By ERIN MERSHON and KERRY YOUNG, CQ Roll Call

House Republicans started celebrating early Thursday, ahead of their vote to repeal and replace the 2010 health care law.

Lawmakers gave Speaker Paul D. Ryan of Wisconsin a standing ovation after his remarks Thursday morning at a GOP conference meeting. Attendees streaming out were confident and even cheerful.

“There were a lot of smiles in the room today,” said Rep. Chris Collins of New York, an ally of President Donald Trump.

The meeting was the party’s first since Majority Leader Kevin McCarthy of California on Wednesday night scheduled Thursday’s vote on the Republican package to overhaul the health care law. He and Whip Steve Scalise of Louisiana announced then that they had secured enough votes for the House to pass the bill.

The party can only lose 22 votes and still pass the measure, but the list of firm “no” votes has been dwindling since early Wednesday, when Reps. Fred Upton of Michigan and Billy Long of Missouri won Trump’s support for an extra $8 billion in funding they say would help some people with pre-existing conditions.

Since then, undecided members like Reps. Rob Wittman of Virginia, John J. Faso of New York and Brian Mast of Florida signaled their support. Rep. Daniel Webster of Florida, a former “no” vote, said he would support the bill after receiving assurances from leadership that at some point in the process, the package would include a change related to Medicaid funding for Florida nursing homes.

Other members who’d said they would vote “no,” like Rep. Jeff Denham and David Valadao of California and Rep. David Young of Iowa, co-sponsored the amendment, led by Upton and Long, that would add the $8 billion fund.

Thursday’s confident tone is a new one for the GOP, which until recently struggled to build support for its health care package despite a seven-year promise to repeal the 2010 health law.

After a series of stumbles — and a catastrophic setback in March when Ryan pulled the original health care overhaul from floor consideration because it lacked the votes to pass — the party returned from its latest April recess somewhat refreshed and ready to reignite the debate. The Upton amendment, along with another from Rep. Tom MacArthur of New York that would let states apply for waivers from some of the health law’s most onerous insurance requirements, ultimately helped build support.

Those amendments, along with some earlier changes, have not been analyzed by the nonpartisan Congressional Budget Office. That agency suggested the first version of the bill would cause about 24 million people to become uninsured in the next 10 years.

Rep. Lou Barletta, R-Pa., said he’s comfortable voting on the bill without first seeing a CBO estimate. “We have a CBO score on the base bill and what we did made it better,” Barletta said of the amendments. 

The House rule incorporates into the bill three amendments, including the MacArthur language that would let states seek waivers from certain requirements.

“The changes are not that significant, so I am not worried about it,” said Rep. Steve Pearce, R-N.M.

Rep. Tom Cole, R-Okla., noted CBO estimates don’t always pan out. “It’s just a factor that you take into consideration,” Cole said of weighing CBO scores in voting on bills.

House starts debate

The House voted 235-192 on the rule that will let Republicans bring the health package to the floor. The rule effectively adds to the bill the amendment from MacArthur to let states seek waivers of certain insurance requirements. It also incorporates Upton’s amendment that would sweeten the funding in states that get waivers for some people with pre-existing conditions by $8 billion over five years.

The rule also will allow lawmakers to bring to the floor a bill from Rep. Martha McSally, R-Ariz., that would block a congressional exemption in MacArthur’s amendment from taking effect. Republicans have said this exemption was included to address concerns about keeping the bill in line with the so-called reconciliation rules, which allow the Senate to clear measures focused on budget changes with simple majority votes.

Democrats and Republicans remained bitterly divided on the underlying bill. Democrats have been quick to note the opposition of groups such as the American Medical Association to the revised version of the GOP health care bill.

“The Republican health care bill is reckless and heartless. I increases the costs of premiums and deductibles. it imposes an age tax on older Americans,” said Rep. Rosa DeLauro, D-Conn., on the House floor Thursday. “It unravels protections for patients with pre-existing conditions.”

Mast, an Army veteran who suffered the loss of his legs during his service, identified himself as a “person with pre-existing conditions” as he defended the GOP bill on the floor. Republicans have argued this week that their measure will protect consumers as insurers flee the exchange market created by the 2010 health care law.

“Every American and every person out there with pre-existing conditions should be asking themselves, how is it that they have coverage if every single insurance provider has pulled out of the market?” he said.

Lindsey McPherson and Simone Pathé contributed to this report.