Aaron P. Bernstein/Getty Images)

GOP HEALTH BILL ADVANCES:

"The latest bill’s changes allow states to opt out of many of the ACA’s key provisions, such as its protection of people with preexisting conditions," our colleagues write. "And to regain moderates’ support it lost with that change, an additional $8 billion was allocated to helping sick people afford their premiums — a figure even the conservative American Enterprise Institute says is not nearly enough." (Check out a full list of how each lawmaker voted.)
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Now, the measure will head to the Senate to face a whole new set of obstacles. On Thursday, Republican leaders there sent an unmistakable message: When it comes to health care, we’re going to do our own thing. “I think there will be essentially a Senate bill,” Sen. Roy Blunt (R-Mo.), the fourth-ranking Senate Republican, told our colleagues. HuffPost’s Michael McAuliff reports that at least a half-dozen GOP senators have already expressed opposition to the tack the House was taking. It remains unclear how closely the Senate measure will resemble the one narrowly passed in the House, or whether Republican senators will resolve their own stark differences. 

-- Trump expressed confidence that it will pass the Senate – calling Obamacare “essentially dead.” "This is a great plan. I actually think it will get even better. This is a repeal and replace of Obamacare. Make no mistake about it," Trump told reporters.

-- Despite the new set of obstacles ahead, Trump and the House GOP had reason to celebrate.

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“Rather than embrace policy cobbled together to replace the 2010 Affordable Care Act, many Republicans simply decided the best move was to approve a flawed bill — and ram it through a flawed process — so that the Senate would get a chance to fix the House’s mistakes, setting up a major negotiation later," Paul Kane writes in his column. "House Republicans did so knowing that their votes will be portrayed by their Democratic opponents as ruthlessly denying millions of people health insurance … Inside the leadership team of [Ryan], there was a gripping fear of what failure would mean for its future overseeing a chamber seemingly incapable of moving important legislation. Ryan had already pulled his American Health Care Act from the floor once … [and] the initial game plan was to simply give up on repealing Obamacare and move on to a broad rewriting of the tax code. But inside the White House, [Trump’s] advisers became increasingly concerned about how little they had to show in terms of early victories. They helped nudge the hard-line House Freedom Caucus and some members of the moderate Tuesday Group back to the bargaining table. The consequence of failure — for a second time in six weeks, after the humiliating first retreat — became a compelling reason to vote ‘yes.’ The question is whether this short-term victory was worth the long-term squeeze.”

"Like y’all, I’m still waiting to see if it’s a boy or a girl," Sen. Lindsey Graham said of the House's health care bill. | Getty

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• Now the wildly unpopular bill heads to the Senate, where it is certain to face many obstacles before it has a chance at passing even on a totally partisan basis — which will take 51 votes. But the way the bill is written might make portions of it (in particular the insurance regulation changes) filibusterable, meaning that Republicans would need 60 votes, including eight Democrats, to include them. [Vox / Sarah Kliff]
• Republicans in the Senate seem utterly unimpressed by the House’s bill. Many have come out against both its substantive provisions and the reckless speed with which it was passed. [Politico / Burgess Everett, Jennifer Haberkorn]
• All eyes are on the Senate’s 13-member working group that is drafting their own bill. It’s a group composed entirely of Republican men, unsurprisingly. But it is also a group that includes hardliners such as Tom Cotton and Ted Cruz but also more mainstream senators like Lamar Alexander and Rob Portman, so it will be interesting to see if what they craft is nearly as extreme as the House’s bill. [Vox / Sarah Kliff]
• Meanwhile, the uncertainty that this whole process is creating for insurers was evident even before the bill passed. On Wednesday, Iowa’s largest remaining Affordable Care Act insurer threatened to leave the state marketplace. The same day, Aetna said it plans to leave Virginia’s individual marketplace. [Washington Post / Carolyn Y. Johnson]
• And Kentucky is already trying to roll back portions of its Medicaid expansion, even before Congress acts. [Reuters / Yasmeen Abutaleb, Robin Respaut​]

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WHAT ELSE IS IN THE BOX:

• Planned Parenthood will be defunded for one year: “The women’s health provider stands to lose about 30 percent of its funding under a provision [in the bill] to block it from getting Medicaid reimbursements for one year, unless its hundreds of clinics stop offering abortions.” (Paige Winfield Cunningham)
• Those who obtain health insurance through their employers — about half the country — could be at risk of losing protections that limit out-of-pocket costs for catastrophic illnesses: “The provision … lets states obtain waivers from certain [ACA] insurance regulations. Insurers in states that obtain the waivers could be freed from a regulation mandating that they cover 10 particular types of health services, among them maternity care, prescription drugs, mental health treatment and hospitalization. … Under the House bill, large employers could choose the benefit requirements from any state—including those that are allowed to lower their benchmarks under a waiver, health analysts said. By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation.” (Wall Street Journal)

• Democrats warn that the bill could increase costs for up to seven million veterans who are eligible to receive health care from the VA system: “An estimated 7 million veterans who qualify for such care do not receive it for a range of reasons: They may live too far away from a VA center, their incomes may be too high for them to be placed in a high-priority group for VA access, or they may have health issues unrelated to their service … By taking away the credits that Obamacare offered for those seeking insurance on their own, the GOP proposal effectively means a tax hike.” (HuffPost)