WASHINGTON -- House Republicans on Thursday overcame weeks of stumbles and delivered a significant measure of progress for themselves and President Trump, finally passing their long-promised replacement for the Affordable Care Act.
The vote marked a major step toward undercutting the law, often called Obamacare, that fueled Republican voters who complain it raised costs and let the government intrude on people's health care.
It was approved, 217-213, one vote more than the bare minimum. All Democrats voted no, as did 20 Republicans, including five from the Philadelphia region.
As the clinching vote flashed on screens on the House floor, Republicans cheered the longtime goal moving within reach. Democrats responded by taunting them about the political price they believe the GOP will pay, chanting, "Nah, nah, nah, nah ... hey, hey, heyyy .... gooood-bye."
For Trump, seeing the measure through the House was a critical step to fulfilling a campaign pledge and pushing his first major legislative initiative through Congress. Though a steep climb awaits in the Senate, he immediately called a celebratory news conference at the White House.
"Most importantly, yes, premiums will be coming down, yes, deductibles will be coming down. But very importantly, it's a great plan and ultimately that's what it's all about," the president said, standing in the Rose Garden with House leaders and Vice President Pence.
Pence specifically credited Tom MacArthur, the South Jersey congressman who cut a deal that gave the bill new momentum after it appeared dead in March.
Trump expressed confidence the plan would clear the Senate, where Republicans have an even slimmer, two-vote margin. "It's going to be an unbelievable victory actually when we get it through the Senate," he said.
As Trump and House leaders celebrated, Republican senators expressed skepticism about the House plan, indicating they would write their own version of the legislation.
"A bill -- finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate -- should be viewed with caution," Sen. Lindsey Graham (R., S.C.) wrote on Twitter, referring to the rushed final days of passage.
The House voted just a day after a final amendment sealed new support and before congressional analysts had time to score -- estimate the cost and impact -- of a bill affecting health care for millions, despite years of Republican criticism that Democrats had jammed Obamacare through Congress.
MacArthur's compromise also threatens to weaken one of the most popular pieces of the current law, protections for people with expensive preexisting health conditions, according to analysts and health advocates.
Sen. Rob Portman (R., Ohio) said he could not support the House plan because it doesn't protect the current law's Medicaid expansion in his state.
At the same time, Senate Republicans will face enormous pressure to find a way to pass something after seven years of pledging to roll back a law hated by the GOP base.
The challenge in winning votes for such a complex and divisive measure was reflected in the Philadelphia area. Aside from MacArthur, every Republican from the region voted against the plan, casting five of the 20 GOP votes against. Many raised concerns that the bill would raise premiums and gut safeguards for people with preexisting conditions.
"It threatens people with preexisting conditions with skyrocketing costs," said a statement from Rep. Patrick Meehan, a Republican from Delaware County. "It threatens essential health care coverage like mental health and opioid addiction treatments. Monthly premiums for many, particularly older Americans nearing retirement, will rise. This bill doesn't repeal or fix Obamacare – it simply shifts its failures from one group of Americans to another."
Republicans, including Meehan, have voted dozens of times to kill the Affordable Care Act. But with Trump now in the White House, this was the first time they had pushed through legislation that actually has a chance to become law.
On the House floor, Speaker Paul Ryan urged his conference to not falter with the goal in front of them. "We can continue with the status quo or we can put this collapsing law behind us," he said moments before the vote.
But the law, long a political burden on Democrats, has gained in popularity as it helped millions of Americans obtain health insurance. Some Republicans argued not for the merits of the House bill, but simply for advancing the process to the Senate, hoping the upper chamber can improve the measure.
Democrats, who as a group voted against the proposal, said it would erase critical protections provided by Obamacare, including those for people with preexisting conditions, and could scale back the Medicaid expansion that has helped more than one million people in Pennsylvania and New Jersey obtain health coverage -- all while making tax cuts that would largely benefit those with high incomes.
The Congressional Budget Office, Congress' official analyst, estimated that an earlier version of the bill could increase the ranks of the uninsured by 24 million over the next decade. It hasn't yet scored the new plan.
"While some in Washington are celebrating today as a victory, this shallow and shameful attempt to score political points at the expense of the sick, poor, elderly and disabled will not soon be forgotten," Gov. Wolf said in a statement after the vote.
Democrats quickly signaled they would use the bill as fodder in next year's congressional elections.
House Minority Leader Nancy Pelosi said voters would find out who "voted to take away their health care." On the House floor, she warned Republicans: "You will glow in the dark."
Republicans said they were unraveling a law that led to rising premiums and deductibles that made Obamacare coverage too expensive for too many, and offered limited choices.
"This, in fact, will preserve the health care they have, will preserve coverage for preexisting conditions, will prohibit discrimination based on gender, and will bring costs down for the vast majority of Americans who are losing coverage today because they simply cannot afford it," MacArthur told a crowd of reporters after the vote.
His amendment brought House conservatives on board with the bill but scared off many centrists. It lets states opt out of the provision restricting insurers from charging higher prices to people with preexisting conditions. He argued that other safeguards would remain in place.