WASHINGTON (AP) – The Senate has voted to move ahead on health care legislation aimed at dismantling the Obama health law.

The vote was 51-50 on Tuesday, a victory for Majority Leader Mitch McConnell and President Donald Trump. Last week, McConnell was forced to postpone the vote, lacking the support of conservatives and moderates.

In a dramatic turn, Sen. John McCain returned from Arizona where he is battling brain cancer to cast a crucial vote on proceeding on health care.

The vote sets up days of debate and votes on repealing and replacing Barack Obama’s health care law. Whatever the Senate approves still requires a vote in the House.

A short time later, President Donald Trump praised the Senate for moving forward on health care repeal. He says a vote Tuesday to take up the Republican health care bill “was a big step.”

Trump adds that he wants “to congratulate the American people” because better health care is on the way.

Shouting “Kill the bill” and “shame,” the demonstrators stood in the visitors’ gallery and chanted. They were led out of the chamber by police but could still be heard.

The Senate chamber was packed, with lawmakers standing to cast their votes.

Join The Conversation On The KDKA Facebook Page

 Stay Up To Date, Follow KDKA On Twitter</s>Senate Republicans are set to vote Tuesday on whether to start debate on overhauling health care. Exactly what they would be debating, though, remains unclear. The Better Care Reconciliation Act, which would repeal and replace the Affordable Care Act? Or the Obamacare Repeal Reconciliation Act, which would effectively repeal the ACA, but not replace it?

Here & Now's Meghna Chakrabarti talks with Julie Rovner (@jrovner), senior correspondent for Kaiser Health News, about the politics and policy of the vote.</s>The Senate is expected to hold a key vote Tuesday in the GOP's attempt to repeal Obamacare.

The procedural motion would begin debate on a Republican health care bill to replace the Affordable Care Act.

Last week, the President pressed Republican senators to agree to an alternative to the Affordable Care Act before taking an August recess. Sen. John McCain, who was recently diagnosed with an aggressive type of brain cancer, announced he would return to Washington for the vote.

You can watch the news conference live in the player above.</s>WASHINGTON (AP) — The Latest on the effort by congressional Republicans to pass a health care bill (all times local):

The Senate has voted to move ahead on health care legislation aimed at dismantling the Obama health law.

The vote was 51-50 on Tuesday, a victory for Majority Leader Mitch McConnell and President Donald Trump. Last week, McConnell was forced to postpone the vote, lacking the support of conservatives and moderates.

In a dramatic turn, Sen. John McCain returned from Arizona where he is battling brain cancer to cast a crucial vote on proceeding on health care.

The vote sets up days of debate and votes on repealing and replacing Barack Obama’s health care law. Whatever the Senate approves still requires a vote in the House.

Protesters temporarily disrupted the Senate proceedings on the health care bill.

Shouting “Kill the bill” and “shame,” the demonstrators stood in the visitors’ gallery and chanted. They were led out of the chamber by police but could still be heard.

The vote got underway on moving head on health care with the goal of erasing much of Barack Obama’s law. The Senate chamber was packed, with lawmakers standing to cast their votes.

Senate Majority Leader Mitch McConnell is urging his colleagues to move ahead on health care legislation with the goal of erasing much of the Obama health law.

McConnell told senators seated in the Senate chamber: “We cannot let this moment slip by.” He made the remarks ahead of a make-or-break vote to take up the bill. The Kentucky Republican said many GOP senators waited for years for the opportunity to scuttle the 2010 law.

Democratic leader Chuck Schumer urged lawmakers to reject it, saying, “Turn back now before it’s too late.”

A vote to move ahead would set up days of debate and votes. Republicans have promised for seven years to repeal and replace the law.

As McConnell set up the vote, protests erupted, chanting, “Kill the bill.”

West Virginia Sen. Shelley Moore Capito has become the latest wavering Republican to say they will back beginning debate on legislation rolling back much of President Barack Obama’s health care law.

