“The tax credit should be enhanced to reduce premiums and better meet the needs of people with low and modest incomes, are older, or live in areas with high health care costs,” said Marilyn Tavenner, CEO of America’s Health Insurance Plans, the health insurance trade group.

“The American Health Care Act needs important improvements to better protect low- and moderate-income families,” she said, adding, “We stand ready to work with members of the Senate and all policymakers, offering our recommendations for how this bill can be improved.”

The bill does not address the near-term funding of $12 billion in Obamacare cost-sharing subsidies next year. Those subsidies lower the co-insurance payments low-income Obamacare enrollees pay out of pocket. That’s funding which insurers say is key to deciding whether they’ll offer exchange coverage in 2018.

“If that gets cut off, a large percent might leave the market,” said Counihan.

The American Medical Association, which represents doctors, had opposed the bill. The group condemned the largely party-line vote that saw the legislation pass 217 to 213, with no Democratic votes and 20 Republicans opposing the measure.

“The bill passed by the House today will result in millions of Americans losing access to quality, affordable health insurance, and those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question,” said Dr. Andrew Gurman, the AMA’s president. He urged the Senate to work on a bipartisan plan that helps fix problems with Obamacare.

House Speaker Paul Ryan cited insurers leaving the market now as the reason for moving forward with AHCA reforms. He noted ahead of the House vote that Aetna said this week it was pulling out of the individual market in Virginia for 2018, after pulling out of Iowa. Meantime, the last statewide insurer in Iowa said it, may have to cut back on coverage in the state.

“We still have a lot of work to do to get this signed into law, and I know our friends in the Senate are eager to get to work,” Ryan said in the White House Rose Garden after passage of the bill.

“We are going to see that work through. You know why we’re going to see this work through? Because the issues are just too important. The stakes are just too high,” he said.

The AHCA was passed along party lines, without a Congressional Budget Office estimate on the impact the bill. The CBO score could come out while the House is in recess next week. That could well influence the next steps toward Obamacare repeal in the Senate.

Watch: Bill George says GOP puts whole insurance market at risk


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