Updated Nov. 15, 2013 9:57 p.m. ET
More than three dozen House Democrats rebuffed a White House veto threat and backed a Republican plan to change the health-care law, underscoring the tensions among members of President Barack Obama's party a day after he proposed his own fix to tamp down complaints.
The Republican plan, a response to unease among millions of Americans who face cancellation of health-insurance policies that don't meet the new law's standards, would give insurers one more year to offer policies that were set to end. Unlike Mr. Obama's plan, the GOP measure would allow insurers to sell those policies to new customers.
The 39 Democrats who backed the plan set a high-water mark in Republicans' efforts to win support from across the aisle to amend or delay portions of the law.
Mr. Obama also faces skepticism among insurers about changes to the Affordable Care Act just a month and a half before it fully takes effect. He met insurance-company executives at the White House on Friday, hoping they would support his plan to extend canceled insurance policies sold in the individual market.
State insurance commissioners, who must approve the revived plans, expressed concern that time was short. "We were already looking at some options, but continuing current policies wasn't one of them because the federal law of the land said that was not an option," said Pennsylvania Insurance Commissioner Michael Consedine. "It's basically turning an aircraft carrier—it takes a lot of time."
The House legislation was written by Rep. Fred Upton (R., Mich.) and won support from 222 Republicans as well as the 39 Democrats. Thirty-five Democratic lawmakers had voted for a GOP bill in July to delay the health law's mandate on businesses.
Administration officials said that Mr. Upton's bill would allow insurers to sell substandard insurance to new customers, undermining the Affordable Care Act, and said Mr. Obama would veto the bill if it came to his desk—unlikely given Democratic control of the Senate. Still, the party defections showed that Mr. Obama was having trouble controlling the backlash as he tried to make good on his promise that "if you like your plan, you can keep your plan."
Democrats who voted for the Republican plan face headwinds in their re-election efforts next year, as most have been targeted by the House Republican campaign arm for supporting the health law. The National Republican Congressional Committee has shifted into overdrive, tailoring news releases about dozens of Democrats such as Reps. Ron Barber (D., Ariz.) and Patrick Murphy (D., Fla.) who are thought to be vulnerable in the 2014 elections. On Friday, the effects of that pressure appeared to bear fruit.
"I would imagine that there would be more and more attacks coming for months on end," Mr. Murphy, a freshman representative, told reporters shortly before voting in favor of the Republican-led bill.
William Galston, a senior fellow at the Brookings Institution and a former policy adviser to President Bill Clinton, called the vote a troubling sign after the president apologized Thursday and took responsibility for fumbling the rollout of the health law. "It's not going to be enough to do one contrite press conference," he said. "He needs to show that he's in touch and in charge and that he understands how important it is to get it right the second time, having failed to get it right the first time."
Some Democrats said Mr. Obama's plan had quelled an even greater uproar. Rep. Mike Doyle (D., Pa.) said he and colleagues might have voted for the GOP bill if there hadn't been an alternative solution. "The good news is the president has responded," Mr. Doyle said.
Mr. Obama's plan would let existing holders of individual insurance policies renew for an additional year in 2014 even if those policies don't meet the Affordable Care Act's standards. The law requires policies to offer certain benefits such as free preventive care and forbids insurers from charging higher premiums to sicker customers.
Some insurers said they had received no warning or direction ahead of Mr. Obama's announcement Thursday, and they weren't sure if renewing already-canceled policies was practical. White House Press Secretary Jay Carney said the administration has been in consultation with insurers on a regular basis.
A White House official described the president's meeting with 15 chief executives from the health-insurance industry as productive but offered few details. They discussed how to minimize disruption for consumers and what steps to take in working with state insurance commissioners on implementing the president's proposed extension, the official said.
Insurers and the administration again discussed the prospect of insurers getting the go-ahead and necessary data to directly enroll people who would qualify for subsidies on premiums, bypassing the troubled health-insurance exchange websites, according to a person familiar with the matter. Such a move would allow insurers to sign up some of the millions of Americans expected to qualify for tax credits towards the cost of their coverage.
The health-insurance industry's top trade group, America's Health Insurance Plans, has warned that the president's proposal to extend canceled policies could lead to higher prices, a suggestion that the White House disputes.
If insurers go along with Mr. Obama's policy shift, as many as several million healthy people may stick with their current plans next year rather than buy coverage on new insurance exchanges set up under the health law. Many consumers upset about the policy cancellations say they enjoyed preferential pricing because of their good health.
Exacerbating the cancellation situation: Many people are having trouble buying coverage that complies with the health law because of problems with the federal HealthCare.gov website, which serves consumers in 36 states, and some state-run websites.
If the exchange plans lose customers with lower-than-average medical costs, that would cut into the profits of insurers, because 2014 premiums were set on the assumption that owners of the canceled policies would move onto the exchanges. That could force premiums higher in 2015.
"We've now taken a riskier situation and thrown gasoline onto it," said Allan Einboden, chief executive of Scott & White Health Plan, a nonprofit insurer based in Temple, Texas. "If your premium has to be so high, it's not affordable to anyone."
Across the country, both insurers and state officials voiced a range of concerns about the president's policy shift.
Ohio's lieutenant governor and insurance director, Mary Taylor, a Republican, expressed concern about adding more "uncertainty and complexity to an insurance market already in chaos." She also said the move will speed premium increases for many consumers and small businesses. Nonetheless, Ms. Taylor and several other state insurance commissioners said they would work with companies that want to reinstate policies.
Meritus, a new health insurer from Tempe, Ariz., estimates the group of people buying coverage will now be reduced by some 100,000 to 200,000 people, because their canceled policies will be reinstated, said Chief Executive Kathleen Oestreich. The late change will only add to consumer concerns stoked by issues with HealthCare.gov, she said.
"This now creates another level of confusion and frustration and anger," said Ms. Oestreich. "People are going to delay their purchase again."
—Timothy W. Martin, Louise Radnofsky and Janet Hook contributed to this article.
Write to Colleen McCain Nelson at colleen.nelson@wsj.com, Siobhan Hughes at siobhan.hughes@wsj.com and Jon Kamp at jon.kamp@wsj.com
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