Capito has been among several moderate Republicans concerned about the GOP bill’s cuts in the Medicaid health care program for the poor, disabled and nursing home residents. She’s also pushed for added funding for programs that help combat the abuse of drugs including opioids.

West Virginia is one of the nation’s poorest states and has an unusually serious drug abuse problem.

Capito says as the Senate debates the bill, she’ll push for policies “that result in affordable health care coverage for West Virginians.”

A Senate Republican who hadn’t declared how he’d vote on repealing much of the Obama health care law says he’ll vote Tuesday to begin debate.

Nevada Sen. Dean Heller’s statement was crucial because GOP leaders can only lose two of the 52 Republican senators and keep the bill alive. Around a dozen declared opposition or lambasted the legislation, but many seemed to be falling into line.

Heller faces perhaps the toughest re-election race next year of any Senate Republican. He and his state’s popular Republican governor, Brian Sandoval, have opposed the GOP bill because of its Medicaid cuts.

Heller said in a statement that doing nothing to solve problems with President Barack Obama’s law wasn’t tenable. He said he’d oppose the final bill if it’s not improved for Nevada.

Sen. Rand Paul says he will vote “yes” on a pivotal health care vote Tuesday afternoon after receiving assurances from Majority Leader Mitch McConnell.

Paul had been a holdout against McConnell’s plans for legislation to repeal and replace “Obamacare.” He argued it did not go far enough in getting rid of the Obama law.

But Paul says McConnell has informed him the Senate will take up a straight-forward repeal bill as he has been urging. And if that’s the case he will vote “yes” to open debate on the legislation.

Tuesday’s vote is make-or-break because if the Senate does not vote to open debate the bill will die.

But if debate starts there will be numerous amendments — and repeal-only is not likely to be the final product.

Republicans are showing signs of optimism that they’ll be able to take up the health care bill. Senators and aides said talks were continuing that might win over enough Republicans to start debate Tuesday.

The discussions involved holding an early vote on a plan scuttling much of the Obama health law and giving Congress two years to enact a replacement. That plan, embraced by conservative Sen. Rand Paul, R-Ky., seems likely to lose. But Paul has said that he will vote to bring up the GOP health bill if he is guaranteed that early vote.

Moderates are seeking additional money for states that would be hurt by cuts in Medicaid, the health insurance program for the poor, the disabled and nursing home patients. Conservatives want a vote on a proposal by Ted Cruz, R-Texas, letting insurers offer bare-bones policies with low premiums, which would be illegal under Obama’s law.

President Donald Trump says “we will soon see whether or not Republicans are willing to step up to the plate!” on health care.

Trump has been pressuring Senate Republicans to vote on a health care bill “after 7 years of talking.” A procedural vote is planned for Tuesday.

Trump says on Twitter Tuesday morning that Obamacare is “torturing” Americans. He says “I have pen in hand” to sign a bill and is urging a vote either to repeal, or to repeal and replace the Obama law.

Trump says it’s “so great” that ailing Republican Arizona Sen. John McCain is returning to Washington to vote for the first time since being diagnosed with brain cancer.

Trump’s describes McCain’s move as “brave” and the senator as an “American hero.” During the 2016 campaign, Trump questioned McCain’s status as a war hero, saying, “He was a war hero because he was captured. I like people who weren’t captured.”

Republican leaders are steering the Senate toward a crucial vote on their health care bill with a fresh burst of drama and optimism, thanks to Sen. John McCain’s declaration that he’ll return to the Capitol for the roll call.

Before the announcement by the cancer-stricken McCain, Senate Majority Leader Mitch McConnell had already planned an initial vote for Tuesday on simply beginning debate on the Republican effort. A victory seemed unlikely because of opposition and criticism from GOP senators toward McConnell’s bill, which would erase much of President Barack Obama’s law.

McCain’s office announced his decision to return late Monday, improving McConnell’s odds. In fact, McCain’s announcement suggested Republican leaders had a good chance of prevailing since it seemed unlikely they’d bring him back if the measure was doomed.</s>Under pressure from President Donald Trump, and a looming August recess, Senate Majority Leader Mitch McConnell is moving forward with a vote that would open up debate on the GOP’s attempt to repeal and replace the Affordable Care Act.

