The U.S. House of Representatives on Thursday passed a bill to repeal and replace the Affordable Care Act, a move that deals President Donald J. Trump his first legislative win.

It now heads to the U.S. Senate for consideration, where its fate is uncertain. If the Senate passes the bill with significant changes, the House would have to approve those edits before Trump could sign it into law.

Graphic shows vote breakdown on bill to replace the Affordable Care Act. (AP Graphic)

The American Health Care Act, also known as “Trumpcare,” narrowly passed the House by 217 to 213 votes — the threshold was 216 votes.

The vote fell along party lines, with zero Democrats supporting it, and 20 Republicans joined them to oppose the bill. Meanwhile, the vote fell on Trump’s 105th day in office. He held a ceremony from the White House Rose Garden to celebrate the bill’s passage with Republican lawmakers.

Trump said he’s “so confident” the Senate will pass the bill, which he said will result in lower premiums and deductibles for patients.

“This is a great plan,” Trump said. “I actually think it will get even better and this, make no mistake, this is a repeal and a replace of Obamacare, make no mistake about it.”

A key part of the bill passed Thursday would allow states to opt out of covering people with pre-existing conditions. The New York Times reported that Trumpcare would terminate Medicaid’s status as an open-ended entitlement. States would receive an allotment of federal funds for each beneficiary or they could take the money in a single lump sum as a block grant.

It would also repeal taxes the Affordable Care Act levies on high-income people, insurers and drug companies, among others, the Times reported.

House Speaker Paul Ryan said the bill’s passage represented a way for Republicans to deliver on the promise they’ve made for seven years to repeal and replace the Affordable Care Act, former President Barack Obama’s legacy achievement and one they’ve said is failing. The new bill, Ryan said, will make insurance companies compete for business, return the power from Washington to the states and usher in a new era of reform.

“We will not falter, we will replace,” Ryan said on the House floor before the vote. “And today is the day we are going to do this.”

The vote came before the Congressional Budget Office could assess the impact of the latest iteration of the bill.  The office estimated that the previous version of the bill, which Ryan pulled from the floor six weeks ago due to a lack of Republican support, would have scaled back the federal debt, but taken insurance away from 24 million Americans after ten years.

Doctors, hospitals, patient advocacy groups, including the American Cancer Society and AARP, joined Democrats in opposing Trumpcare. Activists outside the U.S. Capitol shouted “Shame” as lawmakers left the building after the vote to return to their home districts for a seven-day recess.  

House Minority Leader Nancy Pelosi (D-Calif.) denounced the bill as a tax break for the wealthy and said the bill’s fans were “duped into supporting a bill that will not become law.” House Republicans, she said, will have this vote tattooed on their foreheads, and Democrats will ensure voters remember which Republicans supported the bill for the 2018 midterm elections.

“It’s an opportunity because the public will now see what they gave their name to,” Pelosi said. “They put their name next to you paying more for less. And we’ll make sure that the public is aware of that.”

The bill, meanwhile, is likely to face a slow, uphill battle in the Senate.

“I don’t see any way that it goes back in the form that it comes,” Sen. Bob Corker (R – Tenn.) warned CNN.