The House Budget Committee voted narrowly Thursday to advance the troubled Republican health care bill, with defections by three GOP conservatives underscoring the obstacles party leaders face in maneuvering to avoid a stinging setback to their showpiece legislation.

The vote was 19-17, with Democrats unanimously voting no. Had one more Republican joined them, the measure would have failed in what would have been a damaging, embarrassing — but not fatal — blow to the measure. The legislation has the backing of President Donald Trump, who one lawmaker said called Republicans on the panel to press them to push the bill forward.

The committee was debating a slew of non-binding proposals suggesting changes in the measure, with some expected from Republicans. Those may provide clues about the types of changes GOP leaders believe the legislation will need for it to win House approval, which top Republicans hope will occur next week.

The White House and Republican leaders are already talking to rank-and-file Republicans about revising the bill to nail down support.

Before the vote, panel Chairwoman Diane Black, R-Tenn., appealed to fellow Republicans to back the legislation, calling it “the conservative health care vision we’ve been talking about for years.” The measure would strike down much of former President Barack Obama’s 2010 overhaul and reduce the federal role, including financing, for health care consumers.

“Don’t cut off discussion. Stay with this effort,” she said, calling the measure “a good first step.”

Three members of the hard-line conservative House Freedom Caucus — Reps. Dave Brat of Virginia, Gary Palmer of Alabama and Mark Sanford of South Carolina — opposed the measure.

Democrats said the legislation would strip coverage from millions who gained it under Obama’s 2010 overhaul and bestow a massive gift on the wealthy by repealing many of that law’s tax increases.

“This is Robin Hood in reverse, but far worse,” said the panel’s top Democrat, Rep. John Yarmuth of Kentucky. Citing lawmakers’ town hall meetings that have been jammed with activists opposing the GOP bill, he said, “This bill is not what the American people want.”

Republicans easily swatted down Democratic proposals to allow amendments in the full House that they hoped would embarrass Republicans, such as deleting provisions that would reduce coverage or cut Medicaid.

The committee vote came four days after the nonpartisan Congressional Budget Office projected the legislation would boot 24 million people from health coverage. That includes 14 million who’d lost it next year — a scary scenario for lawmakers facing re-election next year, and overt GOP opposition has grown since that report was released.

The bill would eliminate the tax penalty that pressures people to buy coverage and the federal subsidies that let millions afford it, replacing them with tax credits that are bigger for older people. It would cut Medicaid, repeal the law’s tax increases on higher earning Americans and require 30 percent higher premiums for consumers who let coverage lapse.

House Speaker Paul Ryan, R-Wis., reiterated Thursday that negotiations are ongoing to produce a bill that can actually pass the House. He insisted that Trump was closely involved in that process, disputing reports of “palace intrigue” or any “schism” between himself and the president.

“I am excited about the fact that we have a president who likes closing deals,” Ryan said.

At a late rally in Nashville Wednesday, Trump said: “We’re going to arbitrate, we’re all going to get together, we’re going to get something done.”

But insurgents still abound.

Conservatives want to end Obama’s expansion of Medicaid to 11 million additional low-income people next year, not 2020 as the bill proposes. They say a GOP proposed tax credit to help people pay medical costs is too generous, and they want to terminate all of Obama’s insurance requirements, including mandatory coverage of specified services like drug counseling.

Rep. Mark Meadows, R-N.C., head of the hard-line conservative House Freedom Caucus, continued pushing for changes. He claimed at least 21 members of his group would oppose the measure as written; the bill would fail if 22 Republicans join all Democrats in opposing it.

But underscoring the push-pull problem GOP leaders face in winning votes, moderates feel the tax credits are too stingy, especially for low earners and older people. They oppose accelerating the phase-out of the Medicaid expansion and are unhappy with long-term cuts the measure would inflict on the entire program.

(AP)