Washington: The US House of Representatives voted on Friday to take initial steps toward repealing Obamacare, following Thursday's Senate vote on the issue.

House representatives voted 227-198 for a resolution to determine the congressional budget for the 2017 fiscal year and the appropriate budgetary levels for the 2016-2018 fiscal years, allowing the Republicans to adjust budgets for programs under Obamacare, a legislation pushed through in 2010 to expand the coverage of health insurance by the Barack Obama administration, Xinhua reported.

House Speaker Paul Ryan said the measure passed would launch a "thoughtful, step-by-step process" toward replacing Obamacare.

The Republican Party avoided voting directly to repeal Obamacare, which demands a super majority of 60 votes in Senate to pass, but chose to vote on a budget adjustment resolution, which only requires a simple majority. The Senate voted 51-49 on Thursday in favour of the resolution.

The Republican Party holds 52 seats in the 100-seat Senate and 241 seats in the 435-seat House of Representatives.

In both chambers of Congress, some Republicans were reluctant to vote along party lines as they believe their party should agree on a plan before moving to overturn the current legislation.

Obamacare, officially the Patient Protection and Affordable Care Act, has drawn criticism due to a rise in premiums. US President-elect Donald Trump has vowed to replace it after taking office. </s> WASHINGTON — Republicans narrowly advanced their campaign to roll back the Affordable Care Act on Tuesday, as the Senate voted by a slim margin to begin debating legislation to repeal and potentially replace large sections of the 2010 law signed by President Barack Obama.

But the partisan 51-50 vote — with Vice President Mike Pence breaking a tie — does not assure the success of the GOP’s seven-year quest to dismantle the sweeping law, often called Obamacare.

With health coverage for tens of millions of Americans at stake, it remained unclear Tuesday what kind of health care bill — if any — might emerge by the time a final Senate vote is held, possibly as early as Thursday.

Senate Majority Leader Mitch McConnell, R-Kentucky, has set up a series of votes this week on competing proposals to repeal much of Obamacare, or repeal and replace pieces of the law.

Tuesday’s procedural vote to kick off that process marks a victory for McConnell, who has been laboring for months behind closed doors to rally his divided caucus, and for President Donald Trump, who has been publicly calling out GOP senators to stick with the repeal push.

But to get to the vote, McConnell abandoned customary legislative process, foregoing public hearings and committee debate in a way almost never seen for major legislative proposals.

And he left Republican lawmakers with a series of legislative options — which polls show are also deeply unpopular with Americans — that would leave as many as 32 million more people without health coverage and weaken health protections for tens of millions more.

The GOP plans have been widely panned by independent analysts and vigorously opposed by every major patient advocacy group and every leading organization representing physicians, nurses and hospitals.

Opponents include the American Diabetes Association, the March of Dimes, the AARP, the American Medical Association, the American Lung Association, the National Multiple Sclerosis Society, the American Heart Association and the advocacy arm of the American Cancer Society.

Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska voted against the motion.

Collins posted on Twitter on Tuesday afternoon that she voted against the motion to proceed with debate on the bill because “when dealing w/ a complex issue that affects millions of Americans & ⅙th of our economy, we must proceed carefully.”

“Making sweeping changes to the 50-year-old Medicaid program without a single Senate hearing is a mistake,” she tweeted. “We must work in a bipartisan way to to fix the ACA’s serious flaws.”

In a statement Tuesday, Maine’s junior senator, independent Angus King, called the legislation “misguided,” adding that any version of the bill “will hurt millions of people across the country and tens of thousands of hardworking people across Maine.”

“I’ve never seen a process like this before with no hearings and it will almost certainly produce a terrible bill that will drastically raise costs for people in Maine, put coverage out of reach for many others, and reduce Medicaid funding, causing states to choose between helping seniors or children or people with disabilities,” King said. “As the Senate advances with this bill, I will continue to support and protect people in Maine and work to find solutions that keep people covered and make health care more affordable.”

GOP leaders were aided by the dramatic return to the Capitol by Sen. John McCain, R-Arizona, after surgery last week and a diagnosis of brain cancer. He arrived in the chamber to cheers and a standing ovation from his colleagues.

