US Congress takes first steps toward repealing Obamacare

The Republican-led US Senate launched their much-anticipated effort to repeal the Affordable Care Act early Thursday by passing a budget blueprint which would allow them to begin rolling back the health care reforms.

The House of Representatives, also under Republican control, is set to follow with its own vote as early as Friday, meaning the process for gutting outgoing President Barack Obama's signature domestic program will be in full swing days before Donald Trump takes the oath of office on January 20.

The Senate budget resolution passed by a vote of 51 to 48, largely along party lines, in the dead of night, as the chamber wrapped up hours of debate over amendments to the legislation after 1:00 am (0600 GMT).

"Congrats to the Senate for taking the first step to #RepealObamacare," Trump tweeted. "Now it's onto the House!"

The budget resolution approves parameters that would allow repeal legislation to proceed through the Senate protected from a filibuster and requiring just a simple majority for passage.

Trump made repeal of the law a central plank of his insurgent campaign.

This week he said the Republicans ought to repeal and replace Obamacare "simultaneously."

House Speaker Paul Ryan said he was "in complete sync" with the incoming adminstration.

"We want to make sure that we move these things concurrently," Ryan told reporters, adding that Obamacare was in "a death spiral."

The White House says Obamacare has helped 20 million people gain health insurance, and that key provisions remain very popular, including forbidding insurance companies to deny coverage to people with pre-existing conditions and allowing children to stay on their parents' plans until age 26.

Republican critics have blasted it for causing premiums to soar in some states, and because some insurers have withdrawn from state insurance markets established by the law.

"The goal will be to undo policies and regulations that limited choice, increased costs and diminished access to healthcare," said Republican Senator Thad Cochran.

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.

"We need to move quickly, because the law is collapsing. But we also want to get it right," Ryan said.

But he offered no timeline for when a final repeal might reach the incoming president's desk. Multiple related bills were making their way through multiple committees, he said, and "when we have all of those ready is when we're going to move forward."

Republicans have yet to coalesce around a specific replacement for the existing law, reportedly leading some to express concern about moving ahead too quickly.

On Wednesday, Trump said his administration would unveil its own plans to repeal and replace Obamacare "essentially simultaneously," and that such a move would occur as soon as his secretary of health and human services, Tom Price, is confirmed by the Senate.

But Senate Democrat Debbie Stabenow offered a bleak outlook overnight.

"With tonight's vote, Republicans have pulled the first thread that will unravel our entire healthcare system," she said.