The U.S. Senate voted, 51-50, today to open debate on a potential repeal of the Affordable Care Act.

Vice President Mike Pence broke a 50-all tie when Republicans Susan Collins of Maine and Lisa Murkowski of Alaska sided with all 48 Democrats. Arizona’s John McCain flew to Washington just days after being diagnosed with a cancerous brain tumor to vote in favor of the motion to proceed.

This vote was a big hurdle, but only one step toward repeal of the healthcare law known as Obamacare. Republicans in the senate were expected to move forward with votes for a straight repeal of the ACA, as well as a vote on a version of the bill that includes a number of amendments introduced by Texas Sen. Ted Cruz, a former Republican presidential candidate.

Neither of those votes were expected to pass. Senate Majority Leader Mitch McConnell of Kentucky was expected to follow those votes with the introduction of several amendments, which reportedly would repeal the individual mandate and other aspects of the ACA.

Eventually, the senate will vote again on a final version of the bill. The passage of the MTP was a signal that Republicans are poised to pass at least some sort of ACA repeal, which then might lead to a senate-House conference committee.

In conference, the contents of the bill would be negotiated, presumably along political lines drawn exclusively by Republicans. Once negotiations are complete, the final version would be sent to President Donald Trump to sign into law.

The most recent Congressional Budget Office score of the latest version of the Republican bill estimated that passage of the bill would reduce the federal deficit by $420 billion, largely through cuts in planned Medicaid spending.

The CBO score also estimated that 22 million more Americans would find themselves uninsured by 2026 if the bill passed.

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