As Republicans next move to crafting a final bill, one leading GOP option, favored by conservatives, is to simply repeal most major parts of Obamacare, and then try to pass a new health care law in the future.

Another idea, supported at one point by GOP leaders, would replace most of the law while at the same time dramatically scaling back federal funding of the Medicaid insurance program that covers some 74 million low-income, elderly and disabled Americans.

GOP centrists have complained both of those versions would leave too many Americans without insurance, and have urged McConnell to start the process over, working on a bipartisan approach that will protect those covered under Obamacare.

So far, none of these approaches has garnered the necessary 50 votes from the Republicans’ 52-seat Senate majority.

The lack of GOP consensus prompted Senate Republican leaders to float a new idea Tuesday — a far more limited repeal bill that would target the most unpopular parts of Obamacare, including its insurance mandates.

That plan — dubbed “skinny repeal” — would eliminate only a medical device tax established by Obamacare and two mandates requiring Americans to have coverage and requiring large employers to offer health benefits.

The approach would fall far short of what Republicans have been promising for years.

If it passes, Senate Republicans could at least send something to a conference committee where lawmakers could work out a compromise with a sweeping repeal bill passed by House Republicans in May, giving them yet another shot at unwinding Obamacare.

That would all have to be done without Democrats, who remain fiercely opposed to the GOP repeal push and voted together Tuesday to try to block the beginning of Senate debate.

The skinny repeal plan risks major disruptions to the nation’s insurance markets, as the lack of any insurance mandate could free Americans to buy health insurance only when they get sick, driving up costs.

But it would leave in place other critical parts of the 2010 law, including hundreds of billions of dollars of federal aid to state Medicaid programs and insurance subsidies that help low- and moderate-income Americans

That assistance is credited with helping extend coverage to more than 20 million previously uninsured Americans.

Also untouched would be landmark rules established by Obamacare that require insurers to cover a basic set of benefits and prohibits health plans from discriminating against Americans with preexisting medical conditions.

It remains unclear whether House Republicans would agree to this more limited repeal plan.

But with centrist and conservative GOP senators in deep disagreement, the skinny repeal may be all McConnell can pass.

The repeal-only plan — which is favored by the most conservative GOP senators — would leave an estimated 32 million more people without health coverage over the next decade, according to the nonpartisan Congressional Budget Office, or CBO.

It is opposed by multiple centrist GOP senators.

The alternative proposed by McConnell that repeals and replaces major parts of the law while also dramatically scaling back federal Medicaid assistance is only slightly less disruptive, CBO analysts have concluded.

The McConnell proposal, which has drawn fire from both centrist and conservative Republicans, would leave 22 million more Americans without insurance by 2026.

That plan would be most devastating to the Medicaid safety net, which currently covers some 70 million poor Americans, including children. Federal Medicaid funding would be reduced by more than a third over the next two decades.

And while CBO concluded the “repeal-and-replace” plan could lower premiums for some consumers, it would likely put health insurance out of reach for older and sicker Americans who could be forced to pay larger deductibles or higher premiums than under the current law.

Still unclear is the effect of yet other GOP proposals that could come up for votes in coming days, including one by Sen. Ted Cruz, R-Texas, to allow health insurers to sell skimpier plans that do not include basic benefits such as prescription drugs, maternity care and mental health and substance abuse services.

The Cruz proposal is widely expected to make health coverage more expensive for sick Americans who need to buy more extensive health coverage and has been panned by health insurers as “unworkable.”

But McConnell elected to proceed with voting Tuesday before CBO had an opportunity to assess the potential impact of Cruz’s proposal. </s> The United States House of Representatives on Friday passed a budget measure that begins the process to repeal the Affordable Health Care Act 2010, better known as Obamacare, Reuters reported. The House voted 227-198 to draft a legislation by January 27 that will revoke the healthcare law enacted by President Barack Obama nearly seven years ago.

The US Senate had passed the resolution by a 58-51 vote on Thursday. Republicans hold a majority in both Houses of the US Congress. No Democrat supported Friday’s move, whereas nine Republicans voted against it.

