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Washington — The Senate has blocked a wide-ranging proposal by Republicans to repeal much of former President Barack Obama’s health care law and replace it with a more restrictive plan.

Senators voted 57-43 late Tuesday to reject the plan in the first vote on an amendment to the bill. Those voting “no” included nine defecting Republicans.

The vote underscored problems Republicans will have in winning enough votes to recast Obama’s statute.

The rejected proposal included language by Senate Majority Leader Mitch McConnell erasing the Obama law’s tax penalties on people not buying insurance and cutting Medicaid.

Language by Texas Republican Sen. Ted Cruz would let insurers sell cut-rate policies with skimpy coverage. And there was an additional $100 billion to help states ease costs for people losing Medicaid sought by Midwestern moderates.

Prodded by President Donald Trump, a bitterly divided Senate voted at last Tuesday to move forward with the Republicans’ long-promised legislation to repeal and replace “Obamacare.” There was high drama as Sen. John McCain returned to the Capitol for the first time after being diagnosed with brain cancer to cast a decisive “yes” vote.

The final tally was 51-50, with Vice President Mike Pence breaking the tie after two Republicans joined all 48 Democrats in voting “no.”

With all senators in their seats and protesters agitating outside and briefly inside the chamber, the vote was held open at length before McCain, 80, entered the chamber. Greeted by cheers, he smiled and dispensed hugs — but with the scars from recent surgery starkly visible on the left side of his face.

Despite voting “yes,” he took a lecturing tone afterward and hardly saw success assured for the legislation after weeks of misfires, even after Tuesday’s victory for Trump and McConnell.

Sen. Debbie Stabenow, D-Lansing, said McConnell and other Senate Republicans were carrying out a “purely political exercise” of repealing health care for tens of millions of Americans.

“For the seven months that we have been fighting back, we have seen the overwhelming majority of American people agree with us that health care is a basic human right. The Republican majority really does believe it’s a privilege for a few,” Stabenow told reporters at the U.S. Capitol.

“We ought to be putting this aside and focusing on working together to lower the costs of healthcare, starting with prescription drugs, and finding ways to help people get better and more affordable insurance for themselves and their families,” Stabenow said.

Trump continued to celebrate the vote at a rally later in Youngstown, Ohio that doubled as a victory lap.

“We’re now one step closer to liberating our citizens from this Obamacare nightmare and delivering great health care for the American people” he said.

At its most basic, the Republican legislation is aimed at undoing Obamacare’s unpopular mandates for most people to carry insurance and businesses to offer it. The GOP would repeal Obamacare taxes and unwind an expansion of the Medicaid program for the poor, the disabled and nursing home residents The result would be 20 million to 30 million people losing insurance over a decade, depending on the version of the bill.

The GOP legislation has polled abysmally, while Obamacare itself has grown steadily more popular. Yet most Republicans argue that failing to deliver on their promises to pass repeal-and-replace legislation would be worse than passing an unpopular bill, because it would expose the GOP as unable to govern despite controlling majorities in the House, Senate and White House.

Tuesday’s vote amounted to a procedural hurdle for legislation whose final form is impossible to predict under the Senate’s byzantine amendment process, which will unfold over the next several days.

Indeed senators had no clear idea of what they would ultimately be voting on, and in an indication of the uncertainty ahead, McConnell said the Senate will “let the voting take us where it will.” The expectation is that he will bring up a series of amendments, including a straight-up repeal and fuller replacement legislation, to see where consensus may lie.

Yet after seven years of empty promises, and weeks of hand-wringing and false starts on Capitol Hill, it was the Senate’s first concrete step toward delivering on innumerable pledges to undo former President Barack Obama’s law.

Rep. John Conyers, the Detroit Democrat who supports a single, national insurance plan, said he was “horrified” by Tuesday’s vote, which he predicted would result in more than 50,000 people in his district losing insurance.

“The Affordable Care Act is not perfect and I have said this many times. However, in Detroit alone, the uninsured rate has dropped from 22 percent to 7.4 percent over the last three years. That progress will be undone by today’s vote,” Conyers said in a statement.

The two Republicans voting “no” were Susan Collins of Maine and Lisa Murkowski of Alaska.

Detroit News Staff Writer Melissa Nann Burke contributed.

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