"As I promised to do, I voted against this bill, because we failed to include replacement legislation," said freshman Rep. John Katko (R-NY), one of the three GOP "No" votes.
"With a majority in Congress, I would like to see the GOP come forward with market-based solutions," Katko added.
The other "No" votes from Republicans came from another freshman, Rep. Bruce Poliquin of Maine, and Rep. Robert Dold of Illinois.
Dold holds a classic swing seat in the Land of Lincoln; he won it in 2010, lost in 2012, and then won in a rematch last November.
Looking for a GOP plan
While Republicans have floated many ideas since debate on health insurance coverage began in 2009, GOP leaders have never brought a bill to the floor to actually replace the system, as rank-and-file Republican lawmakers acknowledged on Tuesday that they need to change that record.
"I believe that's exactly what the American public wants us to do is to show an alternative to the Affordable Care Act," said Rep. Dennis Ross (R-FL), who unveiled his own bill last year.
"It's disappointing to me, it's frustrating to me," Ross told me just off the House floor. "I'm tired of repealing without replacing."
Democrats relentlessly mocked the GOP during debate on the House floor on that very point, reminding Republicans that they've never unified behind a new health plan.
"You've done nothing but demagogue this issue for four years," said Rep. Jim McGovern (D-MA).
"It sure seems like Groundhog Day," said Rep. Debbie Dingell (D-MI).
"Here we go again," chided Rep. Doris Matsui (D-CA).
The repeal effort could go before the Senate later this week, though the plan may be blocked by a Democratic filibuster.
Senior Republicans will reportedly release a new plan on Thursday authored by Rep. Fred Upton (R-MI) and Sen. Orrin Hatch (R-UT).
Republicans have given no timetable on when they might vote on a replacement health plan; there was talk about it in 2014 as well, but the effort went nowhere before the mid-term elections.