More than a month after Republicans decided to not vote on a budget resolution that would gut the Affordable Care Act, a revised version of that resolution finally came to the House floor for a vote this afternoon amid concerns that there is no estimate yet on what these changes will cost and how they will affect millions of Americans with pre-existing conditions.

The House passed the bill by a vote of 217 to 213, with only 20 Republicans breaking rank to come out against the American Health Care Act. No Democrats supported the AHCA, which now goes on to the Senate. Because it is a budget resolution — as opposed to a traditional piece of legislation — it will only need a simple majority in that chamber, as opposed to the usual 60 votes.

Among the key points of what’s in the AHCA:

• Nullifies the individual mandate — the requirement that most people have some sort of health insurance.

• Nullifies the employer mandate — the requirement that larger employers provide qualifying coverage to full-time workers.

• Allows individual states to opt out of certain requirements of the Affordable Care Act — like restrictions on charging individuals more for insurance if they have pre-existing conditions, or mandates that insurance providers in that state must cover the ten “essential” health benefits as defined by the ACA.

• Make over-the-counter medications eligible for purchase through tax-advantaged savings plans like flexible spending accounts and health savings accounts.

• Remove the limits on annual contributions to flexible spending accounts.

• Provide a refundable tax credit — based on age and income — of between $2,000 to $4,000 to individuals (capped at a total of $14,000 per family) who do not have access to government health insurance programs or an offer from any employer; are a citizen, national or qualified alien of the United States (and are not incarcerated) who purchase qualifying insurance on their own. Currently, veterans who are eligible for benefits through the Department of Veteran Affairs would not be eligible for these tax credits, even if they don’t want or have VA benefits.

• Increase the limit on Health Savings Accounts so that they are equal to the sum of the annual deductible and out-of-pocket expenses permitted under a high deductible health plan.

• Repeals the 10% tax on indoor tanning services.

• Allows Medicaid expansion to continue to enroll people until January 2020, at which point there will be a “freeze.”

The latest version of the AHCA — only made public late last night — has not yet been scored by the nonpartisan Congressional Budget Office, which is generally required to chime in on budget resolutions before they are passed. Previous CBO scoring of this resolution estimated that it would lead to 52 million additional Americans going without health insurance by 2026, while only cutting about $150 billion from the federal deficit.

Critics of the resolution expect that the amendments allowing for states to opt out of ACA requirements will likely increase the predicted number of uninsured and decrease the estimated deficit reduction.

While neither the resolution nor its amendments went through the traditional committee process, allowing for hearings and debates, Democrats were given a brief opportunity to once again voice their concerns about the AHCA, repeatedly attempting to drive home the fact that Americans with pre-existing conditions may be priced out of coverage if states opt out of requirements that currently limit insurers’ ability to charge higher rates to people with costlier medical issues, or who have had lapses in their coverage.