A Republican drive to repeal the year-old health care law ended in party-line defeat in the Senate on Wednesday, leaving the Supreme Court to render a verdict on an issue steeped in political and constitutional controversy.
The vote was 47-51.
Moments prior to the vote, the Senate had agreed to make one change in the law to strip out a paperwork requirement for businesses.
President Barack Obama, who has vowed to veto any total repeal of his signature legislative accomplishment, has said he would accept the change. It does not directly affect health care.
David Vitter, R-La., voted for the repeal.
"Although the repeal amendment didn't pass today, the fight is not over, and I will continue to push my own repeal legislation in the Senate," Vitter said. "Obamacare is unconstitutional, raises taxes and premiums, cuts Medicare by half a trillion dollars and puts government bureaucrats between patients and their doctors."
Mary Landrieu, D-La., was among Democrats who voted against the repeal.
"People in Louisiana and across the nation made it clear last November that they expected us to come back to Washington focused squarely on creating jobs and reducing the federal deficit," Landrieu said. "Republicans have responded by making it their No. 1 priority to repeal the health care law, which would increase the federal deficit by $230 billion over the next 10 years.
"The health care law that passed Congress is not perfect, and I am open to constructive ideas on how we can improve the law, but I voted for it because it helps Louisiana families and businesses in significant ways."
Earlier this month, the House of Representatives voted to repeal the law. Rep Charles Boustany, R-La., was among those who voted for the repeal.
"I am disappointed the Senate was unable to follow the House's lead and the will of the American people to repeal this terrible bill," Boustany said on Wednesday. "As the Republican majority works to replace this law, I look forward to working with my colleagues on the Ways and Means Committee to develop real alternatives to what the Democrats rushed to pass last year."
Republicans said they have accomplished an objective of forcing rank-and-file Democrats to take a position on an issue that reverberated in the 2010 campaign and may play a role in 2012.
Senate Republican leader Mitch McConnell said the vote marked an opportunity for Democrats who voted for the bill last year "to listen to those who have desperately been trying to get your attention."
"To say, yes, maybe my vote for this bill was a mistake, and that we can do better," McConnell said.
Democrats worked to minimize any political repercussions, a concern for a party already acutely aware it must defend 23 seats -- and its shrunken Senate majority -- in the 2012 elections.
Majority Leader Harry Reid, D-Nev., said the Republican repeal movement would "take away a child's right to get health insurance and instead give insurance companies the right to use asthma or diabetes as an excuse to take away that care."
"It would kick kids off their parents' health insurance," Reid said. "It would take away seniors' rights to a free wellness check."
Democrats also countered with the proposed repeal of the law's requirement that businesses, charities, and state and local governments file income tax forms every time they purchase $600 or more in goods.