WASHINGTON - With a narrow vote to open debate on repealing the Affordable Health Care Act, commonly known as Obamacare, the US Congress is set for a bruising battle to develop legislation to fix America's flawed healthcare system.
Taking his message in his typical boisterous fashion to his base in Youngstown, Ohio, on Tuesday evening, President Donald Trump made the most of the 51-50 vote in the Senate earlier in the afternoon. The Republicans have 52 seats in the Senate, but two Republicans voted against their own party. Vice President Mike Pence broke the tie.
"Today we won 51 to 50 and didn't get one Democrat vote" the US President told a roaring, placard-waving crowd.
"With Obamacare the Washington obstructionists - meaning Democrats - made big promises and every single promise turned out to be a lie," he said.
"For seven years every Republican running for office promised to repeal and replace this disastrous law. Now they must keep their promise. Any senator who votes against repeal and replace is telling America they are fine with the Obamacare nightmare, and I predict they'll have a lot of problems," he warned.
The President ticked off a slew of states where insurance premiums under Obamacare have soared.
However, critics say whatever that has been proposed from the House and Senate so far will only make things worse for the American people, especially for the poor.
The next step is floor debate on the legislation to overhaul the Affordable Care Act but going by the sharp divisions seen in recent weeks, it is uncertain if the Republicans can reach a compromise on what the final Bill will look like.
It remains unclear which provisions will be debated.
What is inevitable is that the debate in the next few days- possibly weeks - will be fierce and partisan.
"The vote to proceed on the 'healthcare' Bill is a step towards passing the most dangerous and destructive legislation in our modern history," Senator Bernie Sanders tweeted soon after the vote.
Even Republican stalwart Senator John McCain, recently diagnosed with brain cancer and returning dramatically to the Senate on Tuesday afternoon just to cast a "yes" vote, warned in a forceful speech that he would not vote for the health care repeal Bill in its current form.
Senate majority leader Mitch McConnell told reporters: "There will be a lot of different amendments offered by different members trying to craft the Bill. It's really entirely impossible to predict, in a reconciliation debate, exactly what amendments will be offered or what amendments will succeed. It's wide open."
The health insurance for millions of Americans, as well as the distribution of the financial burden, are at stake. But ideology also plays a significant role. At the core of the struggle is America's free market healthcare approach. Democrats - while still advocating free market - lean towards a more socialised healthcare system, which the Republicans oppose.
"This is a handful of billionaires who want to do an ideological experiment on millions of Americans," Democrat Senator from Rhode Island, Sheldon Whitehouse, said after the vote.
The Democrats charge that the Republicans are trying to lower the tax burden on the rich. Obamacare prohibited insurance companies from denying coverage or charging more to those with pre-existing medical conditions. The Republican plan weakens this, leaving millions with pre-existing conditions vulnerable to being left with no or extremely expensive insurance.
Obamacare expanded government-funded Medicaid to cover more low-income people. The Republican plan would phase out Medicaid expansion to reduce federal funding over the next decade. This, analysts say, could leave millions of Americans who can least afford it, without basic insurance.
Under Obamacare insurance companies must provide women with maternity care and contraception. The Republicans want to eliminate programmes that help fund abortions.
Late in the evening, on the steps of the Capitol, grim Democratic Party Senators addressed an agitated crowd protesting the repeal of Obamacare.
New Hampshire Senator Maggie Hassan said:"Every house must have access to healthcare. We need to keep fighting, what's at stake here is whether we are going to live up to that ideal that everybody matters."