The House of Representatives have voted to pass a plan to begin demolishing Obamacare, despite mounting qualms among Republicans.
The budget measure – approved by the Senate on Thursday – would create legislation to roll back the 2010 bill.
But lawmakers in both parties are objecting to the lack of any apparent replacement for the far-reaching law.
The political showdown raises a big question mark over medical coverage for more than 20 million Americans.
Can Obamacare be repealed? Egged on by Donald Trump, Republicans have vowed to repeal the law, but conservatives have not yet agreed on a new plan.
The US president-elect, who takes office in one week, tweeted on Friday morning: “The ‘Unaffordable’ Care Act will soon be history!”
The House is debating the budget resolution before a full vote later in the day. The measure instructs four committees on Capitol Hill to draft repeal legislation by 27 January.
Republicans hope the ensuing budget reconciliation bill – which would strip Obamacare of funding – could pass a month later.
It would be able to pass with a simple majority in the Republican-controlled Congress, making it filibuster-proof. The party’s leadership aides voiced confidence that Friday’s measure would pass, but many centrist Republicans said they were not sure how they would vote. There was even indecision among the House Freedom Caucus, a rump of hardline conservatives who have been among the most vocal critics of President Barack Obama’s signature law.
“We need to be voting for a replacement plan at the same time that we vote for repeal,” said one of the group’s members, Representative Mark Meadows.
The Affordable Care Act, known as Obamacare, has provided healthcare subsidies and medical coverage for millions who are not covered through work. It has banned insurers from refusing coverage to people who are already ill, and curbed medical charges to the sick and elderly. But the law has been rocked by rising premiums, large fees and national insurers exiting the marketplaces.
House Speaker Paul Ryan told reporters on Thursday: “We have a responsibility to step in and provide relief from this failing law.” But House Democratic leader Nancy Pelosi has vowed to fight.
And Senate Republican Leader Mitch McConnell – whose chamber approved the budget resolution by 51-48 – acknowledged: “Repealing and replacing Obamacare is a big challenge.
“It isn’t going to be easy.” Republicans have provided few details on their plans to replace Obamacare. It is expected the replacement would seek to end the statute’s unpopular requirement that many individuals buy coverage and that larger companies provide it to workers.
However, experts say these mandates are needed to keep the insurance marketplace solvent.
Mr Trump’s choice for health and human services secretary, Tom Price, will play a key role in shaping the planned overhaul.
The Georgia congressman has previously touted his own Obamacare replacement plan.
The nonpartisan Committee for a Responsible Federal Budget said this month that repealing Obamacare would cost about $350bn (£286bn) over the next decade.
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