The repeal effort sank Wednesday along party lines, 51-47, as expected. But in the process, Republicans forced Democrats on the record in favor of President Barack Obama's signature overhaul and launched what they described as a two-year effort to discredit it in the lead-up to a bid for a second term.
"These are the first steps in a long road that will culminate in 2012, whereby we will expose the flaws and the weaknesses in this legislation," said Texas Sen. John Cornyn, the party's campaign chief.
"We think this is just the beginning," said Republican leader Mitch McConnell. "This issue is still ahead of us."
What's certain is that Wednesday's vote changed nothing about the debate that consumed Congress for two years, dominated the midterm elections and has now moved to the courts.
Two federal judges have ruled the law is unconstitutional, partially or in its entirety, citing a requirement for individuals to purchase coverage and pay a penalty in taxes if they fail to do so. Two other judges have upheld the law.
The controversy is all but certain to be settled by the Supreme Court. Sen. Bill Nelson, D-Fla., announced he would file legislation urging the justices to act quickly.
In spite of the maneuvering and the side-taking, senators overwhelmingly voted to cancel the law's requirement that businesses, charities and state and local governments file income tax forms for every vendor that sells them more than $600 in goods. That repeal was approved 81-17 after Republicans pointed out it had originally been their idea. Obama said he would accept the change.
Acutely aware that they'll be defending 23 seats in the next election, Democrats sought to shrug off the GOP's efforts. Senate Majority Leader Harry Reid, who said earlier in the week he hoped the vote would help Republicans get it out of their systems, called on them to "set aside the battles of the past."
But even as Reid dismissed the repeal effort, he used stark terms to describe how canceling the overhaul would affect millions of Americans. It would, Reid warned, "kick kids off their parents' health care" and "take away seniors' rights to a free wellness check."
The maneuvering reflected the depth of the controversy that still surrounds one of the most ambitious policy overhauls in recent years.
At its core, the law requires most Americans to purchase insurance, a so-called individual mandate that has become one of the principal points of opposition among Republicans and the tea party activists who propelled them to gains last fall.
The bill's critics argue the law gave government too large a role in the health care system, will harm Medicare and burden the economy by raising taxes and fees.
At the heart of the debate is a dispute over how the overhaul would affect the federal deficit.
The Congressional Budget Office reported that the law, once it takes effect, would cut federal budget deficits. But Republicans dispute that, arguing that the forecasts rest on spending cuts to Medicare and other programs that will not materialize.
Democrats tried to argue that the policy debate is largely over.
Sen. Barbara Mikulski, D-Md., called the Republican repeal effort "one more hollow, symbolic, pander-to-the-masses amendment."
"I want to hear their ideas for replacement," she said.
Republicans made clear they have plenty of ideas for replacement - of Democratic senators, if not the health care reform.
"Yes, we were unsuccessful today, but we do know where everybody stands," said Sen. Orrin Hatch, R-Utah.
"We've made some headway," said Sen. John Thune of South Dakota.