The House of Representatives on Thursday voted narrowly to do away with the Affordable Care Act, replacing it with a healthcare bill that would dramatically roll back Medicaid, provide hundreds of billions of dollars in tax cuts to the wealthy, gut protections for patients with pre-existing conditions and add tens of millions of Americans to the ranks of the uninsured. The legislation passed by a 217-213 vote, with 20 Republicans and every Democrat opposed. House Speaker Paul Ryan rushed the vote at the request of President Trump, before the Congressional Budget Office had a chance to “score” the bill, meaning Republicans voted in favor of legislation whose full impact remains unknown. Speaker Ryan hailed the vote as an historic achievement.

Speaker Paul Ryan: “A lot of us have been waiting seven years to cast this vote. Many of us are here because we pledged to cast this very vote.”

President Trump celebrated passage of the bill in a Rose Garden ceremony with Republican congressmembers, saying the legislation would lower healthcare premiums. But a Center for American Progress analysis found that surcharges on premiums for patients with pre-existing conditions could rise by over $140,000 for some cancer patients, while some women could see a 450 percent rise in the cost of insuring a pregnancy. The legislation would also block Medicaid reimbursements to Planned Parenthood for one year unless the women’s health group agrees to stop offering abortions.