The House Budget Committee has voted 19-17 to send the American Health Care Act, which repeals and replaces the ACA, to the House Rules Committee.

The bill narrowly passed the committee, as some staunch conservatives voted against the proposed law.

Reps. Gary Palmer (R-Alabama), Dave Brat(R-VA), and Mark Sanford (R-SC) — all members of the ultra-conservative Freedom Caucus — have opposed the AHCA because they feel it doesn’t repeal Affordable Care Act adequately and the bill subsidizes healthcare costs for low income individuals via tax credits.

The House Budget Committee hearing differed from the markup hearings last week as committee cannot make substantive changes to a bill in reconciliation per House rules. No amendments were offered before AHCA was voted out of committee.

Still, House Budget Chairwoman Rep. Diane Black (R-Tenn.) said the legislation had her support.

“We made a promise to the American people to repeal this law and replace it with patient-centered health care reforms where Americans can have the health insurance they want and need at a price they can afford,” Black said. “This bill is a good first step.”

Committee Ranking Member. John Yarmuth (D-Ky.) slammed the bill, saying it would cause millions to lose coverage and harm access to care.

“This bill and future legislation and rulemaking will put insurance companies back in charge, allowing them to once again to decide who lives and who dies,” he said.

It’s expected that House Speaker Paul Ryan (R-Wis.) will seek to introduce amendments to the bill while in the rules committee to appease more conservative members of the House.

If all 40 members of the Freedom Caucasus and all Democrats vote against the bill, the AHCA will not pass the House.

The bill is also facing an uphill climb in the Senate, where many moderate Republicans have voiced concern that it would rescind Medicaid expansion. Four Republican senators from expansion states said earlier this month that they did not support a previous version of the House bill because it didn’t adequately protect people who’ve gained coverage through the expansion.