WASHINGTON — For a handful of moderates who pushed the Republican health care plan over the top in the House, the vote represented the start and not the end of the issue’s outcome.

Passed with only two votes to spare Thursday, the legislation now goes to the more centrist Senate, which has already vowed to send the measure back to the House with changes.

That reality gave Rep. John Faso, one of two undecided upstate New York Republicans until the last hours, the cover he needed to vote for the bill despite his concerns over its impact.

In an interview as he left the House floor, Faso said he remained uneasy about how changes in Medicaid funding could affect low-income children with medical problems.

“We’re going to get another crack” at the bill, he said.

With Republicans promising for years to repeal President Obama’s signature Affordable Care Act, and voters complaining about high premiums and deductibles, Faso said, “We couldn’t just do nothing.”

A freshman congressman from New York’s Hudson Valley and Catskills Mountain region, Faso had been considered a critical “yes” vote for Republicans.

The GOP American Health Care Act squeaked by on a 217-213 vote, with 20 Republicans and every House Democrats opposing it.

Rep. Elise Stefanik, who represents New York’s far northeast district, also said the House vote means the debate over a new national health care law will continue in the Senate and then back in the House.

Stefanik announced her “yes” vote earlier in the day, saying in a statement she had issues with the bill without being specific.

“The American Health Care Act is not perfect,” she said. “But it is an important step in reforming our broken health care system,” adding she plans to work with the Senate to ”strengthen the support for those with pre-existing conditions.”

Republican Rep. Luke Messer of Indiana applied an Indianapolis 500 analogy to explain his “yes” vote: “Today is a really big deal but it’s really a green flag (the start) not a checker flag (the finish).”

The bill’s impact on individuals with pre-existing medical conditions is a sticking point for Stefanik and other GOP moderates. It preserves Obamacare’s ban on denying coverage but allows insurance companies to charge them higher rates, depending on the seriousness of their condition.

Rep. Lou Barletta, R-Pa., who announced support for the bill last month, said an 11th hour change giving states an additional $8 billion over five years to lower premiums for the sick who could not afford higher premiums allowed some moderates to vote for it.

Still, he said, now that the issue moves to the Senate, “it’s going to be a struggle all the way to the finish line.”

Faso said New York law doesn’t allow insurance companies to charge more to people with medical conditions. He said conversations with House leaders convinced him people “in other states wouldn’t be harmed.”

Democrats contested that assertion. They introduced in the House record during the floor debate letters from the American Medical Association and other medical groups opposing the bill for its lack of sufficient funding to cover Medicaid recipients and patients with medical conditions.

Republican, Rep. Evan Jenkins, R-W.Va., acknowledged in a statement that “more work remains to be done to make this bill better.” He voted to send the GOP health care plan to the Senate “so that work can continue.”

Jenkins’ statement didn’t offer specifics, but in the past he has expressed concern over the loss of Medicaid funding for West Virginia and other states that rely heavily on government assistance for health care.

Republicans in moderate districts have been under public pressure to vote against the GOP plan, a sign House Democrats said Thursday will cost vulernable Republicans their seats in next year’s mid-term elections.

The Democrats, who stood unified against the measure, waved and sang “Na. Na. Hey. Hey. Goodbye” at their GOP colleagues once the bill passed.

Democrats mounted angry opposition prior to the House vote, assailing Republicans for rushing the showdown before the nonpartisan Congressional Budget Office could analyze the impact of the legislation.

In March, the budget office estimated the original Republican bill would end coverage for 24 million people over a decade, including 7 million next year. It also said the cost of insurance would be higher for lower-income and older individuals not yet eligible for Medicare.

“They don’t know how much this bill will cost,” said Rep. Lloyd Doggett, D-Tex. “They don’t know how many Americans will lose their health care. They don’t know what this bill will do.”

Doggett said Republicans were pressured into approving the bill by President Donald Trump. “The Pied Piper of Trump Tower is playing a tune today and they must dance,” he said.

A buoyant Trump hosted Republicans at a White House Rose Garden after the vote. “Make no mistake,” he said. “This is a repeal and replace of Obamacare. It’s essentially dead.”

If so, Democrats said millions would lose insurance from what Massachusetts Rep. Seth Moulton called a “ridiculous bill.”

“How could you do this? You are taking away health protections. What’s wrong with you guys,” said Rep. Jim McGovern, D-Mass,

But for Republicans, it was a day of triumph against Obamacare and the government mandates aimed at providing health care to every American.

“Mandates seldom work. Markets work,” sad Rep. Joe Barton, R-Tex., who said he voted “yes (for) personal freedom.”

Contact CNHI Washington reporter Kery Murakami at kmurakami@cnhi.com.

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