The dismantling of Obamacare has officially begun

Republicans moved a step closer to dismantling the Affordable Care Act, or Obamacare, after the House of Representatives voted to repeal the law without a replacement one day after the Senate did the same.

Acting under pressure from President-elect Donald Trump and Speaker of the House Paul Ryan, the House on Friday passed a budget resolution to defund the healthcare legislation by a near-party vote of 227 Republicans to 198 Democrats. On Thursday, the Senate voted to do the same by a razor-thin margin of 51 to 48 votes.

But if you’re one of the approximately 20 millions of Americans who rely on the Affordable Care Act, you haven’t quite lost your health insurance — yet. The House and Senate votes are the beginning of a long process of dismantling the law and sets the stage for lawmakers to draft full repeal legislation by Jan. 27.

Trump and the Republican leadership have promised to replace Obamacare with something “better” but have yet to give any details of just what that alternative will look like. Details of when the repeal will go into effect, who it will impact, and how much of the law will actually be scrapped are all still unknown.

“This is a critical first step toward delivering relief to Americans struggling under this law,” Speaker Ryan said on the House floor. He added that there would a replacement drafted “in the next couple of weeks” and ensured there would be “a stable transition period” but did not go into specifics. Ryan said at a press conference Thursday, “We’re not holding hard deadlines, only because we want to get it right.”

Republicans’ decision to rush toward repealing the law without having any firm idea of what comes next has caused an outpouring of criticism from Democrats and even some concerns from fellow Republicans.

“I don’t want to vote for this and say it’s the first step (toward repeal), and find out that there are some long-term budget consequences,” said Republican Rep. Mark Amodei, according to Reuters. Some conservative Republicans were still undecided as of Thursday.

“I still have reservations, I’ll put it that way,” Republican Rep. Charlie Dent told the Washington Post.

Republicans have been trying to repeal President Obama’s signature healthcare law basically since it was passed in 2010. They justify their obsession by arguing that repealing the law will give states more control over healthcare and eventually cost the government, and taxpayers, less.

But that’s not exactly supported by numbers. According to an estimate by the nonpartisan Committee for a Responsible Federal Budget, repealing the Affordable Care Act will likely cost the government $350 billion.

To rush the repeal through, Speaker Ryan used an arcane process called “reconciliation,” which allows lawmakers to bypass the regular legislative process on certain issues having to do with spending and taxes. This is exactly what House Republicans attempted to do last year when they tried to repeal Obamacare, before President Obama stepped in to block it.

Although it’s not quite clear what the immediate effect will be, repealing Obamacare could throw the government-regulated insurance markets into chaos and bring uncertainty to the more than than 20 million people who rely on it. It will also have a disproportionately negative effect on women and make access to reproductive healthcare even harder and more expensive. Obamacare prevents insurance companies from charging women more or denying pregnant women coverage altogether by considering pregnancy a pre-existing condition.

Democratic Sen. Kirsten Gillibrand made an impassioned defense of keeping Obamacare for those reasons on the Senate floor Thursday.

“Imagine becoming pregnant and having your insurer drop coverage because you are no longer economic or you cost too much money. Imagine being a cancer survivor and then having your coverage dropped because you survived cancer, and you cost too much money,” Gillibrand said.

Republicans also want to defund Planned Parenthood as part of the Obamacare repeal, on the basis that the healthcare organization also provides abortions. But there is already a law on the books that prevents federal funds from paying for abortions, known as the Hyde Amendment.

Planned Parenthood uses federal dollars only to pay for routine health services, like cancer screenings, STI/HIV testings, and patient counseling. In other words, defunding Planned Parenthood would simply mean taking money away from providing low-cost pap smears, not abortions.

On Friday, Trump expressed his excitement about the House vote by tweeting “The “Unaffordable” Care Act will soon be history!”

Follow Olivia Becker on Twitter: @oliviaLbecker