The House passed a bill Tuesday that would place new sanctions on Russia, Iran and North Korea by a 419-3 vote. The Senate passed a similar bill in June, by a 98-2 margin.

Speaker Paul Ryan released a statement saying: "The bill we just passed with overwhelming bipartisan support is one of the most expansive sanctions packages in history. It tightens the screws on our most dangerous adversaries in order to keep Americans safe."

The House bill requires congressional review of any actions President Trump wishes to take to relieve the sanctions, and the administration has argued that would limit Trump's ability to deal with Russia. But the wide margins mean Trump will have to either sign the bill, or risk an override of his veto.

What's next: This version of the bill heads to the Senate for approval.

The Senate parliamentarian has ruled that more provisions of the Better Care Reconciliation Act — the Senate's Affordable Care Act replacement bill — don't comply with budget rules, meaning they'd need 60 votes to pass. These include a provision allowing insurers to charge older people more in premiums than under current law — the provision AARP has called an "age tax" — and the provision allowing small businesses to sell "association health plans," an important GOP priority.

However, the provision allowing states to choose to receive a Medicaid block grant, rather than a per-person funding cap, does comply with budget rules, meaning it only needs 50 votes like the rest of the bill. A provision broadening the ACA's state innovation waivers to include more of the law's regulations is still pending review.

Why it matters: The Senate bill was already struggling to win support among enough Republicans, and shedding more big pieces isn't going to help.

Senate Majority Leader Mitch McConnell told reporters he looks forward to finalizing the health care bill through an open amendment process by the end of the week. But "this is just the beginning. We're not out here to spike the football," he said.

Majority Whip John Cornyn nodded to Sen. John McCain's speech calling for bipartisan cooperation. Open debate "could well be the beginning of that healing process for this institution."

Meanwhile, Senate Democrats took to the capital steps with a bull horn.

• Sen. Chris Murphy: "There are 51 senators who need to hear from you."
• Sen. Jeff Merkley: "How about if we fill the streets outside every Republican office across America? That's the kind of action we need."
• Sen. Elizabeth Warren: "Make no mistake, we have lost an important battle today. But we have not yet lost this war."