The US House of Representatives on Friday passed a measure paving the way to repeal President Barack Obama's namesake health care program.
The move follows the Senate, which voted after a marathon overnight session Wednesday-Thursday to approve a budget blueprint to repeal the Affordable Healthcare Act.
The House vote passed 227 to 198.
Like the Senate, the House has a Republican majority.
But just a week before Republican President-elect Donald Trump is sworn into office, a sense of urgency has swept over Washington about what his party will put forward as a replacement for the health care law, with Democrats warning of disastrous consequences should Republicans act too hastily.
"This resolution essentially fires the starting pistol... for repealing Obamacare," said Representative Bill Johnson, an Ohio Republican, shortly before the vote.
"This is a critical first step to deliver relief to Americans struggling under this law," House Speaker Paul Ryan told fellow members, describing as a "rescue mission" the latest effort to unwind Obamacare.
"This experiment has failed," and "we have to step in before things get worse."
The Senate passed the budget resolution on Thursday. The measure received no Democratic support in either the Senate or the House, highlighting the intensely partisan fight that lies ahead.
The budget resolution provides Republicans with a powerful tool, called reconciliation, which allows repeal legislation to proceed through the 100-member Senate protected from filibuster blocking tactics and requiring just a simple majority for passage, instead of a higher 60-vote threshold.
Trump made repeal of the law, a key achievement of Obama's Democratic administration, a central plank of his insurgent campaign.
This week he said the Republicans ought to repeal and replace Obamacare "simultaneously."
Unwinding Obamacare will be a monumental task. Republican leadership is moving carefully, stressing it does not want to "pull the rug out from anyone" who might lose their coverage if there is no replacement plan on offer.
The White House, which claims Obamacare as a major success, says more than 20 million Americans have gained health insurance through the law.
Democrats warned that scrapping the Affordable Care Act, which forbids insurance companies from denying health care due to pre-existing conditions and allows children to stay on their parents' plans until age 26, could result in millions of Americans losing coverage.
"Every American will be affected by this vote," said number-two House Democrat Steny Hoyer, citing a faster hike in premiums than under current law, and a likely spike in drug costs.
Nine Republicans voted against the resolution in the House, including moderate Charlie Dent, who expressed "reservations" about repealing parts of Obamacare without a credible replacement at the ready.
"The repeal plan needs to be fully developed and better articulated," he told CNN.
(Staff with AFP)