Republicans took a major step on Thursday in their effort to repeal and replace the Affordable Care Act. The House of Representatives passed a Republican Health Care Bill by a very slim margin. It passed 217 to 213 with no Democratic support and 20 Republicans voting no. Here in Northeast Ohio, one Republican voted for the measure and another against it.

Congressman Dave Joyce, a Republican representing Lake, Geauga and Ashtabula Counties, voted no. He was one of only two Republicans in the Buckeye State to do so.

In a tweet, he said, “The idea that premiums could potentially skyrocket for people with pre-existing conditions and increase three to five times for people nearing retirement is something I find unacceptable.”

Rep. Jim Renacci, over parts of Cuyahoga, Medina and Summit Counties, sees no problems when it comes to pre-existing conditions. The Republican voted for the bill.

“There’s nothing in the bill that stops pre-existing conditions from being covered,” he told us.

Under an amendment, the government will provide $8 billion over 5 years to help people with pre-existing conditions in states that waive coverage.

Renacci says his constituents tell him they don’t like the ACA, because premiums and deductibles are too high and this plan will help fix that.

“In the end it has provisions in it that will bring costs down. It allows states to request waivers if they would like, so that they can establish programs to bring costs down,” Renacci told us.

Renacci calls it “Repeal and Repair.”

MORE | See what other local and state lawmakers are saying about the House passing the bill to repeal and replace Obamacare

Joyce adding in his tweet, “We need to take the time necessary to hold hearings and work together on a step by step basis to develop a long term solution that works for everyone.”

This bill, as written, faces an uncertain future in the Senate where it heads next. Some members feel it’s too harsh and will leave millions without coverage.

This is just one step in the process. A final bill could look significantly different from the one we saw today.