Nothing so accurately frames the 2012 race for control of Congress as the latest vote by the US House to repeal the Affordable Care Act.

The House voted to repeal the measure that dogmatic conservatives dismiss as “Obamacare” shortly after Republicans took control in January 2011.

Since then, they have organized more than thirty separate House votes attacking aspects of the law.

But that was not good enough.

So Speaker John Boehner, majority leader Eric Cantor and the one-note ideologues who make up their House Republican Caucus went through the charade once more Wednesday, as the House voted 244–185 in favor of repeal.

“Thou dost protest too much,” jokes Congresswoman Anna Eshoo, D-California, as her Republican colleagues organized Wednesday’s vote to show that they are really, really, really opposed to healthcare reform that might serve consumers rather than investors. “The chief justice and four other justices of the Supreme Court of our land have upheld the law for healthcare accessibility for every single American,” continued Eshoo. “And what do the Republicans do, but come to repeal?”

Congresswoman Gwen Moore, D-Wisconsin, was blunter. “Same crap, different day. They’ve always been against Social Security, against Medicare, Medicaid. This is just a different day in their history of not wanting to expand the social contract for anybody other than those people who are endowed,” Moore said of the House Republicans. “The success of the Affordable Care Act will reduce profits to their constituencies.”

Of the 244 pro-repeal votes, all but five came from Republicans. (The Democratic votes for repeal—those of Representatives Mike Ross of Arkansas, Mike McIntyre and Larry Kissell of North Carolina, Dan Boren of Oklahoma and Jim Matheson of Utah—came from relatively conservative members who represent Republican-leaning states or districts.) All 185 anti-repeal votes came from House Democrats.

What this all adds up to is one of the clearer contrasts in recent American politics.

Republicans are never going to be satisfied until the ACA is repealed—not just by a GOP-controlled House but by a GOP-controlled Senate—and signed out of law by a Republican president.

To make that happen, however, they will have to keep the House, gain control of the Senate and elect a new president.

And the healthcare debate is likely to define whether they succeed.

The Republican fantasy that Americans want to scrap any regulation of health-insurance companies while undermining access to care by women, children and low-income Americans is just that… a fantasy.

Polling shows that Americans want the insurance companies regulated. They want women to have access to reproductive health benefits. They want all children to have quality care. And they want strong Medicare and Medicaid programs.

There is no question that, for a time, they were ill at ease with the new national program that GOP messaging mavens dauntingly dubbed “Obamacare.” And Republican presidential nominee-in-waiting Mitt Romney and Congressional Republicans are betting they can again gin up fears about “Obamacare” raising taxes, taking over the economy and steering the nation toward nothing less than socialism.

But the “Obamacare” card won’t be as easy to play as in the past.

A statement issued Wednesday by Congressman George Miller, D-California, and other members of the minority caucus on the House Committee on Education and the Workforce notes: “Since the Supreme Court ruled that the historic health reform law is constitutional earlier this month, the American people are saying that it is time to move on and get back to the other important issues of the day. According to a poll from the Kaiser Family Foundation, 56 percent of respondents said that it is time for Washington Republicans to “stop their efforts to block the law and move on to other national problems.” And today, the Washington Post reported that according to their latest poll, only 20 percent of all registered voters want to take away new patient protections from the American people.

It is fair to say that everything—for both parties—comes down to framing the debate.

President Obama and his House and Senate allies can win this fight. But they need to do something that is uncommon for Democrats: share a coherent message.

What’s the message? Congresswoman Tammy Baldwin, D-Wisconsin, sums it up well as she mounts one of the most important Democratic US Senate campaigns of 2012. Baldwin, who came to Congress as a supporters of single-payer “Medicare for All” reform, has her objections to the ACA. But she says:

I disagree with those who want to rip up the decision of an independent court and start over.…

I believe middle class families should have the peace of mind knowing they will have access to quality, affordable health care, regardless of any pre-existing condition.

I believe Wisconsin small business owners should receive assistance to provide health coverage to their employees, allowing them to be more competitive in the global marketplace.

I believe seniors should continue to have access to free preventive care, as well as affordable access to prescription drugs under Medicare.

And I believe that it is the right thing to do to allow over 6 million young people who now have health care to stay on their parents’ health care coverage.

That’s a simple message that goes to the heart of what’s right about the ACA. Democrats do not have to love every aspect of the measure. In fact, they shouldn’t; it’s a compromise, after all. But they will have to defend what is defensible about the Affordable Care Act in a coherent, steady and unblinking manner.