The healthcare law was passed to expand insurance coverage to some 20 million people. It directed insurers to not turn down those who were already ill and asked them to slash medical charges to the sick and elderly. In the last few years, the US Congress has voted more than 60 times to repeal or alter Obamacare.

The campaign to have Obamacare dismantled has been met with concerns as Republicans are not ready with replacement provisions yet. House Speaker Paul Ryan said, “We have to step in before things get worse. This is nothing short of a rescue mission.”

US President-elect Donald Trump on Friday praised the vote on Twitter, saying, “The ‘Unaffordable’ Care Act will soon be history!” He had vowed to have the Act repealed during his presidential campaign. </s> CHICAGO (CBS) — After President Donald Trump demanded a make-or-break vote on the Republican health care plan, lawmakers were expected to bring the legislation to the House floor Friday after a long night of closed-door meetings.

However, with several Republicans still expected to vote no, the GOP health care bill could be rejected.

House Speaker Paul Ryan (R-Wisc.) scheduled Friday’s votes after a meeting at the White House where the president said negotiations with Republican holdouts were over, and he would leave Obamacare in place and pursue the rest of his agenda if the health care plan fails. The president’s ultimatum came after the House postponed a planned vote on the measure Thursday afternoon.

“I think it was a helpful message,” U.S. Rep. Tom Cole (R-Okla.) said. “The president’s done everything he can to put us in a position to win.”

Ryan emerged from closed-door meetings late Thursday night sounding confident about the vote to repeal and replace former President Donald Trump’s signature health care plan, the Affordable Care Act.

“For 7 ½ years, we have been promising the American people that we will repeal and replace this broken law, because it’s collapsing and it’s failing families, and tomorrow we’re proceeding,” he said.

However, with U.S. Rep. Andy Biggs (R-Ariz.) announcing he plans to vote no, CBS News reports at least 35 House Republicans oppose the plan. With Democrats unanimously opposed to the GOP plan, only 22 Republican no votes are needed to reject it.

Many GOP lawmakers have been reluctant to support Ryan’s proposed American Health Care Act, which the Congressional Budget Office has said would leave 14 million fewer people without health insurance in 2018, and 24 million fewer without insurance over the next decade.

“We have to get it right, not get it done fast,” U.S. Rep. Charlie Dent (R-Penn.) said. “I thought the bill misses the mark and that’s why I’ve taken the position I’ve taken.”

Democrats also have ripped the AHCA as a $600 billion giveaway to the super-wealthy, referring to the tax cuts included in the plan.

“Let’s pull off the charade here, and expose what’s really going on. This is just another Republican tax cut for the rich,” U.S. Rep. Jan Schakowsky (D-Ill.) said.

U.S. Sen. Dick Durbin (D-Ill.) has said the Republican health care plan would cause hundreds of thousands of Illinois residents to lose health care coverage next year alone. </s> House of Representatives passed legislation for Republicans to proceed with ‘budget reconciliation’ to end key provisions of Obama’s signature healthcare law

Republicans ready to dismantle Obamacare amid replacement concerns Read more

Congress has set the stage for repeal of the Affordable Care Act, approving a preliminary measure that will allow Republicans to dismantle Barack Obama’s signature healthcare law.

The legislation passed in the House of Representatives 227-198, with nine Republicans joining a united Democratic party in voting against. The narrowly Senate passed the same budget measure in the early hours of Thursday morning.

“This is a critical first step toward delivering relief to Americans who are struggling under this law,” said the House speaker, Paul Ryan of Wisconsin, in a rare floor speech.

The move allows Republicans to use a procedure known as “budget reconciliation” to tear up key provisions of the law. Republican leaders have said they intend to “repeal” and “replace” Obamacare simultaneously to avoid disruptions in healthcare coverage, but they have yet to agree on a replacement plan.

In the days leading up to the voting, a growing number of Republicans began voicing concerns about repealing the law without first agreeing on an alternative. Democrats seized on these divisions and called on Republicans to reveal their plan before gutting the law, which covers an estimated 20 million Americans.



