<P> The night before the rescheduled vote, President Trump, in a final effort to negotiate with those opposing the bill, announced to the House Republicans that the vote the following day would be their only chance to repeal the Affordable Care Act, a goal long sought after by Republicans in Congress . The following morning the bill was brought to the House floor after being approved by the House Rules Committee for four hours of debate preceding the vote, which was expected in the afternoon . It was reported that a couple hours before the expected vote, Ryan made a sudden visit to the White House to meet with Trump, in which Ryan told Trump that the bill did not have enough votes to pass in the House . Shortly after the time of the expected vote it was announced that the Republicans were withdrawing the AHCA from consideration, a decision made after Ryan met with Trump . Following the withdrawal, Ryan stated in a press conference that the country is "going to be living with Obamacare for the foreseeable future", while Trump said that it was tough to pass the bill without support from Democrats; Ryan and Trump both said they were going to move forward on other policy issues . </P> <P> Through the various iterations of bill it has been nicknamed variously as Trumpcare, Ryancare, Republicare, and pejoratively as Obamacare - Lite, and Wealthcare . </P> <P> In April 2017, House Republicans tried to reconcile their divisions with the proposed MacArthur Amendment . The MacArthur Amendment, developed by Representative Tom MacArthur of the Tuesday Group (representing more moderate Republicans) and Representative Mark Meadows of the House Freedom Caucus (representing the hard - line right). The language of the proposed amendment became available on April 25, 2017 . The amendment allows insurers to charge enrollees in their 50s and early 60s more than younger enrollees . It also allows states to waive essential health benefits and certain sections of the community rating program . As revised by the MacArthur Amendment, the ACHA weakens protections for patients with preexisting conditions; under this version of the bill, insurers would be able to charge people significantly more if they had a pre-existing condition . </P> <P> On May 3, House Republicans announced that they had enough votes to pass the bill, after amending it to include an additional $8 billion over five years to subsidize insurance for people with pre-existing conditions . On May 4, 2017, the House of Representatives voted in favor of repealing the Patient Protection and Affordable Care Act and passing the American Health Care Act with a narrow vote of 217 to 213 . 217 Republican Congressmen voted for the bill, while all 193 Democrats and 20 Republicans voted against it . Most of the Republicans who voted against the bill are members of the centrist Tuesday Group, and only one member of the Freedom Caucus voted against the bill . </P>

When did the affordable care act go into affect