The U.S. House of Representatives approved a bill on Thursday to repeal major parts of Obamacare and replace it with a Republican healthcare plan, handing President Donald Trump his biggest legislative victory but setting up a tough fight in the Senate.

With the 217-213 vote, Republicans obtained just enough support to push the legislation through the House, sending it to the Senate for consideration. No Democrats voted for the bill.

The effort now faces new hurdles in the Senate, where the Republicans have only a 52-seat majority in the 100-seat chamber and where just a few Republican defections could sink the bill.

The Republican bill passed on Thursday would allow states to opt out of those provisions. While insurers could not deny people insurance because of pre-existing conditions, they would be allowed to charge them as much as they want.

Democrats blasted the bill, saying it would make insurance unaffordable for those who need it most and would leave millions more uninsured.

Trump made overturning Obamacare a cornerstone of his 2016 campaign and has been frustrated as two efforts to push a bill through the House failed in the last two months, a reflection of the difficulty of reconciling Republican factions.

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