Congress has set the stage for repeal of the Affordable Care Act, approving a preliminary measure that will allow Republicans to dismantle Barack Obama’s signature healthcare law.

The legislation passed in the House of Representatives 227-198, with nine Republicans joining a united Democratic party in voting against. The narrowly Senate passed the same budget measure in the early hours of Thursday morning.

“This is a critical first step toward delivering relief to Americans who are struggling under this law,” said the House speaker, Paul Ryan of Wisconsin, in a rare floor speech.

The move allows Republicans to use a procedure known as “budget reconciliation” to tear up key provisions of the law. Republican leaders have said they intend to “repeal” and “replace” Obamacare simultaneously to avoid disruptions in healthcare coverage, but they have yet to agree on a replacement plan.

In the days leading up to the voting, a growing number of Republicans began voicing concerns about repealing the law without first agreeing on an alternative. Democrats seized on these divisions and called on Republicans to reveal their plan before gutting the law, which covers an estimated 20 million Americans.



“Republicans talk about they’re going to ‘repeal and replace’ – interesting alliteratively, but not realistic,” said House minority leader Nancy Pelosi of California, who led the passage of the law in 2009 and 2010. “For six years they have had a chance to propose an alternative. We see nothing.”

Republicans have been trying to repeal the Affordable Care Act since its passage in 2010.

With both chambers of Congress and the White House now in their grasp, they finally have the opportunity to do so. Before the House vote on Friday, Trump tweeted: “The “Unaffordable” Care Act will soon be history!” But they have yet to agree on a replacement plan.

On Thursday night Ryan said during a CNN town hall meeting that Congress would draft a replacement plan “definitely within these first 100 days” of Trump’s presidency.

During the forum Ryan was confronted by a cancer patient from Arizona who said the Affordable Care Act had saved his life and asked why Republicans would consider gutting the law without something else in place.

“We wouldn’t do that. We want to replace it with something better,” Ryan said. He claimed that the healthcare law was “collapsing” and said that Republicans needed to rescue Americans from soaring premiums and increasing deductibles.

Trump campaigned with zeal on the promise of repealing the law on “day one” and replacing it with “something terrific”. Beyond that, he has offered few details about his proposal.

At a news conference earlier this week, Trump said Republicans would deliver their healthcare plan to replace the law “very quickly”.

But to pass a replacement plan, Republicans will have to craft a proposal that unites their party, which is deeply divided on how to move forward, as well as win over some Democrats, since they would need a 60-vote super-majority in the Senate, where they only have 52 seats.

Democrats have said they are willing to work with Republicans to improve the law but have shown no desire to rescue them over its replacement.

Passing the measure is only a first step. Now lawmakers on various committees will begin drafting the legislation to replace the bill, a lengthy and exhaustive process that will take place across four committees.

“This is a sad day in the history of this country as Republicans begin the process of destroying healthcare in America,” said Representative Hakeem Jeffries, a Democrat of New York. “Repeal and replace is just a slogan, it’s not a solution.”

Also on Friday, Congress approved legislation that would allow retired marine general James Mattis to become defense secretary, granting him an exemption from the law that bars former service members who have been out of uniform for less than seven years from holding the top job at the Pentagon. A White House spokesman said Barack Obama would sign the measure if Congress approved it before he leaves office next week.