Speaker Paul Ryan must be the most relieved politician in America as House passes “Trumpcare” on the second try. Photo: Andrew Harrer/Bloomberg via Getty Images

House Republicans managed to pass a revised version of the American Health Care Act today by the narrowest of margins: 217–213, with two members absent (and three vacancies). Twenty Republicans voted against the bill. All Democrats did so as well.

As Republicans celebrated getting this monkey off their backs and over to the Senate for an uncertain fate, Democrats regaled them with a lusty rendition of “Nah Nah Nah Nah, Hey Hey Hey, Good-bye!” reflecting their belief that some GOP members will lose next year thanks to this vote.

The drive to enact this bill — an earlier version was pulled from a scheduled floor vote in March with defeat certain — looked to have stalled earlier this week. But then one announced “no” voter, Representative Fred Upton, Republican of Michigan, came up with an amendment adding a small but symbolic sum of $8 billion to the funds available to states to deal with people that have preexisting health conditions. When the president and congressional GOP leaders avidly agreed, Upton (accompanied by another prior “no” voter, Bill Long) quickly flipped to “yes.” The momentum crucially shifted based on the claim that the House GOP had “addressed” the preexisting conditions issue.

Still, enough House moderates — especially those concerned about Medicaid cuts that were not changed from the original bill — held out to make the vote close.

Now, in theory, the bill can be taken up by the Senate. But the Senate parliamentarian, whose decisions on which elements of the House bill can pass muster with the Senate’s budget rules could be crucial, is expected to wait for a Congressional Budget Office “scoring” of AHCA — estimates of its impact on cost and coverage that many House Republicans feared, hastening their move to a vote.

Nothing is likely to happen in the Senate until June. So House Republicans will have plenty of time to reflect on what they have wrought before we find out if it’s the shape of the future or just a bad nightmare.