The Republicans who are not totally enthusiastic about repealing Obamacare Read more

“Republicans talk about they’re going to ‘repeal and replace’ – interesting alliteratively, but not realistic,” said House minority leader Nancy Pelosi of California, who led the passage of the law in 2009 and 2010. “For six years they have had a chance to propose an alternative. We see nothing.”

Republicans have been trying to repeal the Affordable Care Act since its passage in 2010.

With both chambers of Congress and the White House now in their grasp, they finally have the opportunity to do so. Before the House vote on Friday, Trump tweeted: “The “Unaffordable” Care Act will soon be history!” But they have yet to agree on a replacement plan.

On Thursday night Ryan said during a CNN town hall meeting that Congress would draft a replacement plan “definitely within these first 100 days” of Trump’s presidency.

During the forum Ryan was confronted by a cancer patient from Arizona who said the Affordable Care Act had saved his life and asked why Republicans would consider gutting the law without something else in place.

“We wouldn’t do that. We want to replace it with something better,” Ryan said. He claimed that the healthcare law was “collapsing” and said that Republicans needed to rescue Americans from soaring premiums and increasing deductibles.

Trump campaigned with zeal on the promise of repealing the law on “day one” and replacing it with “something terrific”. Beyond that, he has offered few details about his proposal.

At a news conference earlier this week, Trump said Republicans would deliver their healthcare plan to replace the law “very quickly”.

But to pass a replacement plan, Republicans will have to craft a proposal that unites their party, which is deeply divided on how to move forward, as well as win over some Democrats, since they would need a 60-vote super-majority in the Senate, where they only have 52 seats.

Democrats have said they are willing to work with Republicans to improve the law but have shown no desire to rescue them over its replacement.

Passing the measure is only a first step. Now lawmakers on various committees will begin drafting the legislation to replace the bill, a lengthy and exhaustive process that will take place across four committees.

“This is a sad day in the history of this country as Republicans begin the process of destroying healthcare in America,” said Representative Hakeem Jeffries, a Democrat of New York. “Repeal and replace is just a slogan, it’s not a solution.”

Also on Friday, Congress approved legislation that would allow retired marine general James Mattis to become defense secretary, granting him an exemption from the law that bars former service members who have been out of uniform for less than seven years from holding the top job at the Pentagon. A White House spokesman said Barack Obama would sign the measure if Congress approved it before he leaves office next week. </s> Washington (CNN) In a major victory for President Donald Trump, the House has voted to dismantle the pillars of the Affordable Care Act and make sweeping changes to the nation's health care system.

The bill now heads to the Senate where it faces daunting challenges because of the same ideological splits between conservative and moderate Republicans that nearly killed it in the House.

Trump said he is confident the bill will pass the Senate, calling Obamacare "essentially dead."

"This is a great plan. I actually think it will get even better. This is a repeal and replace of Obamacare. Make no mistake about it," Trump said at a celebratory White House appearance with House Republicans.

After a dramatic week of negotiations, lobbying from Trump and Republican leaders, the vote ended with 217 GOP lawmakers backing the measure. Twenty Republicans opposed it, as did all House Democrats.

Trump argued the health care process has unified the GOP. "We've developed a bond," he said. "This has really brought the Republican Party together."

"As far as I'm concerned, your premiums are going to come down," Trump said.

Democrats were unable to stop the GOP vote aimed at President Barack Obama's signature legislative achievement. But after the final vote was cast, they chanted "nah nah nah nah hey hey hey goodbye" to their Republican colleagues, with a few members waving, as they believe the vote will lead to many GOP lawmakers losing their seats in the November 2018 midterms.

Thursday marks a political milestone -- one that has painfully eluded Trump and House leaders for months. The controversial health care bill delivered Trump the biggest political defeat of his short presidency in March, when the legislation had to be yanked from the House floor because it simply didn't have enough support.

Under pressure from an antsy Trump looking to score a big political victory, Republican leaders tried again last week, hoping to to get to 216 votes ahead of the President's symbolically important 100-day mark in office. That effort, too, failed.

