WASHINGTON — The Senate on Thursday approved a $716 billion bill to overhaul the Affordable Care Act, a measure that will begin to phase out the law’s most popular benefits and set a new stage for negotiations on a new health care law.
The measure, which is expected to pass the Senate on Friday, is the most significant legislative achievement in a year in which Republicans have held on to control of the Senate by an unusually narrow margin.
With support for the bill falling to its lowest level since the end of the last government shutdown, President Donald Trump was still pressing his case for a deal that will lower costs for some but allow states to continue expanding Medicaid and give them the flexibility to make their own rules on health care coverage.
Senate Minority Leader Chuck Schumer of New York said he would be “happy to accept” the bill.
The bill would provide states with a $100 billion block grant that would help them expand Medicaid and provide subsidies to help them pay for their costs.
The money would be distributed evenly among states, with the federal government paying 80 percent.
Some states, including the District of Columbia and New York, have been unable to get enough federal funding.
In a statement, House Speaker Paul Ryan of Wisconsin said he hoped the bill would give states “the tools they need to grow and compete with the best in the world.”
He said the legislation would be bipartisan, would provide a level playing field for insurance companies and would help keep premiums affordable for the vast majority of Americans.
He said it would help stabilize health care for people with pre-existing conditions, cut costs for insurers and help states make health decisions without the influence of special interests.
The House also passed a bill that would keep the government open through Sept. 30 and avoid another government shutdown.
The legislation would allow states the ability to continue operating a health insurance exchange that would be run by the federal Centers for Medicare and Medicaid Services.
The Senate’s version, which would repeal most of the health law’s Medicaid expansion and make it harder for states to expand their Medicaid programs, passed by voice vote after a tense floor debate.
The Congressional Budget Office estimated the bill’s costs could be about $1.2 trillion.
Trump tweeted early Thursday that he was “on the side of working people, middle class families, seniors, and small businesses.”
Trump and his allies said the Senate bill would create “death panels,” give states the option to opt out of Medicaid expansion, increase premiums for older Americans and help people with preexisting conditions.
Republican leaders have argued that the Senate measure is more moderate and would lower costs and help millions of Americans obtain coverage.
The CBO said in a statement that it did not find evidence of significant impacts on coverage for any of the groups it examined.
Senate Democratic Leader Chuck Grassley of Iowa said in an interview with MSNBC that he had been trying to work with Trump to see how the bill could be passed.
He urged Democrats to be “more open to working with the Republicans” to get a bill through the Senate.
He called on Republicans to be more accommodating with Democrats to pass a bill they will likely be able to pass.
The Republican plan is similar to one proposed by Senate Minority Whip John Cornyn of Texas, who said he is working on a version that would preserve a portion of Obamacare but limit the number of Americans who can receive subsidies to pay for coverage.
Cornyn’s bill would allow individuals to buy insurance across state lines and the legislation includes an exception for people who are “under 65” who are receiving subsidies.
Cornys plan would also create a tax credit for people earning more than $250,000 and for people making more than that.
It would give insurers the option of covering people with incomes up to 400 percent of the poverty level, which has become a benchmark for many low-income Americans.