WASHINGTON - Pressing an election-year point, Republicans pushed yet another bill through the House on Wednesday to repeal the nation's two-year-old health care law, a maneuver that forced Democrats to choose between President Barack Obama's signature domestic achievement and a public that is persistently skeptical of its value.
The vote was 244-185, with five Democrats defectors siding with Republicans.
By Republican count, the vote marked the 33rd time in 18 months that the tea party-infused GOP majority has tried to eliminate, defund or otherwise scale back the program - opponents scornfully call it "Obamacare" - since Republicans took control of the House.
Repeal this year by Congress is doomed, since the Democratic-controlled Senate will never agree.
But Illinois Rep. Peter Roskam said before joining other Republicans in Wednesday's House vote: "Here's the good news. The voters get the last word in November. Stay tuned."
Nor was the vote in the House the only act of political theater during the day as campaign concerns increasingly crowded out bipartisan attempts at law-making in the Capitol.
One day after a campaigning Obama called on Congress to pass his proposal to extend tax cuts on all but the highest wage earners, Senate Republican leader Mitch McConnell of Kentucky offered to allow an immediate vote. "I can't see why Democrats wouldn't want to give him the chance" to sign the bill, he said.
Senate Majority Leader Harry Reid, D-Nev., countered by blocking an immediate vote. "We'll get to the tax issues. That way we'll be able to talk in more detail about Governor Romney's taxes," he said in a reference to Democratic campaign attacks on the GOP presidential candidate's overseas investment, the relatively low rate of income tax he is required to pay and his refusal thus far to release personal tax returns dating before 2010.
The health care debate roiled the campaign for the White House as well as Congress.
Republican presidential candidate Mitt Romney drew boos from his largely black audience at the NAACP convention when he vowed to wipe out Obama's overhaul.
In the House, Republicans assailed the law as a job-killing threat to the economic recovery, but Democrats said repeal would eliminate consumer protections that already have affected millions.
"The intent of the president's health care law was to lower costs and to help create jobs. ... Instead, it is making our economy worse, driving up costs and making it harder for small businesses to hire," said House Speaker John Boehner, R-Ohio. He cited a study by a business group that estimated that one of the bill's taxes would cost up to 249,000 jobs, and a different estimate that a second tax would "put as many as 47,100 in jeopardy."
But House Democratic leader Nancy Pelosi said repeal would take away provisions that guarantee coverage for children with pre-existing medical conditions, reduce prescription drug costs for some seniors, provide for protective checks for patients of all ages and ensure rebates totaling more than $1 billion this summer for policy holders.
"What a Valentine to the health insurance industry," Pelosi said scornfully of the repeal measure. The party leader was a driving force behind the overhaul when she was speaker and Democrats held a majority.
At its core, the law will require nearly all Americans to purchase insurance beginning in 2014, a so-called individual mandate that Republicans seized on to make their case that the program amounted to a government takeover of health care. The law's constitutionality was upheld two weeks ago in a 5-4 Supreme Court opinion written by Chief Justice John Roberts.
There was never any doubt that Republicans had the votes to pass the repeal in the House on Wednesday - or that it would die in the Senate, where Democrats possessed more than enough strength to block it.
That's what happened in January 2011, when the newly installed Republican majority first voted to repeal the law a few days after taking office.
In the months since, the GOP has taken repeated further swipes at the law, including votes to deny salaries to any government officials who enforce it, to abolish a board of officials charged with holding down Medicare costs in the future and to repeal a tax on medical devices.
With the exception of a few relatively modest changes accepted by the White House, all the rest have died in the Senate.
Some Democrats sought something of a middle ground.
Rep. Ron Barber, D-Ariz., elected to his seat a few weeks ago, said the GOP-inspired repeal legislation was a charade and showed the House "cares more about political grandstanding than in getting things done." At the same time, he said, "We must work to improve the legislation," a bow to those who are less than enthusiastic about it, and a point he made during his recent campaign.
The five Democrats who sided with Republicans in the house vote were Reps. Larry Kissel and Mike McIntyre of North Carolina, Jim Matheson of Utah, Mike Ross of Arkansas and Dan Boren of Oklahoma.
All five voted against the law's passage in 2010. Boren, Ross and McIntyre voted to repeal the law in January 2011, while Matheson and Kissel voted then to keep it in place.
Boehner said Republicans wanted to give Democrats who had previously voted to sustain the law a chance to reconsider, contending that "most Americans not only oppose this health care law - they support fully repealing it."
Public reaction to the law has been consistently negative, but apart from conservative Republicans, it is less clear what support exists for repeal.
In a Washington Post/ABC News poll this month, 47 percent of those surveyed said they opposed the law, 47 percent said they supported it and 6 percent expressed no opinion.
Among those who said they were opposed or had no opinion, 33 percent said they wanted it all repealed, 30 percent said they wanted parts repealed and 34 percent said they wanted to wait and see what happens without repeal.