Before the vote on the House floor, House Speaker Paul Ryan made the case that Republicans had no choice but to work to put Obamacare -- what he called a "failing law" -- behind them. "Let's give people more choices and more control over their care."

"Let's return power from Washington to the states," Ryan said.

"A lot of us have been waiting seven years to cast this vote." Ryan said. Many lawmakers, he added are "here because they promised to cast this vote."

'Rocky' plays in GOP meeting

Thursday morning, Republicans were already in a celebratory mode. The theme song to "Rocky" played as members filed in to a meeting in the House basement.

Rep. Daniel Webster described Ryan as almost "giddy."

Asked if he will be relieved when all of this is over, Virginia Rep. Dave Brat said simply: "Highly!"

When it came time for House Majority Leader Kevin McCarthy to speak in the meeting, an image of Gen. George S. Patton popped up on the LCD screens in the room. McCarthy proceeded to roll off several motivational quotes from Patton to urge the conference along.

There was also high praise for Trump: New York Rep. Chris Collins credited the President for getting the bill across the finish line. "This was Donald J. Trump, the negotiator getting it done," Collins said.

Before the final vote, the House unanimously passed a separate bill that will ensure members of Congress and their staffs are subject to the rules of their new health care measure. Originally, Republicans were under fire after it was reported that they wouldn't be subject to the rules of their own bill. Republicans said that they were required to include the exemption under Senate rules.

Democrats ready for 2018 fight

Democrats, for their part, are poised to hold the health care bill over the heads of Republicans next year.

As anxious reporters stood outside of Ryan's office Wednesday night, waiting for guidance on whether there would be a vote Thursday morning, Democratic Rep. Elijah Cummings approached the group to joke that he had a "breaking" announcement.

Republicans had the votes on their health care bill, Cummings said. His punchline: And Democrats will take back the House in 2018.

As originally introduced, the GOP bill would leave 24 million fewer people insured by 2026 than under Obamacare, the non-partisan Congressional Budget Office said. There will not be a new CBO report before Thursday's vote on the legislation.

House Minority Leader Nancy Pelosi blasted the bill and timing of the vote.

"Do you believe in what is in this bill?" she said Thursday. "Some of you have said ... well, they'll fix it in the Senate. But you have every provision of this bill tattoos on your forehead you will glow in the dark on this one."

The remark was met with cheers and applause.

"You will glow in the dark," she repeated. "So don't walk the plank."

But the weight of the moment -- Republicans being able to start the process of replacing Obamacare -- was not lost on Democrats.

Off of the House floor, Democratic Rep. Emanuel Cleaver raised his left pant leg to show a CNN reporter huge scars he has on his knee. He said he has had six surgeries, two to replace his knee.

"I'm thinking about the people back home who are hurting. I'm talking about myself. I mean, I'm a pre-existing condition," he said. "It's not apolitical game for all these people out here in the country who are hurting and scared to death."

Cleaver said when Obamacare was enacted in 2010, he never could have imagined that this day would come.

"I thought that even though this place has become toxic, that nobody would jeopardize the health of millions of people for some political purpose," he said. "And the number is still 24 million people who will be without health coverage."

What's in the bill?

The GOP health care bill would eliminate Obamacare taxes on the wealthy, insurers and others, and get rid of the individual mandate imposed by Obamacare, officially known as the Affordable Care Act. Instead of the Obamacare subsidies that are tied to income and premiums, the GOP plan would provide Americans with refundable tax credits based mainly on age to purchase health insurance.

The legislation would also allow insurers to charge higher premiums to those in their 50s and early 60s, compared to younger consumers.

It would also significantly curtail federal support for Medicaid and allow states to require able-bodied adults to work. After 2020, states that expanded Medicaid would no longer receive enhanced federal funding to cover low-income adults, and those that hadn't expanded would be immediately barred from doing so.

