Senate Republicans voted Tuesday voted to open debate on repealing Obamacare, dramatically reviving an effort that many GOP lawmakers left for dead just a few days ago.

The vote is a huge political win and turnaround for Senate Majority Leader Mitch McConnell and Republicans who’ve promised for seven years to repeal Obamacare if voters gave them control of Congress and the White House.

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Sen. John McCain (R-Ariz.), recently diagnosed with brain cancer, entered the chamber to a standing ovation and cast the 50th Republican vote. GOP Sens. Susan Collins of Maine and Lisa Murkowski of Alaska broke ranks to oppose the measure, forcing Vice President Mike Pence to break a 50-50 tie.

All Democrats opposed the measure. Underscoring the significance of the vote, many senators sat at their desks for the vote.

The vote is no guarantee that the fractured Republican caucuses can coalesce around a single health care plan. Now that debate has officially started, Republicans in the Senate lack 50 votes on a policy. Moderates oppose repealing Obamacare without a replacement, and conservatives don’t like the idea of significantly replacing it.

The leading idea now is to repeal only a small portion of the health law just to get a bill to a conference with the Senate.

After a series of votes on amendments, Republicans would aim to enact a bill repealing three parts of Obamacare: the individual and employer mandates and the medical device tax, according to Republican sources. It could be expanded or altered depending on where the bulk of the conference is.

“Whatever gets to 50,” said Sen. John Thune (R-S.D.).

The goal would be to get an Obamacare repeal bill through the Senate and to a conference with the House. Or perhaps to pass a bill that the House would accept given opposition among some House members to a bicameral conference committee. Still, that scaled-back approach is already hitting some resistance among some GOP senators.

Before Tuesday’s vote, McConnell urged senators to take the first step to “provide relief on this failed left-wing experiment.”

“I’d like to reiterate what the president said yesterday. ‘Any senator who votes against starting debate,’ he said, ‘is telling America that you are fine with the Obamacare nightmare…’ That’s a position that even Democrats have found hard to defend,” McConnell said.

The fate of the vote was uncertain as recently as Tuesday morning. Conservative Sen. Rand Paul (R-Ky.), moderate Sen. Shelley Moore Capito (R-W.Va.) and vulnerable incumbent Sen. Dean Heller (R-Nev.) waited until the final hours before the vote to announce they would support opening debate on the bill.

Paul’s vote was conditioned on the party agreeing to move quickly to a vote on repealing without a replacement. The other amendment would be a leadership-designed repeal and replace bill, he said.

Heller said his support for whatever emerges later is not assured.

“If the final product isn’t improved for the state of Nevada, then I will not vote for it; if it is improved, I will support it,” Heller said.

Capito said she is “committed to reforming our health care system” while also addressing her concerns, which have centered on Medicaid.

Johnson declined to reveal how he would vote up to 20 minutes before the vote started. “No comment,” he repeatedly told reporters.

McConnell and his leadership team threw everything they had at wavering senators: the threat of political disaster if they fail, an open amendment process to allow their ideas to be debated — and the argument that a flawed Senate bill can be fixed later in conference negotiations with the House. Even McCain’s return was used as a sign of positive momentum.

“If we can get the bill through the Senate we can start negotiations with the House,” said Senate Majority Whip John Cornyn (R-Texas).

Administration officials and senators are discussing adding as much as $100 billion more to earlier drafts to help low-income people with premiums, Republicans said. Senators also may consider a scaled back version of Obamacare repeal that would allow them to pass something and get to conference, Republicans said.

A scaled back bill might not pass, however.

“I don’t know if they’ve got 50 but I know that I’m not going to vote for something that’s a scaled down version, that’s a political punt,” said Sen. Lindsey Graham. The South Carolina Republican will vote for the motion to proceed but added that a final product to fix the health care system should go through “regular order.”

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