The U.S. House Energy and Commerce Committee gave its approval Thursday afternoon to a Republican bill to repeal and replace parts of the Affordable Care Act (ACA).

The American Health Care Act (AHCA) passed along party lines on a 31-23 vote after more than 27 hours of debate. Early Thursday morning, the House Ways and Means Committee approved the ACHA on a 23-16 vote (also along party lines) after 18 hours of debate.

The bill next heads to the House Budget Committee so the Congressional Budget Office (CBO) can issue a score for the fiscal impact to the federal government and states before the legislation heads to the Rules Committee and eventually the House floor.

In a letter to Congress issued Tuesday, American Hospital Association (AHA) President/CEO Rick Pollack said the AHA looks forward to continuing to work with Congress and the Trump administration on ACA reform, but it cannot support the proposed bill in its current form. Pollack said any changes to the ACA must ensure that providers can continue to deliver health care coverage to the tens of millions of Americans who have benefitted from the ACA, and any ability to evaluate the new legislation is severely hampered by the lack of coverage estimates by the CBO.

The AHCA would repeal the ACA’s employer and individual mandates to purchase health coverage and replace the law’s means-tested advance premium tax credits and cost-sharing reductions with tax credits that vary by age and income. The package also would end the ACA’s Medicaid expansion, beginning in 2020, and transition the program to a per capita cap funding model. In addition, the package would repeal most of the law’s taxes while maintaining, though delaying, the tax on high-value employer-sponsored health plans (or “Cadillac” tax).

It would impose per-enrollee limits on federal payments to states, using each state’s spending in FY 2016 as the base year to set targeted spending for each enrollee category (elderly, blind and disabled, children, non-expansion adults, and expansion adults) in FY 2019 and subsequent years. Each state’s targeted spending amount would increase by the percentage increase in the medical care component of the consumer price index (CPI) for all urban consumers from September 2019 to September of the next fiscal year.

Starting in FY 2020, any state with spending higher than its specified targeted aggregate amount would receive reductions to their Medicaid funding for the following fiscal year.

A section-by-section breakout of the bill can be downloaded from here.