A key congressional committee has approved the Republican healthcare bill after debating for nearly 18 hours.
The proposed legislation scored its first procedural victory, despite objections from Democrats, hospitals and even some Republicans.
The bill would replace Barack Obama’s signature law, so-called Obamacare.
The other House of Representatives committee considering the plan, known as the American Health Care Act, is still debating the proposal.
“This is an historic step, an important step in the repeal of Obamacare,” said Republican Representative Kevin Brady, chairman of the House Ways and Means committee, which voted 23-16 on the measure in the pre-dawn hours of Thursday.
The committee made no changes to the draft legislation, despite Democratic attempts to introduce amendments.
The chamber’s Energy and Commerce committee was still working through its own marathon session as of Thursday morning.
Congress is aiming to pass the bill, which was unveiled on Monday, within the next few weeks.
The new plan would dismantle much of Mr Obama’s 2010 Affordable Care Act.
It would also:
- limit future federal funding for Medicaid, which covers low-income people
- abolish the requirement that everyone should be insured
- replace subsidies with tax credits
The American Hospital Association (AHA), a leading trade group representing hospitals, said current provisions for “our most vulnerable” would be thrown into doubt.
President Donald Trump met lawmakers on Wednesday to rally them behind the bill, after a stormy 24 hours.
Moderate Republicans are also concerned people will be stripped of cover, while conservatives sense federal overreach.
Democrats continue to argue that it is impossible to push through a bill without knowing its cost and how many Americans would be affected – figures which have yet to be released.
Overall, the plan is expected to cover fewer people than those who gained insurance under the Obama administration’s Affordable Care Act.
However, the predicted numbers and cost will not be clear for about another week, when the Congressional Budget Office delivers its verdict.
What did the hospitals and doctors say about it?
The president of the AHA, which represents about 5,000 hospitals and health networks, said in a letter to Congress that the ability to assess the bill was “severely hampered” by the lack of a proper estimate by the Congressional Budget Office.
But the plans for Medicaid “will have the effect of making significant reductions in a programme that provides services to our most vulnerable populations”, Rick Pollack wrote.
In a separate letter, a large doctors’ group, the American Medical Association, also urged Congress to reconsider reducing insurance for the poor.
The AARP, a lobbying group for older Americans, has opposed the plan too, saying funding for the Medicare insurance programme for the elderly could be cut.
Who is speaking up for the bill?
House Speaker Paul Ryan praised the bill as “a conservative wish list” and “monumental, exciting conservative reform.”
“This is what we’ve been dreaming about doing,” he told reporters.
President Trump campaigned on repealing Obamacare, which he says has suffered from rising premiums and a lack of choice.
White House Press Secretary Sean Spicer said the president was “in full sell mode”.
As well as convincing Americans, he has to first persuade sceptics in his own party.
Republicans control the White House and both chambers of Congress, but it is unclear if they will get enough votes to get the bill through.
The bill will be “dead on arrival” at the doors of the Senate, said Kentucky senator Rand Paul.