House Republicans on Thursday narrowly approved their sweeping health care bill aimed at fulfilling a campaign promise to upend ObamaCare, after resuscitating legislation that had flatlined on the floor not six weeks earlier.
The revised American Health Care Act passed on a 217-213 vote.
"We're going to get this finished," President Trump declared in a celebratory Rose Garden event, surrounded by Republican congressional allies shortly after the vote. He vowed premiums and deductibles will be "coming down" and the Affordable Care Act is "essentially dead."
The passage marked Republicans' biggest step yet toward replacing the Obama administration's signature domestic policy law. The bill heads next to the Senate, however, where it faces an uncertain fate.
All Democrats voted against the bill on the House floor Thursday afternoon, warning it would jeopardize coverage; 20 Republicans voted no. Implying the GOP would lose seats in 2018, Democrats sang, "Na Na Hey Hey Kiss Him Goodbye" toward the end of the voting.
But GOP leaders cheered the result.
"Welcome to the beginning of the end of ObamaCare," Vice President Pence said in the Rose Garden.
Trump, praising House Speaker Paul Ryan, said he's confident in Senate passage and predicted an "unbelievable victory."
The narrow approval Thursday was remarkable considering Ryan had to pull an earlier version from the floor in late March. Amid questions over whether the majority party could advance anything on health care amid deep internal divisions, the White House and congressional leaders barraged rank-and-file holdouts with pressure in recent days to back revised legislation.
"A lot of us have been waiting seven years to cast this vote," Ryan said Thursday.
Capping a fiery debate moments before the vote, Ryan appealed to colleagues to move beyond ObamaCare, which he called a "failed experiment." Citing the situation in Iowa, where the last statewide insurer is threatening to leave, Ryan said: "This is a crisis. … What protection is ObamaCare if there is no health care plan to purchase in your state?"
Health Secretary Tom Price told Fox News' "America's Newsroom" earlier Thursday that he expects the Senate to ensure the best-possible bill emerges and rejected criticism that the GOP plan to replace the Affordable Care Act would lead to reduced coverage.
"What we want to do is have a seamless system, not pull the rug out from anybody," Price said, claiming the proposal would ensure people with pre-existing conditions remain covered.
That issue is a major point of contention.
After the original bill was pulled from the floor in March amid conservative resistance, GOP leaders won over some of those lawmakers by including waivers that states could claim pertaining to ObamaCare's coverage requirements, including for those with pre-existing conditions.
Earlier this week, moderates in turn objected that constituents with pre-existing conditions could effectively be denied coverage by insurers charging them exorbitant premiums.
In a final tweak, leaders added billions more to help people with pre-existing conditions afford coverage. Critics say it's still not enough, but the changes helped attract just enough support from conservative and centrist Republicans to pass – GOP leaders announced overnight they had the votes, setting in motion Thursday's action.
In a sign of how the bill's reputation had changed among conservatives since March, the conservative Club for Growth withdrew its opposition just before Thursday's vote.
Democrats, though, continue to rail against the legislation that would overhaul many key provisions of ObamaCare. Lawmakers took to the floor to call it a "gut punch to America," and a boon for billionaires and "undertakers."
"This disastrous bill has been condemned by almost everyone," House Minority Leader Nancy Pelosi, D-Calif., said Thursday at a press conference. She said the latest version is "worse" than the original and rejected claims it would protect those with pre-existing conditions.
"This is a scar that they will carry," Pelosi said of House Republicans who vote for the plan.
Republicans say a new health bill is necessary to curb rising premium costs and stop insurers from fleeing markets across the country.
"Doing nothing leaves too many Americans out in the cold," House Majority Leader Kevin McCarthy, R-Calif., said. "We tried the ObamaCare way. It is failing remarkably."
But in the Senate, some Republicans consider the House measure too harsh.
The bill would eliminate tax penalties in Obama's law which clamped down on people who don't buy coverage and it erases tax increases in the Affordable Care Act on higher-earning people and the health industry. It cuts the Medicaid program for low-income people and lets states impose work requirements on Medicaid recipients. It transforms Obama's subsidies for millions buying insurance -- largely based on people's incomes and premium costs -- into tax credits that rise with consumers' ages.
The measure would retain Obama's requirement that family policies cover grown children until age 26.
But states could get federal waivers freeing insurers from other Obama coverage requirements. With waivers, insurers could charge people with pre-existing illnesses far higher rates than healthy customers, boost prices for older consumers to whatever they wish and ignore the mandate that they cover specified services like pregnancy care.
The bill would block federal payments to Planned Parenthood for a year, considered a triumph by many anti-abortion Republicans.
The nonpartisan Congressional Budget Office estimated in March that the GOP bill would end coverage for 24 million people over a decade. That office also said the bill's subsidies would be less generous for many, especially lower-earning and older people not yet 65 and qualifying for Medicare.
A CBO estimate for the cost of latest version of their bill has not been released.
The House also easily approved a second bill that Republicans wrote to snuff out a glaring political liability. The measure would delete language in the health care measure entitling members of Congress and their staffs to Obama's coverage requirements, even if their home states annul them.