WASHINGTON -- Senate Republicans voted to advance to floor debate on their efforts to repeal and replace Obamacare.
Vice President Mike Pence cast the tiebreaking vote.
In a dramatic moment, Sen. John McCain returned from Arizona to applause from fellow senators. He cast a necessary Republican vote for the motion after two GOP senators -- Susan Collins and Lisa Murkowski -- sided with all Democrats in opposition.
As the vote began, protesters in the Senate gallery shouted "kill the bill" and "shame, shame, shame!"
The vote came as Senate Majority Leader Mitch McConnell and President Donald Trump dared their fellow Republicans to block their seven-year campaign promise to repeal and replace Obamacare.
The next step is floor debate on the legislation to overhaul the Affordable Care Act even though there aren't any guarantees the votes are there to eventually pass it -- and it's unclear what a final bill will look like.
The vote was up in the air until the last moments, when Several Republican holdouts announced their support, including Sens. Rand Paul, Dean Heller, Rob Portman and Shelley Moore Capito.
Trump, who has repeatedly said he's ready to sign any repeal legislation, celebrated the vote, which creates a path to give him the major congressional victory that's eluded the White House thus far.
"I'm very happy to announce that with zero of the Democrats' votes, the motion to proceed on health care has moved past and now we move forward toward truly great health care for the American people. We look forward to that. This was a big step," Trump said at a White House news conference.
"I want to thank Sen. John McCain," he added. "A very brave man. He made a tough trip to get here."
Democrats are united against the bill, saying it would end health care coverage for millions of Americans.
Sen. Bernie Sanders Monday called the bill the "cruelest, most destructive and irresponsible piece of legislation ever brought to the United States Senate in the modern history of this country."
In a speech at the NAACP national convention, highlighted the possible effects of the bill's provisions, which include cutting Medicaid, defunding Planned Parenthood and roadblocks for those with pre-existing conditions.
Paul, Heller back motion
McConnell won over key holdouts, but those senators haven't said they will back the final measure.
Paul, a Kentucky Republican, said he will support the procedural vote to open debate on the health care bill, so long as leadership guarantees a vote on a full repeal of Obamacare.
"If this is indeed the plan, I will vote to proceed and I will vote for any all measures that are clean repeal," Paul tweeted. Such an amendment would be expected to fail, however.
Heller, who has complained that Obamacare repeal efforts could hurt Nevada residents dependent on Medicaid, nevertheless said he'd vote to move forward. Heller is up for a tough re-election campaign in Nevada next year.
"Obamacare isn't the answer, but doing nothing to try to solve the problems it has created isn't the answer either," Heller said in a statement. "If the final product isn't improved for the state of Nevada, then I will not vote for it; if it is improved, I will support it."
Republican leaders Tuesday worked thread any needle they can to appease other holdouts.
"The only goal is to get onto the bill. Nothing happens until we do, so that's the only goal," a Republican aide said.
"These are the moments legislatively when you get creative. We're getting creative."
If it passes
Leadership was floating a strategy Tuesday morning that lays out a series of proposals that attempt to give everyone they want, even though nearly every element is destined for failure on the floor during the amendment process.
That strategy is as follows, in terms of amendment order:
The full repeal bill that Paul backs.
A bill including the "consumer freedom amendment" from that Sens. Ted Cruz and Mike Lee originally advocated for, that includes a request from Sen. Rob Portman for $100 billion in additional Medicaid funding. That would require 60 votes to pass.
The GOP bill proposed earlier this month that McConnell pulled when too many Republicans opposed it.
Finally, a "skinnier" repeal bill that repeals Obamacare's individual and employer mandates.
This story is breaking and has been updated.
Here is a breakdown of how each senator voted:
Republicans who supported: 50
Lamar Alexander, Tennessee
John Barrasso, Wyoming
Roy Blunt, Missouri
John Boozman, Arkansas
Richard Burr, North Carolina
Shelley Moore Capito, West Virginia
Bill Cassidy, Louisiana
Thad Cochran, Mississippi
Bob Corker, Tennessee
John Cornyn, Texas
Tom Cotton, Arkansas
Mike Crapo, Idaho
Ted Cruz, Texas
Steve Daines, Montana
Mike Enzi, Wyoming
Joni Ernst, Iowa
Deb Fischer, Nebraska
Jeff Flake, Arizona
Cory Gardner, Colorado
Lindsay Graham, South Carolina
Chuck Grassley, Iowa
Orrin Hatch, Utah
Dean Heller, Nevada
John Hoeven, North Dakota
Jim Inhofe, Oklahoma
Johnny Isakson, Georgia
Ron Johnson, Wisconsin
John Kennedy, Louisiana
James Lankford, Oklahoma
Mike Lee, Utah
John McCain, Arizona
Mitch McConnell, Kentucky
Jerry Moran, Kansas
Rand Paul, Kentucky
David Perdue, Georgia
Rob Portman, Ohio
Jim Risch, Idaho
Pat Roberts, Kansas
Mike Rounds, South Dakota
Marco Rubio, Florida
Ben Sasse, Nebraska
Tim Scott, South Carolina
Richard Shelby, Alabama
Luther Strange, Alabama
Dan Sullivan, Alaska
John Thune, South Dakota
Thom Tillis, North Carolina
Pat Toomey, Pennsylvania
Roger Wicker, Mississippi
Todd Young, Indiana
Republicans who opposed: 2
Susan Collins, Maine
Lisa Murkowski, Alaska
Tie-breaking vote: 1
Vice President Mike Pence
Democrats who supported: 0
Democrats who opposed: 48
Tammy Baldwin, Wisconsin
Michael Bennet, Colorado
Richard Blumenthal, Connecticut
Cory Booker, New Jersey
Sherrod Brown, Ohio
Maria Cantwell, Washington
Ben Cardin, Maryland
Tom Carper, Delaware
Bob Casey, Jr. Pennsylvania
Christopher Coons, Delaware
Catherine Cortez Masto, Nevada
Joe Donnelly, Indiana
Tammy Duckworth, Illinois
Richard Durbin, Illinois
Dianne Feinstein, California
Al Franken, Minnesota
Kirsten Gillibrand, New York
Kamala Harris, California
Maggie Hassan, New Hampshire
Martin Heinrich, New Mexico
Heidi Heitkamp, North Dakota
Mazie Hirono, Hawaii
Tim Kaine, Virginia
Angus King, Maine (Independent)
Amy Klobuchar, Minnesota
Patrick Leahy, Vermont
Joe Manchin, West Virginia
Ed Markey, Massachusetts
Claire McCaskill, Missouri
Robert Menendez, New Jersey
Jeff Merkley, Oregon
Chris Murphy, Connecticut
Patty Murray, Washington
Bill Nelson, Florida
Gary Peters, Michigan
Jack Reed, Rhode Island
Bernie Sanders, Vermont (Independent)
Brian Schatz, Hawaii
Chuck Schumer, New York
Jeanne Shaheen, New Hampshire
Debbie Stabenow, Michigan
Jon Tester, Montana
Tom Udall, New Mexico
Chris Van Hollen, Maryland
Mark Warner, Virginia
Elizabeth Warren, Massachusetts
Sheldon Whitehouse, Rhode Island
Ron Wyden, Oregon
