Updated at 1:35 p.m.
WASHINGTON • 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."
Our earlier story, from the Washington Post, which was updated at 6:29 a.m.
WASHINGTON • The Senate voted 51 to 48 early Thursday to approve a budget resolution instructing House and Senate committees to begin work on legislation to repeal major portions of the Affordable Care Act. The House is expected to take up the legislation Friday.
Senate Democrats made a late-night show of resistance against gutting the Affordable Care Act by forcing Republicans to take politically charged votes against protecting Medicare, Medicaid and other health-care programs. The measure narrowly passed without the support of any Democrats.
The hours-long act of protest culminated in the early hours of Thursday when Democrats made a dramatic display of rising to speak out against the repeal measure as they cast their votes. The Democrats continued to record their opposition over their objections of Senate Republicans.
"Because there is no replace, I vote no," said Sen. Claire McCaskill, D-Mo., as she delivered her vote.
Sen. Rand Paul, R-Ky., also voted no, in part over concerns that GOP leaders have not committed to a plan to replace the Affordable Care Act after it is repealed.
Democrats forced nearly seven hours of mostly symbolic votes amid growing concerns in the congressional GOP that the party is rushing to dismantle the ACA without an alternative. Democrats forced the frenzied vote series called a "vote-a-rama" well into Thursday morning, although they could not prevent the GOP from following through on its repeal plans.
Senate Minority Leader Charles E. Schumer, D-N.Y., said Wednesday that Democrats intended to ensure that Republicans are held responsible for any chaos caused by ending President Barack Obama's landmark law providing roughly 20 million people with coverage in various ways.
"Put this irresponsible and rushed repeal plan aside," Schumer said on the Senate floor. "Work with us Democrats on a way to improve health care in America, not put chaos in place of affordable care."
In his news conference on Wednesday, President-elect Donald Trump insisted that repeal would not occur without a replacement plan. "Obamacare is the Democrats' problem. We're going to take the problem off the shelves for them. We're doing them a tremendous favor," Trump said.
The House is expected to take up the measure on Friday, although there were signs that disparate groups of House Republicans were concerned about it.
Moderates said they may oppose the measure because they are nervous about starting the repeal without a replacement plan.
Rep. Charlie Dent, R-Pa., co-chair of the informal caucus of moderate Republicans called the Tuesday Group, said that moderate lawmakers have "serious reservations" about starting the process without replacement plans being spelled out.
And members of the House Freedom Caucus called for a fuller plan before any votes are taken — including on the preliminary budget measure.
"We just want more specifics," said Rep. Mark Meadows, R-N.C., the caucus chairman. "I'm willing to take a vote today if we have the specifics. So it's not as much slow it down for slowing-it-down purposes as it is, we need to know what we're going to replace it with."
Senate Democrats tried to embarrass Republicans in the all-night vote series by forcing them to take tough votes on protecting mental-health services and womens' access to health care. One such measure would block the Senate from passing any legislation "that would reduce or eliminate access to mental health services." Another contains similar prohibitions against cutting funding for maternity care.
Republicans blocked six amendments from Democrats within the first several hours of voting. Among the failed measures was an attempt to prevent any changes to Medicare or Medicaid, or to reduce the number of people enrolled in private health insurance.
Democrats tracked how Republicans voted throughout the night — information that could be used during coming election campaigns, according to Democratic leadership aides who would not speak on the record to divulge internal party strategy.
The voting marathon was expected to end with a final vote instructing the House and Senate committees to begin work on legislation to render useless major portions of Obamacare.
The GOP divisions highlight the difficulty Republicans face in making good on one of their central campaign promises a little more than a week before they take full control in Washington.
Once the Senate passes the budget measure, it will be sent to the House, where it will not be subject to lengthy debate.
Pressure from House Republicans and from Trump's public comments are prodding Republicans to more quickly produce additional details.
House Majority Whip Steve Scalise, R-La., said Wednesday that lawmakers are "in sync" with Trump's wishes but added: "I think it's good that we all continue to press each other to work as quickly as we can."
Trump's comments Wednesday, as well as those made Tuesday in a New York Times interview, seem to conflate various aspects of the repeal process and set out what many on Capitol Hill see as an overly ambitious timeline for action.
Scalise and Rep. Patrick J. Tiberi, R-Ohio, chairman of the Ways and Means subcommittee on health, said that lawmakers are taking a close look at what elements of a replacement plan can be included in the initial Obamacare repeal bill.
That legislation is crucial because Republicans plan to pass it using special budget rules allowing the Senate to approve it with only a simple majority vote rather than a 60-vote supermajority. But Senate rules dictate that only measures with a discrete budgetary impact can be handled under those procedures.
So while Republicans could claim that the bill repealing Obamacare also contains a replacement blueprint, other parts would need 60 Senate votes — and significant Democratic support.
According to multiple GOP individuals, Republicans are looking at whether to use coming reauthorizations of existing programs, such as the Children's Health Insurance Program, as vehicles for Obamacare replacement measures. That could give them leverage to secure cooperation from Democrats.
Another wild card is Trump's pick for secretary of the Department of Health and Human Services, Rep. Tom Price, R-Ga. Trump suggested Wednesday that Price would play a key role in shaping the Obamacare replacement strategy.