WASHINGTON—Relieved Republicans muscled their health care bill through the House Thursday, taking their biggest step toward dismantling the Obama health care overhaul since Donald Trump took office. They won passage only after overcoming their own divisions that nearly sank the measure six weeks ago.

Beaten but unbowed, Democrats insisted Republicans will pay at election time for repealing major provisions of the law. They sang the pop song "Na Na Hey Hey Kiss Him Goodbye" to the GOP lawmakers as the end of the voting neared. The Republicans seemed unworried, many of them busing to the White House for a victory appearance with the president.

The measure skirted through the House by a thin 217-213 vote, as all voting Democrats and 20 mostly moderate Republican holdouts voted no. A defeat would have been politically devastating for President Trump and Speaker Paul Ryan.

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Passage was a product of heavy lobbying by the White House and Republican leaders, plus late revisions that nailed down the final support needed. Leaders rallied rank-and-file lawmakers at a closed-door meeting early Thursday by playing "Eye of the Tiger," the rousing 1980s song from the Rocky III film.

"Many of us are here because we pledged to cast this very vote," Ryan said. He added, "Are we going to keep the promises that we made, or are we going to falter?"

The bill now faces an uncertain fate in the Senate, where even GOP lawmakers say major changes are likely. In a statement, Senate Majority Leader Mitch McConnell called the House vote "an important step" to repealing Obama's law and said, "Congress will continue to act on legislation to provide more choices and freedom in health care decisions."

Republicans have promised to erase president Barack Obama's law since its 2010 enactment, but this year — with Trump in the White House and in full control of Congress — is their first real chance to deliver. But polls have shown a public distaste for the repeal effort and a gain in popularity for Obama's statute, and Democrats — solidly opposing the bill — said Republicans would pay a price in next year's congressional elections.

"You vote for this bill, you'll have walked the plank from moderate to radical," said House Minority Leader Nancy Pelosi, warning Republicans that voters would punish them. "You will glow in the dark on this one."

The bitter health care battle dominated the Capitol even as Congress sent Trump a bipartisan $1 trillion measure financing federal agencies through September. The Senate approved that bill 79-18 a day after the House passed it easily, heading off a weekend federal shutdown that both parties wanted to avoid.

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Ryan cancelled a March vote on the health care bill because disgruntled conservatives said the measure was too meek while GOP moderates said its cuts were too deep.

He abandoned a second attempt for a vote last week. As late as Tuesday The Associated Press counted 21 GOP opponents — one short of the number that would kill the measure if all Democrats voted no.

Over the past few weeks, the measure was revamped to attract most hard-line conservatives and some GOP centrists. In a final tweak, leaders added a modest pool of money to help people with pre-existing medical conditions afford coverage, a concern that caused a near-fatal rebellion among Republicans in recent days.

The bill would eliminate tax penalties Obama's law which has clamped down on people who don't buy coverage and it erases tax increases in the Affordable Care Act on higher-earning people and the health industry. It cuts the Medicaid program for low-income people and lets states impose work requirements on Medicaid recipients. It transforms Obama's subsidies for millions buying insurance — largely based on people's incomes and premium costs — into tax credits that rise with consumers' ages.

It would retain Obama's requirement that family policies cover grown children until age 26.

But states could get federal waivers freeing insurers from other Obama coverage requirements. With waivers, insurers could charge people with pre-existing illnesses far higher rates than healthy customers, boost prices for older consumers to whatever they wish and ignore the mandate that they cover specified services like pregnancy care.

The bill would block federal payments to Planned Parenthood for a year, considered a triumph by many anti-abortion Republicans.

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GOP candidates including Trump put repealing Obama's statute at the top of their campaign pledges, contending it's a failing system that's leaving people with rising health care costs and less access to care.

Democrats defended Obama's law, one of his crowning domestic achievements, for expanding coverage to 20 million Americans and forcing insurers to offer more generous benefits. They said the GOP measure would toss millions off coverage while delivering tax cuts to the wealthy.

The non-partisan Congressional Budget Office estimated in March that the GOP bill would end coverage for 24 million people over a decade. That office also said the bill's subsidies would be less generous for many, especially lower-earning and older people not yet 65 and qualifying for Medicare.

A CBO estimate for the cost of latest version of their bill was not ready before the House vote.

Earlier this week, moderates objected that constituents with pre-existing conditions could effectively be denied coverage by insurers charging them exorbitant premiums.

But GOP leaders seemed to win over a raft of wavering lawmakers after adding $8 billion over five years for state high-risk pools, aimed at helping seriously ill people pay expensive premiums. That was on top of $130 billion already in the bill for states to help customers, though critics said those amounts were insufficient.

The House overwhelmingly approved a second bill that Republicans wrote to snuff out a glaring political liability. The measure would delete language in the health care measure entitling members of Congress and their staffs to Obama's coverage requirements, even if their home states annul them.

Here are the major provisions of the Republican plan, the American Health Care Act

• To help people buy insurance, if they do not have coverage at work or under a government program like Medicare or Medicaid, or through the Department of Veterans Affairs, the bill would offer $2,000 to $4,000 a year tax credits, depending mainly on age. A family could receive up to $14,000 a year in credits. The credits would be reduced for individuals making more than $75,000 a year and families making more than $150,000.

• Under current rules, insurers cannot charge older adults more than three times what they charge young adults for the same coverage. The House bill would allow them to charge five times as much. The Congressional Budget Office said this change would reduce premiums for young adults and increase premiums for older Americans.

• The bill would end Medicaid as an open-ended entitlement to health care and would put the program on a budget. States would receive an allotment of federal money for each beneficiary, or, as an alternative, they could take the money in a lump sum as a block grant, with fewer federal requirements. Medicaid cuts would total $880 billion over 10 years.

• The bill encourages people to maintain “continuous coverage” by requiring insurers to impose a 30 per cent surcharge on premiums for those who experience a gap in coverage.

• Under the bill, states could opt out of certain provisions of the health care law, including one that requires insurers to provide a minimum set of health benefits, such as maternity care and emergency services, and another that prohibits them from charging higher premiums based on a person’s health status. Insurers would not be allowed to charge higher premiums to sick people unless a state had an alternative mechanism, like a high-risk pool or a reinsurance program, to help provide coverage for people with serious illnesses.

• The bill would provide states with $138 billion over 10 years that could be used for various purposes like subsidizing premiums, providing coverage to people with pre-existing conditions and paying for mental health care and the treatment of drug addiction.

• The bill would cut the taxes of high-income people by nearly $300 billion over 10 years by repealing a payroll tax increase and a tax on their investment income imposed by the health care law.

With files from the New York Times

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