The Republican-led US Senate held a procedural vote early Thursday which set in motion the eventual rollback of The Affordable Care Act, President Barack Obama's signature healthcare reform bill.
Votes were held on a fiscal-year budget reconciliation measure between the House and Senate, the legislative vehicle for repealing Obamacare. The measure passed by a vote of 51 to 48.
"With tonight's vote, Republicans have pulled the first thread that will unravel our entire healthcare system," said Democratic Senator Debbie Stabenow.
Obama's eight-year drive to extend medical coverage to tens of millions of Americans is expected to come under sustained assault once President-elect Donald Trump takes office on January 20, with Republican majorities in both houses of Congress determined to repeal it.
"The Republican repeal will put insurance companies back in charge of our healthcare, take away patient protections from every American with health insurance, kick 30 million Americans off their insurance, and drive up the price of prescription drugs for everyone," said Stabenow.
"Rather than repealing health reform and weakening Medicare and Medicaid, Republicans should work with Democrats to improve care and lower healthcare costs for all Americans."
Trump made repeal of the healthcare law central plank of his insurgent White House campaign.
Republicans said the Senate vote is the first nail in the coffin for a hated law they have vowed to help Trump unravel.
"Passage of this resolution begins the important process of repealing and replacing the Affordable Care Act, which I've consistently maintained was flawed from the beginning," said Republican Senator Thad Cochran after the vote.