Paul Ryan got what he wanted from the House Budget Committee — but also got a warning shot across the bow as well. The American Health Care Act (AHCA) passed on a narrow vote, but not before Republican conservatives offered some resistance to it:

The final vote may have been a managed outcome. Kasie Hunt explains that they expected more debate today in the committee and had counted four Republicans on the panel as against the AHCA or leaning toward a no. Four Republican defections would have resulted in a tie, but a plea from the chair may have made the difference:

The Budget Committee vote was 19 to 17, with three conservative Republicans – Representatives David Brat, Gary Palmer and Mark Sanford – joining the panel’s Democrats in voting against it. The committee brought together provisions approved last week by two other panels into a single bill, helping pave the way for a later vote on the House floor.

Before the vote, Republican Representative Diane Black, who heads the committee, called the legislation “the conservative healthcare vision that we have been talking about for years.” To Republicans who are wavering, she said, “don’t cut off the discussion” by voting no. “Stay in this effort,” she said.

That may also be a sign of trouble ahead, too. Ryan needs 218 votes to pass the bill when it comes to the floor, and he has 237 Republicans in the House. He won’t get any Democrats to cross over, so Ryan can only afford to lose 19 Republicans (or possibly 21 to get to 216, as Democrats have five vacancies at the moment). The Washington Post’s Amber Phillips counted 14 definite nays yesterday among House Republicans, and another 23 publicly speaking of “serious concerns” with the AHCA legislation as it stands at the moment. House leadership has been assuring everyone that their colleagues are merely trying to influence the final version of the bill, and that amendments will come when the bill hits the floor, and that they expect most of these potential dissidents to vote for passage.

Next up for Ryan and the AHCA will be the Rules Committee, where some decisions will be made on amendments. The White House expects a manager’s amendment that will incorporate some of their horse-trading over the past two weeks, and the changes may be enough to send the bill off to the Senate. Some Senate Republicans are dreading this, as it means that they will have to take responsibility for either killing off an ObamaCare repeal plan or passing an alternative that will require a conference committee to resolve. The latter option has fallen out of favor over the last few years, but this may be the only way to get a bill to the White House in the end. Mitch McConnell will have his work cut out for him with only a two-vote margin before he has to get Vice President Mike Pence involved. He’s a master of managed votes, however, and the White House will be making a full-court press for cooperation.