WASHINGTON — The new Republican-led House is poised to deliver an emphatic thumbs-down to President Barack Obama's landmark health care overhaul, with no ready substitute of its own.
The House vote Wednesday could turn out to be the high-water mark for repeal, a goal that energized conservative voters in the midterm elections and helped Republicans return to power in Congress. Democrats, who hung on to the Senate, have vowed to block the GOP drive.
But House Republicans say not to underestimate their determination or their willingness to use parliamentary maneuvers to deny the Obama administration funds needed to carry out the law.
"Our vote to repeal is not merely symbolic," said freshman Rep. Nan Hayworth, R-N.Y., an ophthalmologist. "It respects the will of the American people. And it paves the way to reform our health care."
The initial round of debate Tuesday was free of the rancor seen during the marathon sessions that culminated in party-line passage of the historic legislation last year. The law would provide coverage to more than 30 million uninsured people, with tax credits to make premiums more affordable for the middle class, along with an expanded Medicaid program for the poor. Starting in 2014, most Americans would be required to carry health insurance, a first-of-its-kind mandate that Republicans are challenging as unconstitutional in federal court.
Democrats are confident that the law will stand. Millions are already getting its benefits, from lower prescription prices for Medicare recipients with high drug costs to extended coverage for young adults on their parents' insurance plan.
Republicans are "re-litigating, regurgitating and rearguing" a debate that was settled last year, said Rep. Rob Andrews, D-N.J. Repeal is "the wrong bill at the wrong time," he added.
After Wednesday's vote, it's unclear what will ultimately happen. House Majority Leader Eric Cantor, R-Va., dared Senate Majority Leader Harry Reid, D-Nev., to prove that he can keep Democrats united in support of the health care law by bringing repeal to the floor.
"He should bring it up for a vote if he's so confident he's got the votes," Cantor told reporters.
Opponents of the law would probably need 60 Senate votes to overturn it, which is a big stretch given that Republicans have just 47 votes.
The House is scheduled to vote Thursday to instruct several major committees to draft health care legislation that reflects Republican priorities, including limits on medical malpractice awards and stricter language barring taxpayer funding for abortions. But an earlier GOP bill that offered a competing vision to the Democrats' only covered a fraction of the people reached by Obama's law.
No matter, Republicans say. A modest, step-by-step approach may turn out to be more sustainable in the long run than a major new government program whose costs and consequences are still unclear.
The fate of the repeal effort hinges on the quality of the replacement legislation and the care that Republicans put into drafting it, said Rep. Chris Gibson, R-N.Y., a freshman. If it meets the needs and concerns of the public, Gibson said he believes Democrats in the Senate may be persuaded to give it serious consideration.
Easier said than done, Democrats respond. For example, Republicans say they also want to help people with pre-existing medical conditions find affordable coverage. But many experts say that won't be possible unless there's some kind of requirement that healthy people get into the insurance pool as well, thereby helping to keep premiums down.
"They're going to have to deal with that," said Maryland Rep. Steny Hoyer, the No. 2 Democrat.
Polls find the public divided over the law and whether it should be repealed. A recent Associated Press-GfK survey found a 43 percent plurality wants the law changed so that it does more to re-engineer the health care system. About one in four said it should be repealed completely. Fewer than one in five in the AP poll said the law should be left as it is and 10 percent want to change it to do less.
Some surveys that only give respondents two options — keeping the law as it is or repealing it completely — find an edge for repeal.
AP Special Correspondent David Espo contributed to this report.