US House approves Republican healthcare overhaul

House Republicans narrowly approved a controversial plan to dismantle the Affordable Care Act on Thursday, taking a significant first step toward fulfilling a seven-year promise to repeal and replace the 2010 law.

Republicans passed the American Health Care Act with one vote to spare, following a dramatic series of negotiations that exposed deep fissures between the party’s moderate and conservative wings over how to replace former President Barack Obama’s signature legislative accomplishment.

The vote to repeal the Act, nicknamed “Obamacare”, which enabled 20 million more Americans to get health insurance, was Trump's biggest legislative win since he took office in January, putting him on a path to fulfilling one of his key campaign promises as well as a seven-year quest by Republican lawmakers.

The bill passed 217 to 213, with 20 Republicans voting against and no Democrats voting in favour. Bills have a 216-vote threshold.

Despite holding the White House and controlling both houses of Congress, Republicans have found overturning Obamacare politically perilous, partly because of voter fears, loudly expressed at constituents' town-hall meetings, that many people would lose their health insurance as a result.

The revised healthcare bill was immediately mired in controversy, as Democrats vowed to wage the upcoming 2018 midterms over the legacy of Obamacare and its expansion of coverage to millions of Americans.

The Republican plan has drawn particular scrutiny for gutting coverage for people with preexisting medical conditions. Prior to the passage of Obama’s healthcare law, insurers were able to deny coverage to people who were already sick and whose treatment was more expensive.

The Republican bill would allow states to opt out of coverage for preexisting conditions, a move conservatives argue would lower overall premiums by removing sick people from the market. An estimated 27% of Americans under 65 have preexisting conditions, include cancer, heart disease and diabetes, that were not covered prior to the ACA.

To attract support from moderate Republicans who balked at the plan, an additional $8bn was included over five years to fund so-called high-risk pools that would help subsidize people with preexisting conditions.

The Republican healthcare plan also includes an attempt to defund women’s health organisation Planned Parenthood, as well as drastic cuts to Medicaid, totalling $370 billion over a decade.

The bill now moves to the Senate, where the Republicans hold a 52-48 majority in the 100-seat chamber, and is expected to face serious difficulties.

Later in the afternoon, an exultant Trump celebrated with dozens of Republican congressmen at the White House.

"I went through two years of campaigning and I'm telling you, no matter where I went, people were suffering so badly with the ravages of Obamacare," Trump said. "We are going to get this passed through the Senate. I am so confident."