The Republican-controlled House voted 244 to 185 Wednesday to fully repeal the health care reform law, a political move that underscores conservative anger at the Supreme Court decision to uphold President Obama's signature domestic legislative achievement.
No Republicans opposed the bill, and just five Democrats crossed the aisle to vote in favor: Democratic Reps. Mike McIntyre and Larry Kissell of North Carolina, locked in tough re-election fights, Dan Boren of Oklahoma, Mike Ross of Arkansas and Jim Matheson of Utah.
In the previous repeal vote, on Jan. 19, 2011, three Democrats -- Boren, McIntyre and Ross -- joined 242 House Republicans to completely undo the law. There have been other House votes to repeal or defund parts of the law, too, more than 30 in all.
"Plain and simple, the bill is a flawed effort that fails to address the critical issue of rising health costs," Matheson said in a statement.
Boren said he voted for repeal because the law "is too large and too costly" and "my constituents have urged me to support the repeal."
The Democratic-led Senate will almost certainly ignore this version of the full repeal bill - just as it did last year's. Taken at its most meaningful, then, this latest vote was not so much a do-over, as an emphatic messaging effort by Republicans to show the party's conservative base they remain committed to undoing the Affordable Care Act.
And, given the Court's ruling last month, Republican victories at the polls on Election Day may be their best shot at that.
But in the debate leading up to the vote, House Speaker John Boehner said on the House floor, "For those who still support repealing this harmful healthcare law, we're giving our colleagues in the Senate another chance to heed the will of the American people."
He added, "And for those who did not support repeal the last time, it's a chance for our colleagues to reconsider ...for all of us, it's an opportunity for us to do the right thing for our country."
Majority Leader Eric Cantor said, "We have said since day one that we must fully repeal this law. Today, we can start over and we can tell the American people, we are on your side, that we care about your health care, we want quality care and affordable costs. We listened and we've acted."
Minority Leader Nancy Pelosi characterized the bill in remarks on the House floor as a useless "bill to nowhere." She said Republicans need to stop trying to take away patient protections for Americans.
Pelosi had earlier in the day said at a public event that she was not worried many Democrats would jump ship to vote in favor of the Republican repeal bill. She predicted that four or five might because of political pressures, but she added, "Politics be damned. We came (to Washington) to do a job."
Prior to the vote, Democrats failed to get through a motion that would force lawmakers to give up their own tax-payer-subsidized benefits if the repeal bill passed.
But as evidence that Republicans did not view this latest measure as a serious stab at repealing the law, they proceeded Wednesday without knowing its official budgetary effects if enacted. The Congressional Budget Office had said last year's bill would add $210 billion to the deficit over 10 years.
But the cost of repeal could be higher or lower now, following the Supreme Court ruling that allows states to opt-out of a major Medicaid expansion. At least a dozen Republican governors have said they almost certainly won't do the Medicaid expansion. The CBO said it won't have a new score of the health reform law until the week of July 23.