The American Health Care Act cleared another hurdle Thursday when congressmen on the House Budget Committee approved the RyanCare bill 19-17 after more than six hours of testimony and debate with Rep. Dave Brat (R.-Va.), Rep. Mark Sanford (R.-S.C.), and Rep. Gary Palmer (R.-Ala.) joining the 14 committee Democrats opposed to the bill.

“I am proud of the work done by this committee. Our role in this process is to combine the work of the authorizing committees and report the full bill to the House and we have dutifully completed that responsibility,” said Rep. Diane Black (R.-Tenn.), who took over the committee’s gavel from Rep. Tom Price (R.-Ga.), now President Donald Trump’s secretary of Health and Human Services.

Palmer said there was no way he could vote for the RyanCare bill because it wastes the opportunity to seriously return the health care industry to a freer market.

“I voted against the American Health Care Act in the Budget Committee because the promises of changes in the future are insufficient,” he said. “Now that the bill has been reported out of committee, I will continue to work for the changes that are necessary to ensure Medicaid is a viable and affordable program to provide healthcare to the people who need it most.”

Palmer said he does support pieces of the RyanCare bill, such as reforms to the Medicaid program, which is block granted to the states in the bill, but even those reforms do not go far enough.

The American Health Care Act was crafted by Speaker Paul Ryan (R.-Wis.) in private working groups that included congressmen, staffers, and business representatives. Capitol Hill sources have confirmed to Breitbart News that the bill was written precisely to bail out the insurance companies, who miscalculated their support of the 2010 Patient Protection and Affordable Care Act, or Obamacare.

The source told Breitbart News that Republican lawmakers have all been told that nothing in the RyanCare bill can be changed or amended, lest it throw off the conditions that the insurance companies need to continue participating in the Obamacare exchanges and other programs that the RyanCare bill preserves. There have been no successful amendments to the American Health Care Act as it passed through the Ways and Means, Energy and Commerce, and Budget committees. Today the bill stands as it was originally written.

After the House Budget Committee, the RyanCare bill goes to the House Rules Committee, also known as the “Speaker’s Committee.” The Rules Committee does not approve bills, so much as they approve the “rule” governing how congressmen will debate and vote on the bill. Without a rule, the bill cannot come to the floor, except under a formal suspension of the House rules. Because Ryan stocked the committee with his allies, there is no way the bill does not come to the floor. The only question is whether the rule will allow amendments onto the House floor before the vote.

When the House votes on the RyanCare bill, the entire body will be converted into the Committee of the Whole House as if every member is a member of the Budget Committee, and Black as the chairman of the committee will be the bill’s floor manager.

This is critical because the bill stays under the jurisdiction of the Budget Committee through the vote on the House floor and Black does have the privilege of making manager amendments. These amendments are not subject to an addition vote and are used to make technical corrections, but they are also handy for making significant changes in a bill that reflect compromises struck after it has cleared the committee of jurisdiction.

To pass his health care bill, Ryan needs 216 votes, because there are five vacant House seats. There are 237 Republicans and the leading GOP bloc opposing the bill, the House Freedom Caucus, should be good for 30 votes. In the past, Republican leaders, including Ryan, have reached out to Minority Leader Nancy Pelosi (D.-Calif.) to form a coalition or ruling majority to box out conservatives, but this time Pelosi wants RyanCare to fail, too.

There are changes that Ryan can encourage Black to make to the bill in order to pick off conservatives, but too many changes would jeopardize the true purpose of the bill, which is the stabilize the health insurance markets in a way that protects the dominant insurance companies.

The president is not the only one to point out that Republicans are stepping into a mess created by the Democrats.

Black, who is rumored to be considering a run for Tennesee governor, said Republicans had no choice but to act.

“There is always debate and disagreement during the legislative process, but I firmly believe that the result is a better piece of legislation,” she said.

“Obamacare is collapsing and we made a promise to the American people that we would save them from this disastrous law,” she said. “We have now taken yet another step toward our goal of bringing our patient-centered, free-market reforms to the American people.”