Senate Republicans Tuesday afternoon agreed to begin floor debate on healthcare legislation, a hard-fought step amid uncertainty about exactly what plan senators will ultimately be asked to vote on.

The drama of Tuesday’s 51-50 vote—with Vice President Mike Pence providing the tie-breaker—was heightened by the arrival from Arizona of Senator John McCain to help the GOP try to repeal Obamacare following his brain-cancer diagnosis last week.

McCain entered the chamber to applause from both Republicans and Democrats, but then fired off a warning to his own leadership, saying he won’t vote to pass the latest version of the GOP health bill.

“We keep trying to win without help from the other side of the aisle,” McCain said in a speech on the Senate floor after the debate. “We are getting nothing done, my friends, we’re getting nothing done. All we’ve managed to do was make more popular a policy that wasn’t very popular,” he added, referring to Obamacare.

Majority Leader Mitch McConnell of Kentucky is aiming for a final vote this week, but the next step is unclear, and it’s far from certain he’ll get the votes to pass a bill. “We can’t let this moment slip by,” McConnell said on the Senate floor before calling the vote. “We’ve talked about this too long.”

As the vote began, chants of "Kill the bill, don’t kill us!" and "Shame!" broke out in the Senate visitors’ gallery.

Republican leaders have promised senators they’ll each get a chance to vote on their preferred plan, with a final measure to be put together by leadership at the end of the debate. Among the proposals is a simple repeal of Obamacare with a two-year delay, which McConnell has said Trump would sign. Senators may also consider a more stripped-down repeal bill that eliminates the individual mandate along with a few key elements of Obamacare.

The House passed its Obamacare replacement plan in May. Senator Rand Paul of Kentucky, who had insisted on a simple-repeal vote, said on Twitter that if it fails, the GOP will vote on "whatever version of CLEAN repeal we can pass."

Another possibility is a repeal-and-replace version that McConnell has been revising. A third is a so-called skinny repeal that would repeal part of Obamacare—the requirements that most individuals obtain insurance and that most employers offer it to their workers, and perhaps the tax on medical devices.

"Everything’s on the table. It’s whatever we can get out of the Senate and get to a conference" with the House to reach a compromise, said second-ranking Senate Republican John Cornyn of Texas.

The House bill, H.R. 1628, would wind down an expansion of Medicaid insurance for the poor and eliminate $1 trillion in taxes on the wealthy, insurers and drugmakers used to fund the law. Republicans say it would allow a market-based system that would let people make more health-coverage decisions for themselves. It would replace Obamacare subsidies with tax credits based primarily on age that phase out for people with incomes above $75,000.

House Republicans passed a bill in early May that the nonpartisan Congressional Budget Office said it would cause millions to lose health coverage. After the House vote, McConnell crafted a Senate repeal-and-replace plan in secret, but last week he was forced to admit it lacked enough GOP support. The CBO said it would cause 22 million fewer people to have healthcare by 2026, similar to estimates for the House bill. The majority leader also acknowledged that a repeal-only bill lacked the votes to advance.

Senator Susan Collins of Maine has said she opposed repealing Obamacare without an adequate replacement and expressed concern about cuts in Medicaid coverage for low-income Americans.

Democrats were united against opening debate on healthcare. Minority Leader Chuck Schumer of New York said before the vote that the Republican majority knows "darn well what’s going to happen when there’s a conference. A vote in favor of the motion to proceed this afternoon will be a permission slip to slash Medicaid, hurt millions" and cut taxes on the rich, he said.

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