, where Democrats will almost certainly filibuster it. Obama has indicated he will veto the legislation if it makes it to his desk.
That made Tuesday's vote largely a symbolic exercise designed to satisfy the GOP base and to give newly elected Republicans an opportunity to vote for repeal, a central campaign pledge.
The bill passed, 239 to 186. All but three Republicans who voted backed it; every voting Democrat opposed the bill.
"Repealing Obamacare is a top priority for Republicans in Congress," House Rules Committee Chairman Pete Sessions (R-Texas) said after the vote. "Today, the House took a stand against its job-killing, costly regulations."
Unlike dozens of previous repeal bills championed by congressional Republicans, this one would delay enactment of the rollback by six months to give GOP lawmakers an opportunity to come up with an alternative.
The four-page bill directs House committees to develop replacement legislation that meets 12 criteria, including: lowering health insurance premiums; preserving patients' ability to keep their doctors; providing affordable coverage to people with preexisting medical conditions; increasing the number of Americans with insurance; providing states more flexibility to run Medicaid programs for the poor; and not raising taxes.
Reaching those goals has proved very difficult for congressional Republicans, who have not advanced any legislation that would achieve them since the Affordable Care Act was enacted in March 2010.
The law guarantees health coverage to sick Americans for the first time. It has dramatically expanded coverage, providing an estimated 10 million previously uninsured people with insurance. And billions of dollars of government subsidies have allowed many consumers to get low-priced health plans.
But the law has driven up premiums for some. And it includes billions of dollars in new taxes to offset the cost of the new protections.
With control of both the House and Senate, senior Republican lawmakers are meeting regularly to develop replacement healthcare legislation.
That may take on increased urgency this summer, if the Supreme Court backs the latest legal challenge to the healthcare law, which would take away some of the tax subsidies that millions of Americans rely on to get insurance through the law.
But the Republican Party remains deeply divided over what a replacement healthcare bill should look like and how to balance the cost of providing Americans with added protections while adhering to promises not to increase spending.
While Republicans struggle to reach consensus, the Obama administration is working to underscore the law's importance to millions of Americans.
On Tuesday at the White House, Obama welcomed a group of Americans who credit the law with improving their lives, including several who were able to get care for serious illnesses.
"The Affordable Care Act is not an abstraction," the president said. "The notion that we would play politics with the lives of folks who are out there working hard every single day, trying to make ends meet, trying to look after their families, makes absolutely no sense."
Christi Parsons in the Washington bureau contributed to this report.