It has yet to be scored by the nonpartisan Congressional Budget Office to determine how much the bill will cost or how many people could lose coverage. The CBO report in March on an earlier iteration of the bill predicted that 24 million fewer people would be covered.
Atop Democratic target lists for 2018 are the 23 Republicans who sit in districts that were won by Hillary Clinton last November. Of those members, 14 ended up voting for the bill, with just nine opposing it. One of those no votes, Florida Rep. Ileana Ros-Lehtinen, announced earlier this week she wasn't seeking re-election, so that's one open race Democrats are feeling hopeful about.
Many of the Republicans who ended up voting against the bill cited concerns that the legislation didn't do enough to protect people with pre-existing conditions — echoing a major attack line Democrats are already using, and will surely stick with over the next 18 months.
Moderate New Jersey Republican Tom MacArthur worked with members of the conservative Freedom Caucus to come up with an amendment to the GOP's American Health Care Act that allows states to seek waivers from Obamacare requirements, including on coverage for people with pre-existing conditions.
Further changes put more money toward "high-risk pools" to help defray costs for people with pre-existing conditions. But NPR's Alison Kodjak reported that "an analysis released Thursday by consulting firm Avalere Health concludes that amount would be inadequate for providing full health coverage for the number of people who now buy insurance in the individual market and have medical problems."
"At this time, I cannot support the AHCA with the MacArthur amendment because I'm concerned that a small percentage of those with preexisting conditions may still not be protected," Colorado Rep. Mike Coffman, who sits in a district Clinton won, said in his statement explaining his decision.
For Democrats, it's a pronounced turn of events since Obamacare passed in 2010. With Republicans riding high on the public opposition to the law, Democrats' majority in the House was decimated that year, with 63 seats and control of the House lost.
But sentiment has changed on Obamacare, with Gallup finding this month that 55 percent now approve of ACA.
The AHCA faces a much tougher road in the Senate, and if it dies there, some of those vulnerable GOP members may have taken what ends up being a futile vote.
But there's another side to consider, too. For Republicans who have made the refrain "repeal and replace Obamacare" their mantra for seven years now, not acting on their signature campaign promise could risk depleting enthusiasm among their core voters, who they also need to turn out in November 2018 to combat a Democratic base energized against Trump.
And after the first attempt at repeal failed in an embarrassing fashion, House Republicans and President Trump badly needed a win. That's why they took a victory lap in the White House Rose Garden on Thursday afternoon, even though the bill is far off from becoming law.
"The American people expected us to deliver on the promises we've made and that's what House Republicans have just done," National Republican Congressional Committee communications director Matt Gorman wrote in a memo after the vote.
Republicans have pointed out that more insurance companies are pulling out of state-run exchanges, and the GOP bill will cut about $765 billion in taxes over the next decade, NPR's Scott Horsley reported, though mostly for wealthy Americans.
Some Democratic operatives were already gloating on social media that the Rose Garden event provided great footage for attack ads against House Republicans next year.
Ultimately, for the most vulnerable House Republicans, this may be a vote they won't be able to escape over the next year and a half — even if it never becomes law.
