Senate Republicans voted Tuesday to open debate on repealing Obamacare, dramatically reviving an effort that many GOP lawmakers left for dead just a few days ago.

The vote is a huge political win and turnaround for Senate Majority Leader Mitch McConnell and Republicans who've promised for seven years to repeal Obamacare if voters gave them control of Congress and the White House.


Sen. John McCain (R-Ariz.), recently diagnosed with brain cancer, entered the chamber to a standing ovation before casting his vote. Sen. Ron Johnson (R-Wis.) got on board only after engaging in a long conversation on the Senate floor with McConnell. GOP Sens. Susan Collins of Maine and Lisa Murkowski of Alaska broke ranks to oppose the measure, forcing Vice President Mike Pence to break a 50-50 tie.

All Democrats opposed the measure. Underscoring the significance of the vote, many senators sat at their desks for the vote.

The vote is no guarantee that the fractured Republican caucuses can coalesce around a single health care plan.

“There’s a lot of work ahead of us and I don’t think anybody’s taking anything for granted,” said Sen. John Thune (R-S.D.). "If we can get something by the end of this week through the Senate it would at least position us so that we can get to conference with the House.”

Now that debate has officially started, Republicans in the Senate lack 50 votes on a policy. Moderates oppose repealing Obamacare without a replacement, and conservatives don’t like the idea of significantly replacing it.

Both policies are expected to get a vote, but both are expected to fail. In addition, the Senate will vote on key amendment — a proposal by Sen. Ted Cruz to allow insurers to sell plans not covered by Obamacare rules and a plan from Sen. Rob Portman to move people covered by Medicaid expansion to private insurance.

Those proposals had been combined with the broader GOP plan to replace Obamacare, a bill that has been under development in the Senate for two months but was set aside last week when it became clear there wouldn’t be 50 GOP votes. Nine conservative and moderate Republicans joined all Democrats on a 43-57 vote that effectively killed the measure Tuesday evening.

Republicans who voted to reject their party's repeal-and-replace plan were Collins, Murkowski, and Sens. Rand Paul of Kentucky, Bob Corker of Tennessee, Lindsey Graham of South Carolina, Dean Heller of Nevada, Jerry Moran of Kansas, Tom Cotton of Arkansas and Mike Lee of Utah.

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Shortly before 6 p.m., Republican leaders released the text of the new amendment.

"Just to show you how troubling this process is, at 10 of 6 we received a [178-page] amendment," Collins said. "That is major policy and we're going to have potentially an hour and a half to read through that many pages?"

Dozens of other amendments are planned, including the lengthy "vote-a-rama" process of unlimited amendment expected on Thursday evening.

“We’re going to be doing a lot of voting so I hope you eat your Cheerios,” said Senate Majority Whip John Cornyn (R-Texas).

The leading idea now is to repeal only a small portion of the health law in order to get a bill to a conference with the House.

Republicans would aim to enact a bill repealing three parts of Obamacare: the individual and employer mandates and the medical device tax, according to Republican sources. It could be expanded or altered depending on where the bulk of the conference is.

"Whatever gets to 50," said Sen. John Thune (R-S.D.).

The goal would be to get an Obamacare repeal bill through the Senate and to a conference with the House. Or perhaps to pass a bill that the House would accept given opposition among some House members to a bicameral conference committee. Still, that scaled-back approach is already hitting some resistance among some GOP senators.

But it’s already running into trouble.

“I'm not going to vote for something that's a scaled down version, that's a political punt," Graham said earlier Tuesday. The South Carolina Republican will vote for the motion to proceed but added that a final product to fix the health care system should go through "regular order."

Collins said the proposal wasn’t described at the weekly Senate GOP policy lunch.

“And so apparently that is an amendment that the leader would offer at the end,” she said. “I have no idea what’s going into that.”

And Republicans are considering making further changes to the repeal-and-replace plan. Administration officials and senators are discussing adding as much as $100 billion more to earlier drafts to help low-income people with premiums, Republicans said.

Before Tuesday's vote, McConnell urged senators to take the first step to “provide relief on this failed left-wing experiment.”

“I’d like to reiterate what the president said yesterday. ‘Any senator who votes against starting debate,’ he said, ‘is telling America that you are fine with the Obamacare nightmare…’ That’s a position that even Democrats have found hard to defend,” McConnell said.

The fate of the vote was uncertain as recently as Tuesday morning. Paul, Heller and moderate Sen. Shelley Moore Capito (R-W.Va.) waited until the final hours before the vote to announce they would support opening debate on the bill.

Paul’s vote was conditioned on the party agreeing to move quickly to a vote on repealing without a replacement. The other amendment would be a leadership-designed repeal and replace bill, he said.

Heller said his support for whatever emerges later is not assured.

“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,” Heller said.

Capito said she is “committed to reforming our health care system" while also addressing her concerns, which have centered on Medicaid.

Johnson declined to reveal how he would vote up to 20 minutes before the vote started. “No comment,” he repeatedly told reporters.

McConnell and his leadership team threw everything they had at wavering senators: the threat of political disaster if they fail, an open amendment process to allow their ideas to be debated — and the argument that a flawed Senate bill can be fixed later in conference negotiations with the House. Even McCain’s return was used as a sign of positive momentum.

"If we can get the bill through the Senate we can start negotiations with the House,” Cornyn said.