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Passed by a razor thin margin, the bitterly divided Senate voted to officially bring plans to repeal and replace "Obamacare" up for a debate, setting the stage for a dramatic tussle over the future of health care in America and the signature law passed by Democrats in 2010.
The final tally was 51-50, with Vice President Mike Pence breaking the tie after two Republicans joined all 48 Democrats in voting "no."
Among the Republicans to cast votes in favor was Sen. John McCain, who returned to the Capitol for the first time after being diagnosed with brain cancer.
Greeted by cheers, the 80-year-old Arizona senator smiled and dispensed hugs - but with the scars from recent surgery starkly visible on the left side of his face.
Despite voting "yes," he took a lecturing tone afterward and hardly saw success assured for the legislation.
"I voted for the motion to proceed to allow debate to continue and amendments to be offered," McCain asserted. "I will not vote for the bill as it is today. It's a shell of a bill right now. We all know that."
Long known as a maverick, McCain spared no punches as he took aim at Republicans whom he said are "getting nothing done."
At the White House, though, Trump wasted no time in declaring a win and slamming the Democrats anew.
"I'm very happy to announce that, with zero of the Democrats' votes, the motion to proceed on health care has just passed. And now we move forward toward truly great health care for the American people," Trump said. "This was a big step. I want to thank Senator John McCain - very brave man."
Trump continued to celebrate the vote at a rally in Youngstown, Ohio, that doubled as a victory lap.
"We're now one step closer to liberating our citizens from this Obamacare nightmare and delivering great health care for the American people," he said.
At its most basic, the Republican legislation is aimed at undoing Obamacare's unpopular mandates, including the requirement that all Americans purchase an insurance policy. According to the IRS, as many as 8 million people chose to pay a tax of at least $695 instead of having health insurance.
Proponents of a repeal also want to erase Obamacare taxes and unwind an expansion of the Medicaid program for the poor, the disabled and nursing home residents. A report by the nonpartisan Congressional Budget Office predicted the result would be 20 million to 30 million people losing insurance over a decade, depending on the version of the bill.
North Carolina senators Richard Burr and Thom Tillis, both Republicans, voted in favor of the procedural move on health care.
"I am glad the Senate has finally begun to build a solution to the health care crisis facing our nation," Senator Burr said in a statement sent to ABC11. "This debate will allow each and every Senator the opportunity to bring forward their ideas for consideration through an unlimited amendment process. It is my hope that at the end of this process we will pass legislation fulfilling our promise to the American people: repealing and replacing Obamacare."
Tillis, the junior senator, echoed a similar sentiment.
"Over the last several years, Obamacare has hit hard-working North Carolina families with skyrocketing premiums and fewer choices, while small businesses have struggled to comply with the law's costly and burdensome regulations. The status quo of Obamacare is unsustainable, and today?s procedural vote sets the stage for an open amendment process where all Senators - Republicans and Democrats alike - will be able to put forward their ideas to reform our nation?s health care system."
The procedural vote offered no clear indication of what lawmakers would ultimately be voting on, and in a sign of the uncertainty ahead, Majority Leader Mitch McConnell (R-Kentucky) said the Senate will "let the voting take us where it will." The expectation is that McConnell will bring up a series of amendments, including a straight-up repeal and fuller replacement legislation, to see where consensus may lie.
"The people who sent us here expect us to begin this debate, to have the courage to tackle the tough issues," McConnell said ahead of the vote.
The vote drew protesters to the Senate visitors' gallery who chanted "Kill the bill, don't kill us." Capitol Police said 31 of them were charged with disrupting Congress, and 64 others were charged with illegally demonstrating in a nearby Senate office building.
Many North Carolina Democrats also assailed Tuesday's vote, which drew condemnation from colleagues across the Capitol.
"Today's vote was not about America's health care, but about scoring a political win for the Trump Administration," Rep. G.K. Butterfield (D-North Carolina) lamented in a statement sent to ABC11. "It is a total disappointment that, rather than put politics aside and work in a bipartisan fashion to bring down costs and ensure more Americans have access to care, Republicans eagerly continue to push a plan that will weaken our economy, leave working Americans with higher medical costs, and jeopardize care for up to half a million North Carolinians who gained coverage since the Affordable Care Act was implemented. Each vote cast today to put Trumpcare on the Floor is a vote to jeopardize the health care of millions of families."
Rep. David Price (D-North Carolina) offered his take in a tweet: "I strongly oppose any proposal to repeal the critical protections of the ACA. We must instead work together to strengthen the law."