Updated at 2:39 p.m. ET
The House voted Thursday to narrowly approve a Republican-drafted measure that would eliminate many of the provisions of the Affordable Care Act — the first step toward keeping one of President Trump's campaign pledges and a victory for GOP lawmakers who have long railed against Obamacare, as the ACA is commonly known. The vote was 217-213.
The measure moves to the Senate, where its fate is far from certain.
"Finally after years of waiting, we have the chance to do something good today," House Majority Leader Kevin McCarthy told lawmakers. Democrats accused Republicans of ramming the bill through without fully understanding its provisions or its implications.
The bill included last-minute amendments designed to draw votes from the most conservative House Republicans in the House Freedom Caucus as well as from their more moderate counterparts.
The changes were necessary after the original bill was pulled from the floor in March when it became apparent it would not pass. And last week, GOP leaders considered bringing it back, but then decided not to risk another vote.
Republican members had their arms twisted by President Trump in phone calls and attended a last-minute pep rally Thursday morning, in which GOP House leaders reportedly told them it was "time to live or die by this day."
The measure, known as the American Health Care Act, was called "a monstrosity" by House Minority Leader Nancy Pelosi, who said centrist Republicans who voted for the bill will have "walked the plank from moderate to radical," adding, "you will glow in the dark" after voting for the bill.
The House voted on the bill without any knowledge of how many Americans will be affected, or the measure's price tag. That's because the Congressional Budget Office, the official scorekeeper, hasn't had a chance to analyze the amended bill. But the CBO estimated an earlier version of the measure would mean 24 million people could lose their insurance.
But we do know the bill would cut taxes imposed by the Affordable Care Act and slash funding for Medicaid, which was expanded under the ACA, by more than $800 billion. It would also allow states to seek waivers for many of the patient protections in Obamacare, including those provisions intended to help people with pre-existing conditions.
The measure does provide $8 billion for states to set up high-risk pools to cover those with pre-existing conditions who are unable to find affordable coverage on the open market. That last-minute addition was key to winning support from some House Republicans who were especially concerned about coverage for pre-existing conditions. But critics say it is woefully short of the amount of money actually necessary to guarantee affordable coverage.
An array of medical groups, led by the American Medical Association, had opposed the measure. In a statement Wednesday, AMA President Andrew Gurman said, "None of the legislative tweaks under consideration changes the serious harm to patients and the health care delivery system if AHCA passes. Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill — that millions of Americans will lose their health insurance as a direct result of this proposal."
The retirees' group AARP also had opposed the GOP bill.
But Republicans pointed to the number of insurance companies who have pulled out of state-run exchanges, leaving consumers with few choices and rising prices for health insurance in many states. "This is a crisis," said House Speaker Paul Ryan, "that is happening right now."
"A lot of us have waited seven years to cast this vote," Ryan added. "A lot of us are here because we promised this vote."
Whether the Senate will go along with the House measure is another story. Few Senate Republicans have expressed any interest in the House plan, and it's expected to be significantly altered when it reaches that chamber. And polls have shown the GOP measure to be extremely unpopular with voters, potentially placing at risk the political careers of lawmakers who back it.
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