It’s not clear which version of the legislation will come up for a vote, part of the reason why McConnell and other Republican leaders have had trouble lining up support for their latest attempt to reform health care.

With a current majority of just 52 politically diverse Republican senators, the atmosphere is ripe for tight votes (part of the reason they’ve flown in Sen. John McCain days after he announced he had brain cancer). Republicans can only afford to lose two votes.

The Senate balance of power ebbs and flows between large and small majorities. But tie votes are rare: Vice presidents Joe Biden and Dan Quayle served a combined 12 years and never saw a single one.

For context, here are some other notable squeakers in modern Senate history:

The Affordable Care Act: Senate Democrats needed 60 votes and, at the time, had exactly 60 Democratic senators. The health care law that still dominates debate squeaked by thanks to a unanimous Democratic vote in a dramatic Christmas Eve vote in 2009.

Nomination of Betsy Devos: Several of President Trump’s nominees drew opposition and debate, but the vote to confirm Education Secretary Betsy Devos was the closest. She was confirmed 51-50, thanks to a tie-breaking vote by Vice President Mike Pence.

The Clinton taxes and deficit reduction plan: President Bill Clinton’s first budget was ambitious. It tackled the growing federal deficit in part by raising taxes on upper-class Americans (individuals earning over $115,000). The package is still debated but is credited with sharply reducing the deficit. It passed after Vice President Al Gore voted to break a Senate tie.

The Bush Tax Cuts: President George W. Bush helped guide through two large packages of tax cuts. The second of these, the Jobs and Growth Tax Relief Reconciliation Act, cut upper and middle class tax rates as well as investment (capital gain) taxes. But it nearly died in the Senate. It took Vice President Dick Cheney to break a tie on the final conference report to make those cuts law.

The 1974 New Hampshire Senate seat battle: The chamber essentially deadlocked on what to do about the closest Senate race in U.S. history. The 1974 New Hampshire race sparked two recounts and a final tally of 110,926 for the Republican to 110,924 for the Democrat. (Yes, that’s a two-vote margin.) The Senate Rules Committee was tied 4-4 over how to resolve this. Ultimately, the full Senate also had trouble acting and the two candidates agreed to a revote, which Democrat John Durkin won.</s>Reviving their touch-and-go effort to repeal the Affordable Care Act, Senate Republicans narrowly agreed Tuesday to begin debate on an undefined health care bill that could change how millions of Americans obtain insurance.

In a dramatic showdown that required Vice President Mike Pence to break a tie vote and that prompted Republican Sen. John McCain to return to Washington days after a cancer diagnosis, the Senate agreed to start an unusual and grueling process of drafting legislation — amendment by amendment — on the Senate floor.

The 51-50 vote to begin debate was a shot of momentum for Republicans, including President Donald J. Trump, whose years-old quest to dismantle Obamacare appeared to collapse last week. But unified opposition from Democrats and discord within the GOP ranks means passage of a final bill remains an elusive target.

"This is the beginning of the end for the disaster known as Obamacare," Trump said at a Rose Garden press conference after the vote. "Now we're all going to sit together and we're going to try and come up with something that's really spectacular."

Democrats, including Maryland Sens. Ben Cardin and Chris Van Hollen, opposed the motion and predicted that whatever proposal emerges would include deep cuts to Medicaid as well as changes to private insurance.

"Republicans now own the uncertainty and chaos that they have injected directly into the U.S. health care system," Cardin said. "Every Republican who voted to proceed to a phantom bill has voted to disregard the health of millions of Americans."

Just more than 12 million Americans, including about 133,000 Marylanders, have signed up for private insurance through the marketplaces created under the Obamacare law — which cater to people who don't purchase coverage through their employer. Another 14 million, including 288,000 in Maryland, benefit from a provision that raised the amount of money people may earn and remain eligible for Medicaid.

