In a pre-dawn vote Thursday, Republicans in the U.S. House of Representatives secured a legislative victory as they attempt to scrap and replace former president Barack Obama’s health care plan amid mounting intra-party opposition.

After 18 hours of debate, the House Ways and Means Committee abolished the tax penalty in the Affordable Care Act that is imposed on people who don’t buy health insurance.

The 23-16 vote, which was along party lines, was symbolically important because it abolished part of the law that Republicans most despised.

Several hours after the vote, Senate Republican Leader Mitch McConnell said legislators need to see a Congressional Budget Office (CBO) estimate of the impact the measure will have on the federal deficit.

“I think we need to know that,” McConnell told reporters at a breakfast hosted by Politico.

Other lawmakers, such as Republican Senator Tom Cotton, maintain the rush to approve a replacement bill, particularly without budget estimates, would have long-term detrimental effects.

House Republicans and White House Budget Director Mick Mulvaney both predicted a CBO estimate would be available by early next week, prior to combining two versions of the bill and presenting the combined measure to the House Budget Committee.

The House Energy and Commerce Committee also worked feverishly on the replacement bill, the American Health Care Act. But the committee’s attempts to fast-track the legislation have been stymied by Democrats who extended the debate well into Thursday.

The prospects of replacing the current health care law, commonly known as Obamacare, is far from certain even with Republicans in control of the White House and both chambers of Congress.

Opposition to the replacement plan is intensifying among influential lawmakers who believe it is too similar to Obamacare. Those on the far right said the replacement plan fails to address conservative principles by maintaining government subsidies of Obamacare under the guise of refundable tax credits for people who buy their own health insurance.

In addition to mounting Republican congressional opposition, influential health groups such as the American Medical Association, the American Hospital Association, and the AARP, an advocacy group for older people, are coming out against the Republican bill, warning it could result in a rise in the number of uninsured people.

Hospitals are complaining to lawmakers that the replacement bill cuts Medicaid and other programs.

America’s Health Insurance Plans, which represents insurance providers, applauded the elimination of the tax penalty but warned that proposed Medicaid changes “could result in unnecessary disruptions in the coverage and care beneficiaries depend on.

U.S. President Donald Trump, meanwhile, is planning to go all out to get a House repeal measure approved. Trump met privately in the Oval Office Wednesday with conservative activists and emphasized the replacement bill is strong and imperative. The president said the biggest challenge was in the Senate, where many conservatives and moderates oppose the replacement bill for various reasons.

Trump told the conservative leaders he was prepared to secure votes from holdout senators by holding campaign-style rallies in stadiums and in other large venues in the senators’ home states.

Republican congressional leaders have said they want to get the replacement measure on the president’s desk before the Easter break in early April.


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