"We're finally getting rid of this train wreck called Obamacare," said Rep. Buddy Carter (R-GA).
The vote came after weeks of negotiations among Republicans which produced several changes, allowing states to get a waiver to certain bedrock portions of the Obama health law.
In an at times chippy debate on the House floor, Democrats denounced the GOP health care changes.
"Trumpcare is another false promise," said Rep. Marcy Kaptur (D-OH).
"Tens of thousands of Americans will die if this bill passes," said Rep. David Cicilline (D-RI).
"This is not how Washington is supposed to work," said Rep. Cheri Bustos (D-IL).
A number of Republicans who wanted much more in the way of change still voted for the bill, encouraged by their leaders to move the process forward and on to the Senate.
"This is a step in the right direction," said Rep. Ron DeSantis (R-FL). "I would like to do more, but we are where we are."
"It's time to do this," said Rep. Ted Yoho (R-FL), a House Freedom Caucus member who had been a reluctant supporter of the initial GOP plan.
"It's this, or we get stuck with the Affordable Care Act forever," Yoho added after a closed door meeting of GOP lawmakers.
Most of the 20 Republicans who voted against the bill were more moderate GOP lawmakers, though a few conservatives joined in as well.
The GOP plan does a variety of things in a bid to lower health care premiums:
+ The bill does not repeal the Obama health law, but it does revamp it in significant ways
+ The GOP plan does away with $1 trillion in tax increases over 10 years passed with the original Obamacare legislation
+ The plan eliminates the penalties for not buying insurance (individual and employer mandate)
+ Medicaid spending would be reduced by $880 billion over ten years under the GOP plan
+ Republicans would set up various funds, totaling over $150 billion, to help states offset the cost of higher premiums, especially for those with pre-existing conditions
+ States would be allowed to seek waivers from certain underlying features of the Obama health law, like Essential Health Benefits, community rating and more
+ Subsidies for people to buy insurance on the health exchanges would be ended, and replaced instead with a new refundable tax credit plan
+ States would be allowed to get a waiver and set up high risk pools to help with coverage costs
House Republicans went from the Capitol to the White House after the vote, celebrating its approval with President Trump in the White House Rose Garden.
"Welcome to the beginning of the end of Obamacare," said Vice President Mike Pence, who then yielded the stage to his boss.
The health care plan now goes to the Senate, where Sen. Lamar Alexander (R-TN), the head of the committee dealing primarily with health policy, immediately signaled that he was ready to work on the matter.
But there were already signs of trouble for the House bill in the Senate.
"I’ve already made clear that I don’t support the House bill as currently constructed because I continue to have concerns that this bill does not do enough to protect Ohio's Medicaid expansion population," said Sen. Rob Portman (R-OH).
Portman and a number of other Republican Senators have long made clear they don't like the direction of the House bill, which would have to be altered in order to get a bare majority in the Senate.