CHARLESTON, W.Va. — Seven years to the day after President Barack Obama signed into law the Affordable Care Act, the U.S. House of Representatives was scheduled to vote Thursday on a proposed replacement in the form of the American Health Care Act.

As of early Wednesday afternoon, though, the bill was not a guarantee for House passage and far from a lock in the waiting U.S. Senate.

Because there are five open seats in the U.S. House, passage currently requires 216 votes. No House Democrats have indicated they’ll vote for the American Health Care Act, which means approval hinges on fewer than 21 Republicans voting against the bill.

A Wednesday count from ABC News indicated 22 Republican U.S. House representatives remained uncommitted on the proposal, though that number was fluctuating frequently.

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3rd District Congressman Evan Jenkins (R-W.Va.)

Reportedly among the undecideds was 3rd District Congressman Evan Jenkins (R-W.Va.).

“He is continuing to study the bill to determine if it meets the needs of West Virginians,” was the response Wednesday from Jenkins’ press office about where he stood on the potential, long-promised Obamacare replacement.

There was no immediate comment from 1st District Congressman David McKinley (R-W.Va.).

Early Wednesday afternoon, 2nd District Congressman Alex Mooney (R-W.Va.) released the following statement: “I am still evaluating the legislation and reviewing amendments that are still being considered that could change the underlying bill. I am also listening to input from my constituents in the 2nd District.”

2nd District Congressman Alex Mooney (R-W.Va.)

The New York Times included both McKinley and Mooney on its “support” column for the AHCA, while Jenkins was on the separate “undecided or unclear” list.

The proposed American Health Care Act, introduced earlier this month, would end the ACA individual mandate for health insurance retroactive to Dec. 31, 2015 along with the tax penalties assessed annually for not having coverage.

Income-based subsidies currently available to people buying health insurance on ACA exchanges are to be replaced with tax credits determined by age and income.

The Medicaid expansion would end in 2020.

1st District Congressman David McKinley (R-W.Va.)

Changes made to the bill this week in an attempt to shore up more support have allowed for work requirements for some Medicaid recipients, those who are able to work and have no dependents.

The bill has also been adjusted to permit block grant Medicaid funding for states, as opposed to per capita allotments.

“Every member of Congress has constituents that have cancer, that have somebody in their family with cancer or who have survived cancer,” said Kirsten Sloan, senior vice president of policy for the American Cancer Society’s Cancer Action Network, an advocacy organization for people with cancer and cancer survivors.

For the members of Congress still weighing their votes, “You want to able to say to your constituents that the plan that you are supporting will protect them from huge out-of-pocket costs and will ensure that they can get the kind of treatment that they need to fight their disease,” Sloan said.

In her view, the proposed American Health Care Act will not do that.

Sloan called the AHCA is a “triple threat.”

“There will be higher premiums for middle age and older people, higher out-of-pocket costs for people who choose insurance and then no guarantee that the plan that you choose will cover the services that you need,” she told MetroNews.

A report from the Congressional Budget Office estimated the number of uninsured Americans would grow by 24 million Americans before 2026 under the proposal.

If approved in the U.S. House, the health reform bill would next go to the U.S. Senate where it’s said to be on shakier ground.

U.S. Senator Joe Manchin (D-W.Va.) has already indicated he will not support the bill in its current form.

U.S. Senator Shelley Moore Capito (R-W.Va.) has questioned the sizes and targets of the proposed tax credits in the bill, its effects on the Medicaid expansion in West Virginia and state flexibility allowed within it.

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