The Senate has approved a bill to roll back the Affordable Care Act’s health care law’s subsidies and taxes on medical equipment, and to eliminate or reduce the tax on medical devices that are currently paid for by insurance companies.

The legislation, the Senate GOP health care bill, passed 50-49 in a procedural vote on Thursday.

The bill, the GOP bill, would replace Obamacare’s subsidies, taxes, and tax penalties with a flat tax, the most significant change since President Donald Trump signed the law into law in March.

The tax would be paid for through an excise tax on healthcare-related goods and services, a tax on the medical devices and devices that doctors use to diagnose and treat patients, and a tax that is paid by employers.

Senators have been debating the bill for weeks and the bill’s fate will depend on whether enough Democrats agree to support it, which is a daunting prospect.

The Congressional Budget Office has said that a Senate-passed version of the bill would increase premiums by $1,000 per person and by 20% for people making more than $100,000, but that it would offset the impact on health care spending by providing subsidies to lower-income people.

The CBO also estimates that the bill will lead to 23 million fewer Americans having insurance by 2026.

The House passed its own version of a version of Trump’s healthcare bill last week, but it was defeated in the Senate.

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