The Senate GOP got its majority vote to start debate on the House healthcare bill when Vice President Mike Pence broke a 50-50 tie Tuesday.

Senators Susan Collins of Maine and Lisa Murkowski of Alaska were the only Republican senators voting "no."

With the vote 48-2, the remaining Republican senators to vote were John McCain of Arizona and Ron Johnson of Wisconsin. Senators stood and applauded McCain, who was recently diagnosed with brain cancer, as he entered the chamber.

He and Johnson, a Conservative who has been critical of the healthcare bill, both voted "yes."

Debate now begins on the House bill that passed in June.

McCain, speaking to the chamber after the 51-50 vote, said changes were needed before he could support the bill for passage.

"I will not vote for this bill as it is today," McCain said, looking bruised by his recent surgery.

In his deadpan humor for which he is known, McCain said, "I stand here today looking a little worse for wear I'm sure."

McCain has served in the Senate for 30 years.

Before the vote, a shout of "kill the bill" could be heard in the Senate chamber.

Senators are expected to proceed to 20 hours of debate on repealing parts of the Affordable Care Act, including a separate bill repealing the law with a two-year delay, according to The Wall Street Journal.

Numerous amendments are expected to go forward.

One possibility is a so-called “skinny repeal” that would repeal the individual and employer mandate in the ACA.

Twitter: @SusanJMorse