The US Senate has narrowly voted to begin a debate on a bill to end the Affordable Care Act, known as Obamacare.
With the Senate deadlocked on 50-50, Vice-President Mike Pence used his tie-breaking vote.
Scrapping the policy was a key Trump campaign pledge.
Senator John McCain, who was recently diagnosed with brain cancer, turned up to cast his "yes" vote.
President Trump had earlier warned Republican senators that there may be repercussions if they didn't push through the measures.
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