The GOP-led House voted to repeal the landmark health-care law Wednesday as three Democrats joined all 242 Republicans to back the resolution.

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WASHINGTON — After taking a largely symbolic stand Wednesday, Republicans now begin a new phase of their effort to overturn the health-care law, pursuing a variety of strategies: court tests, funding cutoffs and piecemeal changes.

The GOP-led House easily passed its two-page repeal resolution Wednesday after less than two days of floor debate. Three Democrats — Dan Boren of Oklahoma, Mike McIntyre of North Carolina and Mike Ross of Arkansas — joined all 242 Republicans in support of the resolution.

The remaining 189 Democrats, including 10 who opposed the law last year, voted against repeal. Rep. Gabrielle Giffords, D-Ariz., wounded in the Jan. 8 shooting rampage in suburban Tucson, did not vote.

The repeal effort is likely to go nowhere in a Senate still ruled by Democrats. Even if the resolution passed there, repeal wouldn’t survive a certain presidential veto.

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That’s one reason the House on Thursday plans another vote directing committees to look for specific changes that can be made to the health-care law.

Changes in the next two years could include reducing paperwork burdens on businesses, permitting sale of coverage across state lines, withholding money to implement the law and denying funds for grants and other health-related programs.

Still, many political hurdles stand between House Republicans and success in those endeavors, as one chamber generally needs to reach compromise with the other — and the president — to achieve anything.

Senate Republican Leader Mitch McConnell of Kentucky said the GOP will push for repeal despite seemingly long odds, since Democrats control 53 of the 100 seats in that chamber.

“The Democratic leadership in the Senate doesn’t want to vote on this bill,” McConnell said after the House vote. “But I assure you, we will.”

Republicans may have a better chance of success in court.

Washington and 24 other states have joined Florida’s lawsuit in federal court challenging the health-care law — six states signed on Tuesday — and Virginia is pressing a separate case. Those states echo a key Republican argument in contending the law’s requirement that nearly everyone buy insurance by 2014 or face penalties is unconstitutional. (The so-called individual mandate began as a Republican idea from the 1990s.)

In December, U.S. District Court Judge Henry Hudson ruled a person can’t be forced to buy coverage; the Obama administration is appealing. But Virginia, which filed the suit, also is appealing, saying Hudson should have overturned the entire law. The case is expected to wind up before the Supreme Court.

First, though, some congressional Democrats say they’re open to change: “We will certainly look at any good ideas that come down,” said House Minority Whip Steny Hoyer, D-Md.

But Democrats also warn that the law is a carefully crafted balancing act, and removing one piece could jeopardize success of another.

For instance, Republicans are eager to overturn the individual mandate but would keep terms barring insurers from rejecting people with pre-existing conditions. But doing that risks sending premiums higher, since healthy people in theory would be less inclined to buy coverage while the number of people needing coverage would increase.

“The argument for a mandate is that if you’re going to lower costs, improve access and improve the quality of care, you have to increase the risk pool,” said House Minority Leader Nancy Pelosi, D-Calif.

Several bipartisan discussions are under way about possible changes in the law, but they are expected to languish.

As a result, most Republican efforts are likely to be little more than political posturing, independent analysts suggest. “Republicans need to ask themselves whether they want to impede implementation of a law that they disagree with but that they cannot stop,” said Paul Ginsburg, president of the Center for Studying Health System Change, a research group.

By picking off pieces that may be unpopular, Republicans insist they can chip away at the law, but they’re vague about what they will do next, or when.

Asked about a timeline, House Majority Leader Eric Cantor, R-Va., said the committees “are not all organized right now.”

Once they are, analysts look for these issues to surface quickly:

• Small business. Probably the change most likely to win congressional approval is repealing the new requirement that every business-to-business transaction involving goods or services cumulatively worth more than $600 be reported to the government.

The requirement is expected to raise about $17 billion over 10 years, since it’s expected to encourage better transaction reporting. The business community has howled about it because of paperwork concerns.

Support appears to be growing for repeal of this provision, and making up the lost money by curbing some prevention programs. For example, the law creates a Prevention and Public Health Fund that’s estimated to cost $12.9 billion through 2019.

• Implementation funds. The nonpartisan Congressional Budget Office (CBO) says agencies will need $10 billion to $20 billion over 10 years to help put the law into effect.

For instance, the IRS will need personnel and technology to help put into place the new system of tax credits aimed at helping lower-income people afford coverage. And the Department of Health and Human Services will be writing a series of regulations governing how insurance exchanges, or marketplaces, work. House budget-writers can try to deny the funds, but the Senate is unlikely to go along.

• Grants and other programs. CBO estimates the law authorizes spending $106 billion through 2019 for such programs. But it said in a Jan. 6 letter to House Speaker John Boehner that more than $86 billion was “for activities that were already being carried out under prior law” or previously approved.

Among them: $39 billion for the Indian Health Service and $34 billion for more grants to different health centers.

“The Indian Health Service funds are crucial for a lot of states, and these programs have had strong bipartisan support,” said James Horney, director of federal fiscal policy at the Center on Budget and Policy Priorities, a liberal budget watchdog.

• Coverage across state lines. People can buy only individual policies sold by insurers licensed in their state. Republicans are eager to break down those barriers, and their plan is expected to be a top priority.

But the effort will face a tough opponent: states, which have most regulatory authority over insurance and argue they can best protect consumers and closely watch whether insurers remain financially viable.

Information from the Tribune Washington bureau is included in this report.

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