A medical malpractice bill that limits attorney fees and some patient damage fees in civil lawsuits was passed by the House on Wednesday by a narrow margin of 218 to 210, with numerous Republicans voting against the measure.

The biggest point of contention was over a provision that places a cap of $250,000 on noneconomic damages awards to victims, which includes for pain and suffering. Nineteen Republicans voted against the bill, many of them citing this as a key reason, saying it would trample on states’ rights because it would take away their ability to establish their own laws on the matter.

At least two dozen states do not cap noneconomic damages, and several state supreme courts — including Washington and Florida — have determined they are unconstitutional.

“This represents a massive expansion of federal authority,” said Rep. John J. Duncan Jr. (R-Tenn.), who voted against the bill.

“It’s a power grab by Washington,” said Rep. Steve Cohen (D-Tenn.), who also voted against the measure.

The opposition from Republican members is a break from the past, when conservative lawmakers have consistently united in their support of similar measures. Several conservative groups, such as Frontiers of Freedom and the Institute for Liberty, also opposed the bill. And former U.S. attorney general Edwin “Ed” Meese, a Republican, announced his opposition Tuesday, calling the bill “constitutional malpractice.”

In a letter sent to House Speaker Paul D. Ryan (R-Wis.), Meese said the bill was a “sweeping effort to federalize tort law with our system of federalism, which reserves that province solely to the states.”

The $250,000 cap for “noneconomic damages” is separate from damages plaintiffs receive based on future economic losses. Noneconomic damages are meant to compensate victims for pain and suffering, as well as permanent disfigurement or other serious disabilities that may not interfere with their ability to work.

The caps would apply broadly to all manner of medical malpractice, including errors in surgery, side effects from unsafe drugs, abuse and neglect in nursing homes, and sexual assault by doctors.

The issue will probably decrease the odds of the Senate taking up the measure, opponents and proponents of the measure said. The Senate has routinely declined to vote on previous tort measures passed by the House, but with Republicans in control of both chambers, some are more optimistic about this bill’s chances.

Democrats did not break from tradition. They have consistently opposed tort legislation. Republicans have accused them of being swayed by large campaign donations they get from trial lawyers. Democrats have said, and continued to say Wednesday, that they are against such measures because people who have been harmed would be unable to seek justice.

Rep. Hakeem Jeffries (D-N.Y.) called the bill “cruel” and “heartless” as he made this argument against the measure.

A Washington Post article earlier this month examined the case of a Pennsylvania man, Steven Hanes, who underwent surgery in 2013 to have a testicle removed that was causing him pain. After a doctor removed the wrong testicle, he filed a medical malpractice suit and was awarded $630,000 in noneconomic damages — more than twice the amount that the new bill would allow.

The limits on lawyer fees was not debated Wednesday. That provision would limit fees based on a sliding scale, in some cases cutting by half the amount a lawyer would receive from malpractice awards. On average, lawyers receive between 30 and 40 percent of the award, according to several medical and legal groups who follow tort policy.

In a statement released just after the vote, the American Association of Neurological Surgeons — a major proponent of the bill — said it “applauded” the bill’s passage, calling it “common sense, proven, comprehensive medical liability reform that will help contain health care costs.”

The Center for Justice & Democracy — a major opponent of the bill — said it “strongly condemned” its passage.

Joanne Doroshow, the center’s executive director, called it a “harsh and mean-spirited bill that will harm the most vulnerable and severely injured Americans. This includes brain-damaged children, quadriplegic workers, and seniors in nursing homes.”