The House of Representatives on Thursday voted narrowly to do away with the Affordable Care Act, replacing it with a healthcare bill that would dramatically roll back Medicaid, provide hundreds of billions of dollars in tax cuts to the wealthy, gut protections for patients with pre-existing conditions and add tens of millions of Americans to the ranks of the uninsured. The legislation passed by a 217-213 vote, with 20 Republicans and every Democrat opposed. House Speaker Paul Ryan rushed the vote at the request of President Trump, before the Congressional Budget Office had a chance to “score” the bill, meaning Republicans voted in favor of legislation whose full impact remains unknown. Speaker Ryan hailed the vote as an historic achievement.

Speaker Paul Ryan: “A lot of us have been waiting seven years to cast this vote. Many of us are here because we pledged to cast this very vote.”

President Trump celebrated passage of the bill in a Rose Garden ceremony with Republican congress members, saying the legislation would lower healthcare premiums. But a Center for American Progress analysis found that surcharges on premiums for patients with pre-existing conditions could rise by over $140,000 for some cancer patients, while some women could see a 450 percent rise in the cost of insuring a pregnancy. The legislation would also block Medicaid reimbursements to Planned Parenthood for one year unless the women’s health group agrees to stop offering abortions.

The bill was opposed by almost every sector in the healthcare industry, including hospitals, doctors, health insurers and consumer groups.

After the bill’s passage, members of the Democratic caucus led a protest against Republicans outside the Capitol, chanting “Vote them out!” This is Vermont independent Sen. Bernie Sanders.

Sen. Bernie Sanders: “President Trump, you do not stand with the working class of this country when you throw 24 million people off of health insurance, when you raise premiums for older workers, when you defund Planned Parenthood and when you cut Medicaid by $800 billion. And then, on top of all of that, you give $300 billion in tax breaks to the top 2 percent. That is not standing with the working class of this country. That is going to war against the working class of this country.”

The healthcare bill faces a steep climb in the Senate, where Republicans control just 52 out of 100 seats.