WASHINGTON -- In a major victory for President Donald Trump, the House voted Thursday to dismantle the pillars of the Affordable Care Act and make sweeping changes to the nation's health care system.
The bill passed, 217-213, with 20 Republicans and all Democrats voting against the measure.
Several Democratic lawmakers mocked their Republican colleagues by singing "Na Na Na Na Hey Hey-ey Goodbye" as the measure gained the necessary votes.
The implication was obvious: Democrats believed many Republicans had just cost themselves their political careers by voting for an overhaul of Obamacare.
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.
Aurora Republican Rep. Mike Coffman announced ahead of the vote that he would vote no. Republican Reps. Scott Tipton, Ken Buck and Doug Lamborn voted in favor of it. Democratic Reps. Diana DeGette, Jared Polis and Ed Perlmutter voted against.
An 11th-hour amendment that helped seal 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.
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, Speak 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," he said. "Let's return power from Washington to the states. A lot of us have been waiting seven years to cast this vote."
Many lawmakers, he added are "here because they promised to cast this vote."
The health care bill, the American Health Care Act, eliminates Obamacare taxes on the wealthy, insurers and others, and get rid of the individual mandate imposed by 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.
The GOP bill doesn't touch one another beloved piece of Obamacare -- letting children stay on their parents' insurance plans until the age of 26.