Republicans have pushed the GOP health care overhaul past an initial procedural hurdle in the House. That moves the chamber toward a climactic final vote that's a big gamble for President Donald Trump and congressional leaders.

Friday's procedural vote was 230-194.

The early vote inserted changes into the measure that leaders hoped would win over unhappy Republicans. It would improve Medicaid benefits for some older and handicapped people and abolish coverage requirements President Barack Obama's 2010 law imposes on insurers.

It remained uncertain whether GOP leaders had enough votes to prevail on final passage.

Conservatives complain the Republican bill doesn't do enough to erase Obama's law. GOP moderates are unhappy that it would cause millions of voters to lose coverage and boost medical costs for others.

Democrats were solidly opposed.