The Republican-controlled House has voted for the 51st time in 38 months to neuter the nation's health care law.
The vote was 238-181 with nearly all Democrats opposed. Now the bill goes to the Senate, where it's expected to die.
The measure would overhaul the system for paying doctors and others who treat Medicare patients. At the same time, it delays the penalty for failing to purchase coverage under the law.
The combination prompted opposition by the American Medical Association. That's despite the group's advocacy for changes in the Medicare payment system.
The vote is the first attacking the president's health care law since Republicans won an election for a House seat this week in a campaign that featured health care as an issue.