The new Republican House, as expected, voted Wednesday to repeal the landmark health care reform bill that Democrats pushed to passage last year, initiating a deja-vu debate on the proper role of government in the nation's medical system.
The repeal bill now goes to the Democrat-controlled Senate, where Majority Leader Harry Reid, D-Nev., has vowed to ignore it. Even in the unlikely event that Republicans force a vote and the Senate approves the repeal, President Obama would be certain to veto it.
Republicans said the repeal vote was just the opening volley in their effort to alter the Democrats' trillion-dollar law, which aims to force every American to get health insurance while stopping insurance companies from discriminating against those with pre-existing medical conditions.
Leading House Republicans scheduled a news conference today to begin outlining legislation they hope will replace the Democratic measure.
Republicans contend the Democrat-passed law intrudes on personal freedom, federalizes a huge chunk of the American economy and threatens to bust the federal budget through a series of subsidies aimed at helping more Americans afford health insurance.
"Like a tree that's rotten at its center, we have to cut it down and put something else in its place," Rep. Dave Camp, R-Mich., chairman of the Ways and Means Committee, said of the health reform law.
Democrats sharply disagreed, saying that in the unlikely event that the repeal bill becomes law without a replacement, Americans would begin losing benefits that health reform is already giving them.
They said seniors would lose price breaks on prescription drugs they now get under Medicare, and families would lose the ability to keep children on their parents' health plans until age 26.
The repeal bill passed by a largely party-line vote of 245-189, with every Republican and only three Democrats, all from conservative districts, voting for it.
The vote set the stage for what will likely be years of debate and legislating aimed at altering the health law. Democrats say they want to keep improving the law, but the changes they suggest pale in comparison with the rewrite that Republicans want.
Republicans want to strike the provision forcing everyone to have health insurance -- a move that 26 states are trying to accomplish through federal court cases.
The individual mandate is a central tenet of the Democratic bill. In theory, by forcing healthy young people to buy insurance, it gives insurers income that will make it easier for them to stop charging higher rates and denying coverage to those with pre-existing conditions.
Rep. Fred Upton, R-Mich., chairman of the House Energy and Commerce Committee, said the Republican legislation will ensure that those with pre-existing conditions will be able to get affordable coverage. But the statement he released Wednesday did not explain how Republicans would pay for that move.
Republicans also plan to keep the popular provision allowing children to stay on their parents' health plan until age 26.
Upton said the GOP also plans to try to reform the costly medical malpractice system and replace the Democratic law's mandates on business with a series of incentives encouraging businesses to offer health care to their employees.
"Those are just some of the principles I believe we can agree with on both sides of the aisle," Upton said. "So, first is repeal, then replace."
Democrats said there was a grave danger in repealing the legislation before a replacement has even been written.
"There's never been a credible alternative offered to replace" the Democratic bill, said Rep. Richard E. Neal, D-Mass.
The two days of debate before the repeal vote seemed like a toned-down version of the debate the House had last March, when the health bill was approved.
In the wake of the recent shooting of Rep. Gabrielle Giffords, D-Ariz., and a national debate on whether the tone of the nation's politics is too harsh, most lawmakers seemed to dial it back a notch.
But there were exceptions.
Rep. Michele Bachmann, R-Minn., dubbed the health care bill "the crown jewel of socialism."
And on Tuesday night, Rep. Steve Cohen, D-Tenn., likened the Republican rhetoric attacking the bill to that used by the Nazis.
"They say it's a government takeover of health care, a big lie just like Goebbels," the Nazis' master propagandist, Cohen said. "You say it enough, you repeat the lie, you repeat the lie, and eventually, people believe it."
All four Western New York lawmakers spoke on the House floor about the legislation. Rep. Tom Reed, R-Corning, set the most strident tone.
Speaking Tuesday about what he called "this job-killing Obamacare bill," Reed labeled the legislation "a monstrosity of new spending and government bureaucracy."
Rep. Chris Lee, R-Amherst, also called the bill "a monstrosity," but in general his tone was more tempered. He said the GOP would offer malpractice reform, while encouraging the sale of medical insurance across state lines and joint insurance purchasing by small businesses.
"Republicans are pursuing these common-sense reforms because we made a promise to the American people, and because we believe health care reform needs to address both affordability and accessibility," he said.
As for the local Democrats, Rep. Brian Higgins of Buffalo said: "We will be amending and improving the law for years to come. However, the bill before us today takes us back, not forward, with no serious plan to reduce costs or improve quality and coverage."
Rep. Louise M. Slaughter, D-Fairport, stressed that the Democratic law bans health care discrimination against women, including insurers' previous practices of charging women more for coverage and listing being a victim of domestic violence as a pre-existing condition.
"Any attempt to repeal or defund this legislation is simply unfair to us, our daughters, our mothers and our granddaughters," she said.
The debate came amid numerous polls that show the American public opposes the Democratic health law but also the Republican repeal plan.
An ABC News-Washington Post poll taken Jan. 13-16 found that while 50 percent of those surveyed said they opposed the Democratic law and 45 percent said they supported it, only 18 percent of respondents backed the GOP attempt to repeal the law in its entirety.
Still, House Speaker John Boehner noted that Republicans vowed during last year's election campaign that brought them a majority in the House to repeal the law.
"Repeal means keeping a promise," Boehner, R-Ohio, said. "This is what we said we would do."
At the White House, though, Obama's spokesman, Robert Gibbs, termed the House vote "not serious" and said of the repeal effort: "I just don't think it's going anywhere."