Georgia Republican Tom Price, the conservative lawmaker who has been one of Congress’s most vehement opponents of the Affordable Care Act, was sworn in Friday morning as health and human services secretary after a starkly divided Senate vote to confirm him.

Price won confirmation on a party-line vote of 52-47, which came around 2 a.m. Senate Democrats, united in their opposition to him as the government’s top health official, argued that the intersection of his personal investments and legislative behavior warranted deeper scrutiny of his ethics.

But without the numbers to defeat his confirmation, Democrats instead marshaled a protracted war of words, reading testimonials from Americans with severe, expensive-to-treat illnesses and gratitude to the ACA, Medicare or Medicaid — cornerstones of federal health policy that the Democrats accused the nominee of wanting to undermine.

The new secretary offered no remarks following his swearing-in hours later by Vice President Pence. But the biggest challenge he faces — one on which progress in Congress seems uncertain for now, despite GOP lawmakers’ pledges for immediate action — was the first subject Pence mentioned in his introduction.

“President Trump has made it the top priority of this new Congress to repeal and replace the Affordable Care Act with health-care reform that will lower the cost of health insurance without growing the size of government,” Pence said.

Vice President Pence swears in Tom Price as the new health and human services secretary as his wife, Betty Price, holds a bible. (Mark Wilson/Getty Images)

Price’s confirmation to lead the Department of Health and Human Services raises anew the question of what role the White House will play as Republicans try to come up with an approach to abolishing the 2010 law and creating a more conservative set of health-care policies.

[Republican town halls are getting very, very nasty]

At his first news conference after the election in November, Trump said that his administration would submit a repeal-and-replace plan “almost simultaneously” with Price becoming secretary. He said the plan “will most likely be on the same day or the same week, but probably the same day. Could be the same hour.”

In an interview with The Washington Post the following weekend, Trump said that a plan with the goal of “insurance for everybody” was “very much formulated down to the final strokes.” He reiterated that he was just waiting for Price to take office.

Yet when Price was asked at his confirmation hearing whether he was involved with writing a plan, he drew laughs by partly deflecting the question.

Trump has since seemed to retreat from his earlier timetable. In an interview with Fox News host Bill O’Reilly that aired Sunday, he described the process of crafting a new plan as “very complicated” and acknowledged that undoing a law and putting something in its place “takes a while to get.”

“Maybe it’ll take till sometime into next year,” Trump said, although “the rudiments” could be released in late 2017. His comments were ambiguous about whether the White House was preparing its own plan.

“We’re gonna be putting it in fairly soon,” he said, without elaborating.

In their home districts, some Republican lawmakers are hearing from constituents increasingly worried that their health coverage could be interrupted or lost if the GOP-controlled Congress rescinds the law, as long promised, without a clear sequel. Leaders for the health insurance industry and state insurance commissioners warned last week that more health plans almost certainly will defect from ACA marketplaces for 2018 unless Congress and the Trump administration provide some concrete assurances within the next two months.

Price, a 62-year-old orthopedic surgeon from a wealthy Atlanta suburb, chaired the House Budget Committee and led Republican opposition to the ACA, including helping to draft several comprehensive bills to replace it.

The debate over his nomination had opened in the Senate on Wednesday night with Democrats casting the prospect of him leading HHS in apocalyptic terms.

[Tom Price belongs to a doctors group with un­or­tho­dox views on government and health]

It began with Sen. Ron Wyden (Ore.), the ranking Democrat on the Senate Finance Committee, predicting that “this is about whether the United States will go back to the dark days when health care worked only for the healthy and wealthy.”

Sen. Bernie Sanders (I-Vt.), who as a 2016 presidential candidate energized many progressive voters, accused the White House of hypocrisy. The president, he contended, had campaigned on promises not to cut the nation’s main entitlement programs but then chose as his HHS secretary a congressman who has long sought to weaken them.

“The American people are still waiting for that one tweet that says, ‘I will keep my promise,’” Sanders said.

However, Senate Majority Leader Mitch McConnell (R-Ky.) delivered a sharply different portrayal, saying that Price “doesn’t just understand health-care policy as a policymaker, though he does deeply. He also understands it as a practicing physician.”

As debate was ending, Wyden returned with a stinging denunciation. The Democrat focused on what he called “a coverup” by Price about his purchase last year of discounted stock in a small Australian biotechnology company in which a fellow GOP congressman is the largest shareholder. Alleging that the nominee “failed to come clean” about whether he had special access to buy the stock because of his position, Wyden said, “It ought to shake this body’s confidence in Dr. Price.”

The starkly split vote that followed mirrored the polarized outcome of several of Trump’s Cabinet-level appointments — which moved forward with little of the comity that has traditionally defined the Senate’s culture.

Friday morning, House Speaker Paul D. Ryan (R-Wis.), who has been closely aligned with Price for years, praised his confirmation.

“For Americans struggling under Obamacare, today is a big step forward,” Ryan said in a statement. “Having Dr. Tom Price at the helm of HHS gives us a committed ally in our work to repeal and replace Obamacare and finally provide Americans with a better system.”