Senate Republicans cleared their first major hurdle in their effort to repeal and replace the Affordable Care Act, securing the votes needed to proceed to debate. The motion to proceed, which officially starts debate on a bill, passed the Senate 51 to 50, with Vice President Mike Pence casting the tie-breaking vote. Lisa Murkowski of Alaska and Susan Collins of Maine were the lone Republicans to vote no. Sen. John McCain (R-Ariz.), who is recovering from surgery that found a malignant brain tumor, landed in Washington, D.C., just as the vote began. Republicans held the vote open until McCain made it to the Senate floor to vote yes.