And it would allow states to relax some key Obamacare protections of those with pre-existing conditions, which are among the health reform law's most popular provisions. States could apply for waivers to allow insurers to offer skimpier policies that don't cover the 10 essential health benefits mandated by Obamacare. Also, insurers would be able to charge higher premiums to those with medical issues if they let their coverage lapse. States requesting waivers would have to set up programs -- such as high-risk pools -- to protect insurers from high-cost patients.

An eleventh-hour amendment that helped seal the missing GOP votes would add $8 billion over five years to fund high-risk pools and go toward patients with pre-existing conditions in states that seek waivers under the Republican legislation. The legislation already included $130 billion in the fund.

However, the GOP bill doesn't touch one beloved piece of Obamacare -- letting children stay on their parents' insurance plans until the age of 26. </s> WASHINGTON - The Senate voted Wednesday to defeat a bill that would have repealed Obamacare within two years without any immediate plan to replace the sweeping health care law.

Senators voted 45-55 in favor of the bill, falling six votes short of the 51 needed to pass it. Seven Republicans voted against it: John McCain of Arizona, Dean Heller of Nevada, Susan Collins of Maine, Rob Portman of Ohio, Lamar Alexander of Tennessee, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia.

The vote comes on the second day of a 20-hour Senate debate on health care as Republican leaders scramble to win enough votes from their own members to pass something to replace the Affordable Care Act. The Senate began its session Wednesday morning with about 17 hours left in the debate.

Here's a look at where things stand now:

What are they voting on today?

The big vote so far was the failed attempt to pass the amendment by Sen. Rand Paul, R-Ky., to repeal the Affordable Care Act within two years, which would have given lawmakers time to come up with a replacement plan before the law expired. The proposal is the same as one passed by Congress in 2015, which was vetoed by former president Barack Obama. Collins is the only Republican senator who voted against the bill both times.

With a Republican president in the White House, GOP leaders tried again. Paul and other conservatives have led the push for a complete repeal of Obamacare. But there has been a lot of hesitation among Republicans for "repeal" without a plan for "replace."

What have they already voted on?

On Tuesday, senators voted 50-50 to begin debate on a health care bill. Vice President Pence had to come to the Senate chamber to break the tie and allow debate to start.

After that, the biggest news came Tuesday night when senators defeated a Republican bill, on a vote of 43-57, to replace Obamacare. Nine Republican senators voted against the legislation, which was drafted by Senate Republican leaders.

It included a proposal by Sen. Ted Cruz, R-Texas, to allow insurers to sell bare-bones health care plans that don't cover maternity care and other major benefits as long as the companies also sell plans that include a full range of benefits.

The defeated plan also included a proposal by Sen. Rob Portman, R-Ohio, to provide $100 billion in aid to help low-income Americans pay their medical bills after they lose Medicaid coverage as a result of the Senate health care bill.

What are Democrats doing?

The Democrats have been voting against the Republican bills to repeal and replace Obamacare. They also are using procedural tactics to try to slow down the debate process.

For example, Sen. Joe Donnelly, D-Ind., will offer a motion Wednesday to send health care legislation back to the Finance Committee for consideration. On Tuesday, they objected to the usual Senate practice of waiving the reading of the bill, so Senate clerks had to spend several hours reading the leadership replacement bill aloud.

What happens after the 20 hours of debate are over?

A vote-a-rama will begin on dozens of amendments offered by senators of both parties. That is expected to start Thursday.

Do Republican Senate leaders have an endgame?

With the defeat of the comprehensive replacement bill and the "clean" repeal bill, GOP leaders are now looking to pass a "skinny repeal" bill that would make limited changes to Obamacare. It would likely strip out the law's tax on medical devices and its requirements for individuals to buy health insurance and large employers to provide coverage for their workers.

If that plan passes the Senate, it would most likely go to a conference committee of House and Senate negotiators who would try to work out a final compromise.

Democrats say Senate leaders just want to pass anything they can take to this conference committee, where the real bill would be crafted.

"It's becoming clearer that, in the end, the majority leader might push a much scaled-back version of repeal in the hopes of passing something, so-called skinny repeal, just to get to conference," Minority Leader Chuck Schumer, D-N.Y., said in a speech on the Senate floor Wednesday. "But my colleagues, make no mistake about it, skinny repeal is equal to full repeal. It's a Trojan horse designed to get the House and Senate into conference where the hard-right flank of the Republican Caucus, the (House) Freedom Caucus, will demand full repeal or something very close to it."

