Bill Cassidy

Sen. Bill Cassidy, R-La., heads to the Senate on Capitol Hill in Washington, Thursday, July 13, 2017, for a meeting on the revised Republican health care bill which has been under attack from within the party. Cassidy has expressed opposition to the bill as current written. (AP Photo/J. Scott Applewhite) ORG XMIT: DCSA114

J. Scott Applewhite

WASHINGTON — Both of Louisiana's Republican U.S. senators joined Senate leaders in agreeing to move ahead — through a measure that passed without a vote to spare — with debating proposals to tear down much of the federal health care law.

The vote gives President Donald Trump and GOP leaders a crucial initial victory but launches a weeklong debate promising an uncertain final outcome.

U.S. Sens. Bill Cassidy, of Baton Rouge, and John Kennedy, of Madisonville, each voiced support for the effort to repeal and replace the Affordable Care Act, sometimes referred to as "Obamacare," and each described their votes Tuesday as a step in the process.

"Nothing changes until the first step is taken. This is the first step," Cassidy, a physician who has put forth his own proposals for the health care overhaul, said in a statement shortly after the vote. "There will be many others. But we must replace Obamacare with something which fulfills President Trump’s campaign pledges to maintain coverage, protect those with preexisting conditions and lower premiums without mandates.

"Power needs to be returned to the patients and states."

Kennedy, who was elected to the Senate in a heated race last fall, said he had promised voters he would support the repeal of the Affordable Care Act.

"Today, I worked to fulfill that promise,” he said in a statement. “I look forward to continuing to work with my colleagues on both sides of the aisle to deliver a health care system to the American people that looks like it was designed on purpose.”

With Vice President Mike Pence breaking a 50-50 tie, the Tuesday vote began the debate on possible legislation. Several other votes would be needed to finalize any repeal.

The vote came after weeks of deadlock in the Senate and with two Republicans casting votes against the motion to move forward.

"It's a shell of a bill right now, we all know that," U.S. Sen. John McCain, R-Ariz., told the chamber after the motion to proceed was adopted with his vote. "I know many of you will have to see the bill substantially changed to support it."

The Senate has recently weighed three separate proposals: a straight repeal of the health law, with plans to come up with a replacement later; a leadership-crafted alternative proposal; and a partial, or "skinny," repeal. It remains to be seen which will gain more traction amid this week's debate.

"This is just the beginning," Senate Majority Leader Mitch McConnell, R-Kentucky, told reporters.

McConnell said he hopes the chamber will end this week with a measure that can go to the House for approval or go to conference with the House for final negotiations.

Gov. John Bel Edwards, a Democrat who expanded Medicaid under the existing federal Affordable Care Act, has urged Congress to work toward a bipartisan approach on health care. He has repeatedly voiced concern about the potential threat to Medicaid expansion under GOP-friendly proposals.

Critics of the current proposals warn the overhaul could threaten health care coverage for thousands of people in Louisiana — particularly the poor, chronically ill or disabled.

The Louisiana Budget Project, which advocates on behalf of low- and moderate-income families in the state, said that any of the proposals currently up for discussion could have negative impacts in the state.

"Unfortunately, Bill Cassidy and John Kennedy sided with their party bosses in Washington over their constituents back home, who understand that all of the bills before the Senate would move us backward," Budget Project Director Jan Moller said. "Sen. Cassidy still has the opportunity to keep the promises he made to Louisianans by voting against bills that cut Medicaid and take away protections from people with pre-existing conditions."

Moller echoed Edwards' call for restarting discussions with a bipartisan focus.

Moderate Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, were the only Republicans to defect from their party's quest. Their complaints about the legislation have included its cuts to Medicaid, which provides health insurance for the poor, the disabled and nursing home residents.

Not a single Democrat backed the effort to overthrow former President Barack Obama's signature domestic legislative achievement. In an unusual move, most of them sat in their seats during the climactic roll call, eyeing Republicans as they cast their votes.

Technically, Tuesday's vote meant the Senate would consider a measure the House approved in May eliminating much of Obama's statute. Like legislation McConnell crafted mostly behind closed doors — and has since revised — it would eliminate Obama's tax penalties on people not buying policies, cut Medicaid, erase many of the law's tax boosts and provide less generous health care subsidies for consumers.

But if a measure eventually emerges following the debate and amendment period, it is likely to look quite different. Because the chamber's moderates and conservatives are so split over how to replace Obama's overhaul, leaders have discussed passing a narrow bill repealing only some unpopular parts of that law — like its penalties on individuals who eschew coverage — with the ultimate goal being to negotiate a final package with the House.

In the moments before the vote, most GOP critics of the legislation fell into line to allow debate to begin. They included conservative Sens. Rand Paul, of Kentucky, and Mike Lee, of Utah, plus moderates Rob Portman, of Ohio, and Shelley Moore Capito, of West Virginia.

Paul said he was voting yes after McConnell told him the Senate would debate his proposal to scuttle much of Obama's law and give Congress two years to enact a replacement — an amendment that seemed certain to lose.

Trump kept up the pressure on GOP lawmakers, tweeting that "After 7 years of talking, we will soon see whether or not Republicans are willing to step up to the plate!" He added: "ObamaCare is torturing the American People. The Democrats have fooled the people long enough. Repeal or Repeal & Replace! I have pen in hand."

At least a dozen GOP senators have openly said they oppose or criticized McConnell's bill, which McConnell has revised as he's hunted Republican support.

Besides allowing an early vote on Paul's repeal plan, moderates were seeking additional money for states that would be hurt by cuts in Medicaid. Conservatives wanted a vote on a proposal by Ted Cruz, R-Texas, letting insurers offer bare-bones policies with low premiums, which would be illegal under Obama's law.

With leaders still struggling to line up enough votes to approve a wide-ranging overhaul of Obama's law, there was talk of eventually trying to pass a narrow bill — details still unclear — so House-Senate bargainers could craft a compromise. That, too, was encountering problems.

"This idea that we're going to vote on something just to get in conference and then figure it out later is nuts," Sen. Lindsey Graham, R-S.C., told reporters.

Had Tuesday's vote failed, it would have been an unalloyed embarrassment for a party that finally gained control of the White House, Senate and House in January but still fell flat on its promise to uproot Obamacare.

Obama's law was enacted in 2010 over unanimous Republican opposition. Since then, its expansion of Medicaid and creation of federal insurance marketplaces has produced 20 million fewer uninsured people. It's also provided protections that require insurers to provide robust coverage to all, cap consumers' annual and lifetime expenditures and ensure that people with serious medical conditions pay the same premiums as the healthy.

The law has been unpopular with GOP voters, and the party has launched numerous attempts to dismantle the statute. All until this year were mere aspirations because Obama vetoed every major one that reached him.

Ever since 2010, Republicans have been largely united on scuttling the statute but divided over how to replace it.

Those divides sharpened with Trump willing to sign legislation and estimates by the nonpartisan Congressional Budget Office that several GOP bills would cause more than 20 million people to become uninsured by 2026. Polls showing growing popularity for Obama's law and abysmal approval ratings for the GOP effort haven't helped.

Advocate reporter Elizabeth Crisp and Associated Press writers Alan Fram, Erica Werner and Andrew Taylor contributed to this report.

Follow Elizabeth Crisp on Twitter, @elizabethcrisp.