Congressional Republicans are taking the first steps toward dismantling President Barack Obama's health care law, facing pressure from President-elect Donald Trump to move quickly on a replacement.
"We have a responsibility to step in and provide relief from this failing law," Speaker Paul Ryan, R-Wis., told reporters Thursday. "And we have to do it all at the same time so that everybody sees what we're trying to do."
Yet Ryan said there are no "hard deadlines" for a GOP replacement in tandem with the repeal effort, underscoring the difficulty for Congress despite the president-elect's call to both repeal the law and replace it with legislation to "get health care taken care of in this country."
That will be challenging, to say the least, considering the complicated web of Congress, where GOP leaders must navigate complex Senate rules, united Democratic opposition and substantive policy disagreements among Republicans.
By a near party-line 51-48 vote early Thursday, the GOP-run Senate approved a budget that eases the way for action on subsequent repeal legislation as early as next month. The Republican-controlled House planned to complete the budget on Friday, despite misgivings by some GOP lawmakers.
Trump took to Twitter to praise the development: "Congrats to the Senate for taking the first step to #RepealObamacare — now it's onto the House!"
Republicans are not close to agreement among themselves on what any replacement would look like.
The 2010 law extended health insurance to some 20 million Americans, prevented insurers from denying coverage for existing conditions and steered billions of dollars to states for the Medicaid health program for the poor. Republicans fought the effort tooth and nail, and voter opposition to the law helped carry the GOP to impressive victories in 2010, 2014 and last year.
The health care law does have problems, but independent experts say it's an exaggeration to call it a total failure. Republicans are focusing most of their criticism on the shortcomings of private plans sold on health insurance exchanges, but many support the expansion of Medicaid coverage to millions of low-income people.
Thursday's Senate procedural vote will set up special budget rules allowing the repeal vote to take place with a simple majority in the 100-member Senate, instead of the 60 votes required to move most legislation.
That means Republicans, who control 52 seats, can push through repeal legislation without Democratic cooperation. They're also discussing whether there are some elements of a replacement bill that could get through at the same time with a simple majority. But for many elements of a new health care law, Republicans are likely to need 60 votes and Democratic support, and at this point, the two parties aren't even talking.
Kentucky Sen. Rand Paul, unhappy that the measure endorsed huge budget deficits, was the sole Republican to vote against it.
Increasing numbers of Republicans have expressed anxiety over obliterating the law without a replacement to show voters.
Sen. Susan Collins, R-Maine, said she wants at least to see "a detailed framework" of a GOP alternative health care plan before voting on repeal. She said Republicans would risk "people falling through the cracks or causing turmoil in insurance markets" if lawmakers voided Obama's statute without a replacement in hand.
Separately, Sen. Bernie Sanders, I-Vt., whose Democratic run for White House last year struck a chord with young people and the party's progressive wing, has teamed up with top Democratic leaders to organize about 50 rallies this weekend to trumpet support for the law.
"A good, strong political party needs obviously an inside-the-Beltway strategy, but it also needs an outside-the-Beltway strategy," Sanders said. "There are very few people who will tell you that the Democrats have done a good job in terms of an outside strategy, in terms of standing up with working families and the middle class and lower-income people."