2017-05-04nytimes.com

The vote, 217-213, on President Trump's 105th day in office, keeps alive the Republican dream to unwind the signature legislative achievement of former President Barack Obama. The House measure faces profound uncertainty in the Senate, where the legislation's steep spending cuts will almost certainly be moderated. Any legislation that can get through the Senate will again have to clear the House and its conservative majority.

Just before the House vote, the Senate on Thursday gave final approval to a $1.1 trillion spending bill that will finance the government through September, and unlike the health care legislation, the spending bill had broad bi-partisan support.

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Republican leaders changed the House bill to woo hard-line conservatives, allowing state governments to roll back required coverage for "essential" services like maternity and emergency care. States could also seek waivers that would let insurers charge higher premiums for customers with pre-existing medical conditions. Those changes could be rejected by moderate Republican senators.

And Democrats are confident that some provisions of the House bill will not comply with special budget rules that Republicans must follow in order to skirt a Senate filibuster.



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