After weeks of fits and starts, House Republican leaders planned Thursday to try yet again to pass legislation to repeal and replace major parts of U.S. health care law.

A sizable number of House Republicans have been either opposed to the bill or undecided in recent days. But Republican leaders now say they have the votes to pass the legislation, called the American Health Care Act.

Here’s everything you need to know on voting day, starting with the basics.

Wait, didn’t the Republican plan fail for good over a month ago?

It definitely looked that way on March 24, when Republican leaders withdrew the AHCA rather than putting it to a House vote they were sure to lose spectacularly.

“Obamacare is the law of the land, and it will remain the law of the land until it’s replaced. We are going to be living with Obamacare for the foreseeable future,” a dejected Republican House Speaker Paul Ryan said at the time.

Things have changed since then. Under heavy pressure from U.S. President Donald Trump, the GOP has tweaked and amended the bill to flip votes from members of the conservative House Freedom Caucus, which made up the largest block of opposing votes from within the party.

On Wednesday, GOP leaders said they had done enough to secure the votes to pass the plan, so here we are.

Do Republicans actually have the votes?

The House majority leader, Kevin McCarthy of California, told reporters Wednesday night that Republicans do indeed have enough votes to pass the bill.

Yet suspense remains.

First, a reminder about the math. If all members vote, and all Democrats oppose the bill, Republicans can lose no more than 22 members to approve the repeal.

In recent days, roughly 20 Republicans have said they opposed the measure, but that number shrank slightly on Wednesday. How much it ultimately shrinks remains to be seen.

But numerous other members have been undecided about the bill, or their positions have been unknown. So the math is not as simple as counting up the number of Republicans who say they oppose the health care plan.

McCarthy said the full House vote would take place early Thursday afternoon, after what is surely to be an impassioned debate.

Is Thursday’s vote the end of Obamacare?

Not entirely.

In the past seven years since a Democratic Congress and the Obama administration pushed through the Affordable Care Act, the House has taken more than five dozen votes to repeal all or part of it.

But today’s vote is a first-stage effort, with the bill designed — at least originally — to address only those parts of the sprawling law that have budgetary implications. It is designed that way to try to make it easier for the legislation to be passed in the Senate under a “reconciliation” process that allows bills with budgetary impact to be passed by a simple majority, rather than a filibuster-proof 60-vote majority.

So then what is and what is not in the House bill?

In broad strokes, the legislation has a lot to do with money. For instance, it would substantially reduce the funding for subsidies that the existing law has provided to most people buying health insurances through insurance marketplaces, which the law created. The GOP plan also makes other changes to those subsidies in ways that will generally help younger adults and make premiums more expensive for older ones.

The bill also would eliminate several taxes that are in place to pay for the current law, including on health insurers.

It would not eliminate the requirement that most Americans carry health insurance. Instead, it would get rid of the penalty imposed for not having insurance and create a new deterrent for not having coverage: a 30 per cent surcharge that insurers could tack onto their rates.

Would this plan mean more people go without health insurance?

Yes.

According to an estimate of the original version of the bill by the Congressional Budget Office, 24 million more people would be uninsured by 2026.

The CBO has not updated that forecast since House Republicans have been tinkering with aspects of the legislation in an attempt to secure enough votes.

Will the bill’s changes prove enticing?

House leaders have made changes to their bill in an attempt to win passage.

One amendment, drafted by Republican Rep. Tom MacArthur would allow states to apply for waivers to opt out of certain insurance requirements of the health care law.

That won over the House Freedom Caucus. But it worried more moderate House members, who feared it would make insurance unaffordable for people with pre-existing medical conditions.

Another amendment, offered by Republican Rep. Fred Upton aimed to ease those concerns. It would provide $8 billion (U.S.) over five years to help states cover people with pre-existing conditions.

How much will those changes cost?

The CBO has not had time to review the changes Republicans have made to the bill, so it will not be providing a budget estimate before lawmakers vote on the measure Thursday. Before Republicans added $8 billion to the bill, the Committee for a Responsible Federal Budget said these alterations could save up to $5 billion or cost as much as $265 billion, since it’s unclear how many states will seek waivers to change the benefits packages or the ratings rules that insurers must comply with under current federal law.

According to a CBO estimate issued in late March, the House GOP plan would cut the federal deficit by $150 billion between 2017 and 2026.

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Is Medicaid going to be affected?

Absolutely.

The GOP health bill would cut $880 billion from the Medicaid program over the next decade, according to the most recent CBO estimate. This program provides health coverage for low-income Americans and helps pay for long-term care for people with disabilities and seniors.

Under the existing law, 11 million people have gained Medicaid coverage. For the next few years, the 31 states that have expanded their Medicaid programs under the law could keep going, but new people eligible under the expansion could not enrol.

Then, starting in 2020, the program would switch to a very different method of federal payments, breaking with its history of paying a certain proportion for everyone enrolled and moving to a system in which each state would being given a certain amount per person — a change that critics predict would starve the program as time goes by.

What about people with pre-existing conditions?

Under Barack Obama’s law, insurers are prohibited from denying coverage to individuals based on pre-existing medical conditions, such as cancer, depression or asthma. And the law requires insurers to offer “community rating,” meaning they cannot charge those with costly medical conditions more than they charge other consumers in the general insurance pool.

But the MacArthur amendment which will now be part of the Republican AHCA, allows states to obtain a waiver from the Health and Human Services Department that would let them charge customers with pre-existing conditions more than other people. If HHS did not respond to a state’s waiver request within 60 days, the requested change would automatically go into effect.

Health experts predict that the result would be a sharp rise in premium increases for those with medical problems. Before Obamacare became law, individuals with chronic diseases paid several times as much as others — if they could afford or be approved for a policy in the first place.

Concerned about the effect the MacArthur amendment would have on those with long-standing medical conditions, GOP Reps. Fred Upton and Billy Long crafted a provision Wednesday that provides $8 billion to help these patients pay for increased premiums and out-of-pocket costs.

What do Democrats think about all this?

Democrats are not pleased.

But they do not have the numbers to stop the bill. All they can do is air their grievances and hope enough Republicans heed their warnings and vote against it.

Expect to hear complaints from Democrats on two fronts: The substance of the bill and the process by which Republicans are passing it.

For one thing, the vote will occur without a new analysis from the Congressional Budget Office, the official scorekeeper on Capitol Hill.

Democratic Rep. Jim McGovern complained on Wednesday night about what he described as “fixes upon fixes to fix the fixes to fix the fixes.”

This process, McGovern said, is a mess. “I don’t know how anybody can defend it,” he added.

What comes next?

Even if the House passes the bill Thursday, the health care law will remain in place — at least for now.

The repeal bill would then head over to the Senate, where it is not likely to be met with great celebration.

Yes, Republican senators share their House colleagues’ desire to repeal major parts of the Obama-era health law.

But they might not agree on exactly which parts.

Already, Republicans in the Senate have aired a variety of concerns about the House plan, including how it would affect states that expanded Medicaid under the health law and whether it would raise premiums to unaffordable levels for older Americans.

In other words, expect to see plenty of changes to the House bill — and, in the long run, plenty more fits and starts.

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