Many of those enrollees are facing steep premium increases and fewer choices because healthier people have been opting against buying insurance. In Maryland, state officials are considering a 52 percent premium increase requested by CareFirst BlueCross BlueShield, the state's dominant insurer.

Those kinds of premium increases, Senate Majority Leader Mitch McConnell said, have kept the GOP focused on repealing President Barack Obama's top domestic policy despite setbacks in the House and Senate.

"We've had to accept it for a long time. We don't have to accept it any longer," McConnell said. "They didn't send us here just to do the easy stuff."

In Maryland and other states, insurers have been clear that the uncertainty coming out of Washington is a major contributor to the proposed rate increases in the first place. Trump has threatened to undermine an unpopular requirement that Americans buy coverage or face a tax penalty, for instance — a move that could increase premiums even more.

Now, the Senate is crafting a health care bill on the fly. Advocates predicted that would do little to bring certainty to those markets.

Vincent DeMarco, a longtime health care advocate in Maryland, described the vote as "a terrible step" toward stripping health insurance from millions of Americans and lamented that lawmakers "don't even know what they are voting for."

The unusual procedural approach McConnell embraced Tuesday led to an equally rare level of drama as lawmakers arrived in Washington unsure of the vote's outcome. Democrats sat quietly at their desks and delayed voting until all Republicans votes were tallied. Protestors chanted "kill the bill" and "shame" from the chamber's gallery before being escorted out.

Throughout the morning undecided Republicans steadily began to announce they would support beginning debate. One of the holdouts, McCain, strolled on to the Senate floor to cheers from his colleagues. Returning to Capitol Hill after surgery and a recent diagnosis of brain cancer, McCain cast one of the final votes needed to start work on the bill.

The Arizona senator and former Republican presidential nominee then delivered a blistering speech that criticized the process Republican leaders used to push the repeal legislation forward and called for a more bipartisan approach to legislating.

He also appeared dismissive of his party's chances of approving a bill under that process.

"Our health care insurance system is a mess. Something has to be done," McCain said.

"If this process ends in failure, which seems likely, let's return to regular order," said McCain, referring to a process by which committees craft bills and hold hearings before bringing that legislation to the floor.

Two Republicans joined Democrats in opposing the motion to proceed, Sens. Susan Collins of Maine and Lisa Murkowski of Alaska. A third undecided Republican, Sen. Ron Johnson of Wisconsin, huddled for several minutes at McConnell's desk before casting a vote to start debate.

As Republicans now move toward crafting a bill, one GOP option — favored by conservatives — is to simply repeal most major parts of Obamacare, and try to pass a new health care law sometime in the future. McConnell submitted that proposal as the first amendment to be considered by lawmakers.

Then McConnell is expected to offer a revised version of the House-passed bill to replace Obamacare, the Better Care Reconciliation Act.

But so far, neither approach has garnered the 50 Republican votes needed for approval.</s>Republicans on Capitol Hill are continuing with their fight to repeal and replace ObamaCare, but former Eli Lilly (LLY) USA President Alex Azar holds a grim outlook for the future of health care reform, telling the FOX Business Network’s Stuart Varney, “Well, maybe there’ll be an amendment that’s in favor of apple pie and motherhood and baseball and that might pass, but I have trouble seeing that anything is going to get 50 votes in the U.S. Senate right now.”

According to Azar, Medicaid is a key issue.

“It is very hard to see, given what we’ve seen in the Senate that anything that comes out of a possible House and Senate conference committee will deal at all with Medicaid…The liberal Republicans seem to be so entrenched in the Medicaid expansion, very hard to see that.”

But when Varney questioned what the alternative is, asking Azar,“Can you just walk away entirely as ObamaCare collapses?” Azar predicted, “I think at the end of the day this is a hot potato that lands back in [Health & Human Services] Secretary Price’s lap for him to use as many authorities as he has to grant flexibility and try to dig us out of the ObamaCare mess as much as he can.”</s>WASHINGTON, D.C. - The Senate passed a vote today to begin discussing repealing the Affordable Care Act, with Vice President Mike Pence casting the tie-breaking vote to move forward.

