Congressional Republicans made good Wednesday on a central campaign pledge from the 2014 midterms, delivering a bill repealing the health care reform law they loathe to President Obama’s desk, forcing a certain veto.

The bill passed 240 to 181, with one House Democrat supporting the bill and three Republicans opposing it, after passing the Senate 52 to 47 last month. Neither margin is large enough to override a veto.

But House Speaker Paul D. Ryan said the vote would prompt the direct clash that Republican voters have long sought. “We are confronting the president with the hard, honest truth: Obamacare doesn’t work,” he said at a news conference Wednesday.

The problem for GOP leaders is that the repeal vote is too little, too late for GOP voters across the country who hold increasingly dim views of party leaders in Washington and have flocked to outsider presidential candidates Donald Trump and Ben Carson. Ryan, barely two months into his new role as GOP standard bearer, has been left to sell another symbolic vote — the latest in dozens of anti-Obamacare votes — as a significant step forward to frustrated conservatives.

Over the past month, Ryan has sought to strike a delicate balance between tempering expectations about what can be done while Obama is still in office and pledging to pursue a “bold alternative agenda” that will highlight the differences between Republicans and Democrats going into 2016. And in recent days, Ryan has portrayed the repeal vote as the first step in doing so.

[Paul Ryan pledges a ‘complete alternative’ to the Democratic agenda]

“I mean, how many times have we been saying we want to put bills on his desk that say who we are and what we believe versus what he believes,” Ryan (R-Wis.) told Fox News host Sean Hannity on Tuesday night. “We have to go on offense in 2016, and we have to offer a bold agenda to the country.”

Wednesday’s vote is a milestone in that Republicans have finally maneuvered past the Senate filibuster that left all the previous Obamacare repeal measures languishing, using the arcane budget reconciliation process that was employed by Democrats in 2009 to pass Obama’s signature domestic achievement. The bill also blocks Planned Parenthood from receiving federal health care funds after the group found itself under renewed GOP attack.

[Ryan: Republicans are ‘confronting the president’]

While Republicans say the votes taken last month in the Senate and Wednesday in the House offer an important blueprint for repealing the health care law under a Republican president, the fact that the measure will go to Obama’s desk is also an occasion for GOP catharsis after a year when Senate Democrats successfully used the filibuster to bottle up all but a handful of Republican bills.

“The good news is, with this reconciliation bill, there will finally be some clarity,” Rep. Trent Franks (R-Ariz.) said Tuesday. “The president will very glibly veto it. But at least then it will be on him and everybody will know it.”

The White House has mostly ignored the effort to repeal the single policy initiative most identified with the president, issuing a one-page veto pledge last month, and Democratic lawmakers this week called it yet another act in a long-running bit of political theater.

Rep. Jim McGovern (D-Mass.) said the bill “will get the fastest veto that we have ever seen, that’s ever happened in this country.”

“This is a political sound bite; this is a waste of taxpayer money; this is just a waste of everybody’s time,” he said on the House floor Wednesday.

But conservative activists have maintained pressure on GOP lawmakers to follow through on their Obamacare repeal pledges, saying that the process will create momentum for the actual repeal of the law under a Republican president.

Meanwhile, the bold agenda Ryan has promised awaits.

In a speech delivered last month at the Library of Congress, Ryan pledged to put forth a “complete alternative to the left’s agenda” but remained sketchy on what that agenda may address. The pitfalls for moving aggressively in an election year are numerous — not least of which is the potential for fouling the message of the party’s eventual nominee. Ryan, notably, is crosswise with national front-runner Donald Trump on such major issues as immigration and entitlement reform.

[Being GOP’s next Great Communicator will be delicate task for Paul Ryan]

Ryan is mindful about not getting too far ahead of the House Republican Conference in setting policy priorities, having made fulsome promises to adhere to a more bottom-up management style.

One pledge that Ryan did make is to develop not only a plan to repeal Obamacare under a Republican president, but to replace it with a more free-market-oriented reform package. Republicans have shied away from floating detailed Obamacare replacements that could be subject to close analysis for financial and health care impacts.

That drew mockery from Democrats this week: “I’m curious, where is your alternative?” McGovern said Wednesday. “Is it hidden in some secret room in the Capitol? Maybe Donald Trump has it? Perhaps we should alert the Capitol Police or, better yet, maybe we can call the FBI to locate the Republican plan on health care?”

Asked whether he planned to bring an alternative bill to the House floor in 2016, Ryan said Wednesday that “nothing’s been decided yet.”

Republicans are set to convene next week in Baltimore for their annual policy retreat, where much discussion is expected on the congressional GOP agenda for the coming year. Ryan continues to face pressure from the most conservative members of the Republican conference, who drummed out former Speaker John A. Boehner for not being more confrontational with Democrats.

“The question is: Will Ryan just be a good speechmaker or be a good policymaker?” Rep. Raul Labrador (R-Idaho), a co-founder of the hard-line House Freedom Caucus, told reporters Wednesday. “So far he’s shown that he’s a great speechmaker.”

Members say there is a thirst to address the strategy and communications issues that have left so many GOP voters disillusioned with Congress.

“We’re in a real conundrum right now,” Franks said, referring to the alienation of the conservative base — a phenomenon he blames on the proliferation of Senate filibusters. “We have got to somehow help the American people understand what is really happening here, and the way that we can do that, I think, is to show them that when the Republicans are in control in the House, we have passed everything that the base has wanted.”

Ryan has hinted that the solution to the conundrum is simple if daunting: “We need a new president; it’s just that simple,” he said in the Library of Congress speech.

The sitting president continues to confound Hill Republicans, as the congressional reaction Tuesday to Obama’s executive orders on firearms sales showed. Future executive actions, not to mention events on the presidential campaign trail and the world at large, threaten to complicate Ryan’s efforts to advance a coherent GOP agenda, as Ryan acknowledged Friday.

“If we’re ever going to get our country back on track, we need to make this year about ideas, not about Obama’s distractions,” he said. “And that is exactly what we’re going to do.”