Why has it been so difficult for the Senate to reach agreement?

Republican leaders have been trying to please the conservative and moderate wings of their party, and they have so far failed to win the support of both groups.

Conservatives generally want a complete repeal of Obamacare's taxes and regulations while moderates worry that ending the law's Medicaid expansion will leave struggling Americans with no way to afford medical coverage.

"Ultimately, we want to get legislation to finally end the failed Obamacare status quo through Congress and to the president’s desk for his signature," Majority Leader Mitch McConnell, R-Ky., said Wednesday in a speech on the Senate floor. "This certainly won’t be easy. Hardly anything in this process has been." </s> US Congress approves first step for repealing Obamacare

The US House of Representatives on Friday joined the Senate in passing a critical measure that marks the first major step toward repealing outgoing President Barack Obama’s landmark but controversial health care reforms.

The House’s party-line vote of 227 to 198 approved a budget blueprint which provides Republicans, who control both chambers of Congress, with a framework for dismantling the Affordable Care Act.

But just a week before Republican President-elect Donald Trump is sworn into office, a sense of urgency has swept over Washington about what his party will put forward as a replacement for the health care law, with Democrats warning of disastrous consequences should Republicans act too hastily.

“This resolution essentially fires the starting pistol… for repealing Obamacare,” said Representative Bill Johnson, an Ohio Republican, shortly before the vote.

“This is a critical first step to deliver relief to Americans struggling under this law,” House Speaker Paul Ryan told fellow members, describing as a “rescue mission” the latest effort to unwind Obamacare.

“This experiment has failed,” and “we have to step in before things get worse.”

The Senate passed the budget resolution on Thursday. The measure received no Democratic support in either the Senate or the House, highlighting the intensely partisan fight that lies ahead.

The budget resolution provides Republicans with a powerful tool, called reconciliation, which allows repeal legislation to proceed through the 100-member Senate protected from filibuster blocking tactics and requiring just a simple majority for passage, instead of a higher 60-vote threshold.

Trump made repeal of the law, a key achievement of Obama’s Democratic administration, a central plank of his insurgent campaign.

This week he said the Republicans ought to repeal and replace Obamacare “simultaneously.”

Unwinding Obamacare will be a monumental task. Republican leadership is moving carefully, stressing it does not want to “pull the rug out from anyone” who might lose their coverage if there is no replacement plan on offer.

The White House, which claims Obamacare as a major success, says more than 20 million Americans have gained health insurance through the law.

Democrats warned that scrapping the Affordable Care Act, which forbids insurance companies from denying health care due to pre-existing conditions and allows children to stay on their parents’ plans until age 26, could result in millions of Americans losing coverage.

“Every American will be affected by this vote,” said number-two House Democrat Steny Hoyer, citing a faster hike in premiums than under current law, and a likely spike in drug costs.

Nine Republicans voted against the resolution in the House, including moderate Charlie Dent, who expressed “reservations” about repealing parts of Obamacare without a credible replacement at the ready.

“The repeal plan needs to be fully developed and better articulated,” he told CNN.

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Also, Like us on facebook </s> As soon as the House approved the GOP health care bill on Thursday, Democrats were working on using it against Republicans in next year's midterm elections.

"They have this vote tattooed on them. This is a scar they carry," House Minority Leader Nancy Pelosi declared just after the American Health Care Act passed the House.

Just to rub it in, many Democrats on the House floor began singing "Na Na Hey Hey Kiss Him Goodbye" to their colleagues across the aisle after the vote, a moment of schadenfreude hoping for the same fate many of their own suffered after the Affordable Care Act passed in 2010.

Democrats need to flip 24 seats to win back the House in 2018, and the congressional vote to repeal and replace Obamacare may well have made that a much easier task. Some of the most vulnerable House Republicans voted in favor of the GOP health care plan on Thursday. No Democrats voted for it, while 20 Republicans opposed it, and it only eked by with 217 yay votes — one more than it needed to pass.