Two Republican Senators voted no, but there were three that were pinpointed as possible swing votes, and all three of them decided to vote with their Republican colleagues.

Senators Rob Portman of Ohio, Dean Heller of Nevada, and Shelley Moore Capito of West Virginia all recently said they have doubts about repealing the Affordable Care Act, but decided against blocking the motion to move forward to floor debate.

John McCain, who was recently diagnosed with brain cancer, flew from Arizona to D.C. to take part in the vote, which actually turned out to be crucial to the vote passing since it ended in a 50-50 tie with Vice President Pence breaking the deadlock.

The Senate now has to debate healthcare for 20 hours on the Senate floor as different proposals are brought up, including a potential full ACA repeal and the Better Care Reconciliation Act.

Again, today's vote in itself doesn't affect the ACA, but its the first step for the Senate to begin discussions toward overhauling the ACA.</s>But it's unclear whether Republicans can cobble together enough votes to dismantle the Democrats' health care law as the majority struggled to even get to the threshold to take up the issue — and then only did so with Pence's help.

Several Republicans, including Sen. John McCain of Arizona, who was just diagnosed with brain cancer, said they cannot, at this time, support the GOP's replacement plan.

Lee, who was undecided early Tuesday on how he would vote, said he backed the longstanding Republican effort to get rid of Obamacare and wanted to fulfill that promise.

His preferred approach would be to repeat a 2015 vote to dump Obamacare but delay its implementation for two years while the Senate comes up with a new law.

"We campaigned on repealing Obamacare for seven years," Lee said in a statement. "I hope my colleagues will honor their promise and vote with me for the 2015 repeal bill."

Hatch, meanwhile, says he's "focused on the art of the doable," meaning he would like to repeal Obamacare and put in place a GOP solution immediately.

Hatch called Tuesday's vote a "critical first step" and noted the debate would be open to amendments so every senator, including Democrats, could offer changes.

"I'm pleased so many of my Republican colleagues came together to keep our promise to the American people and I look forward to a robust debate with my colleagues on both sides of the aisle," Hatch said.

None of the Senate's 46 Democrats or the two independents who caucus with them voted to start debate on the health care law.

Sen. Diane Feinstein, D-Calif., said after the vote Tuesday that Republicans are moving ahead to gut Obamacare "with no idea what comes next."

"People's lives are on the line — to proceed in this manner is the height of irresponsibility," Feinstein said in a statement. "This is a gut-check moment for our country. Over the coming days, senators need to decide whether taking health coverage away from millions of Americans and devastating our health care safety net is what they were sent here to do."

Democrats, she added, will "do all we can to defeat this monstrous effort."

Later Tuesday, senators voted 57-43 to reject the plan in the first vote on an amendment to the bill. Those voting "no" included nine defecting Republicans, Lee among them. Hatch supported it.

The vote underscored problems Republicans will have in winning enough votes to recast President Barack Obama's statute. The rejected proposal included language by Senate Majority Leader Mitch McConnell erasing the Obama law's tax penalties on people not buying insurance and cutting Medicaid.</s>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.

The importance of the vote was highlighted by Sen. John McCain's decision to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.

At a White House event Monday, President Trump highlighted what he called the "failures" of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump urged an approach that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later at a lunch with lawmakers, he advocated repeal and replace.

But it's still not clear what the Senate will be voting on. There are multiple bills in play.

The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.

NPR's health and politics teams have been doing our best to shed some light on what's a very confusing situation, even by health policy standards.

What are they voting on?

There are at least four bills that could advance to the Senate floor. Here's our summary, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.

We worked with NPR member station reporters and editors to create an interactive Q&A on how key elements of the bills would affect people in different states.

What if the Senate parliamentarian says 'nope'?

Another potential wrinkle came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won't get.

And if Obamacare remains the law of the land?

For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That's proving to be difficult and might drive up costs for consumers.

Congressional action could have an enormous impact on people's health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some key actions and regulations that could affect the exchanges and Medicaid (and more).
The Senate votes against the Better Care Reconciliation Act of 2017 amendment.