Even members who bit the bullet and voted yes, on what they admitted was an imperfect bill, sounded anything but certain about the vote they had just cast.

Florida Rep. Carlos Curbelo — who represents a Miami district Hillary Clinton won in 2016 by 16 points — made a "game-time decision" on the vote, his spokeswoman told the Miami Herald, and now will be looking to the Senate to smooth out some issues with the bill.

"Today's vote is just a step in the legislative process for this bill — not the end of it," Curbelo said in a taped statement. "We have worked hard to improve the legislation, but we have a long way to go."

It has yet to be scored by the nonpartisan Congressional Budget Office to determine how much the bill will cost or how many people could lose coverage. The CBO report in March on an earlier iteration of the bill predicted that 24 million fewer people would be covered.

Atop Democratic target lists for 2018 are the 23 Republicans who sit in districts that were won by Hillary Clinton last November. Of those members, 14 ended up voting for the bill, with just nine opposing it. One of those no votes, Florida Rep. Ileana Ros-Lehtinen, announced earlier this week she wasn't seeking re-election, so that's one open race Democrats are feeling hopeful about.

Many of the Republicans who ended up voting against the bill cited concerns that the legislation didn't do enough to protect people with pre-existing conditions — echoing a major attack line Democrats are already using, and will surely stick with over the next 18 months.

Moderate New Jersey Republican Tom MacArthur worked with members of the conservative Freedom Caucus to come up with an amendment to the GOP's American Health Care Act that allows states to seek waivers from Obamacare requirements, including on coverage for people with pre-existing conditions.

Further changes put more money towards so-called "high-risk pools" to help defray costs for people with pre-existing conditions. But NPR's Alison Kodjak reported that "an analysis released Thursday by consulting firm Avalere Health concludes that that amount would be inadequate for providing full health coverage for the number of people who now buy insurance in the individual market and have medical problems."

"At this time, I cannot support the AHCA with the MacArthur amendment because I'm concerned that a small percentage of those with preexisting conditions may still not be protected," Colorado Rep. Mike Coffman, who sits in a district Clinton won, said in his statement explaining his decision.

For Democrats, it's a pronounced turn of events since Obamacare passed in 2010. With Republicans riding high on the public opposition to the law, Democrats' majority in the House was decimated that year, with 63 seats and control of the House lost.

But sentiment has changed on Obamacare, with Gallup finding this month that 55 percent now approve of the ACA.

The AHCA faces a much tougher road in the Senate, and if it dies there some of those vulnerable GOP members may have taken what ends up being a futile vote.

But there's another side to consider, too. For Republicans who have made the refrain "repeal and replace Obamacare" their mantra for seven years now, not acting on their signature campaign promise could risk depleting enthusiasm among their core voters, who they also need to turn out in November 2018 to combat a Democratic base energized against Trump.

And after the first attempt at repeal failed in an embarrassing fashion, House Republicans and President Trump badly needed a win. That's why they took a victory lap in the White House Rose Garden on Thursday afternoon, even though the bill is far off from becoming law.

"The American people expected us to deliver on the promises we've made and that's what House Republicans have just done," National Republican Congressional Committee communications director Matt Gorman wrote in a memo after the vote.

Republicans have pointed out that more insurance companies are pulling out of state-run exchanges, and the GOP bill will cut about $765 billion in taxes over the next decade, NPR's Scott Horsley reported, though mostly for wealthy Americans.

Some Democratic operatives were already gloating on social media that the Rose Garden event provided great footage for attack ads against House Republicans next year.

Ultimately, for the most vulnerable House Republicans, this may be a vote they won't be able to escape over the next year and a half — even if it never becomes law.
The Republican-controlled United States House of Representatives votes in favor of the repeal of the 2010 Patient Protection and Affordable Care Act and passage of the House's 2017 American Health Care Act, by a narrow, 217–213 vote. Twenty Republicans and all Democrats opposed the bill, which now heads to the United States Senate for its legislative action.