Congress can not passed a real and complete replacement using reconciliation because they do not have 60 votes. The Republicans can never get Democrats to participate in a full replacement as long as Obamacare exists. The only legislative procedure available to the Republicans is a repeal, which can be achieved with simple majority. The hope is once Obamacare has been repealed the Democrats will come to the table and draft a true bipartisan healthcare and health insurance reform. McCain's vote destroyed any hope of getting a bipartisan reform bill, and will leave the anger and hostility toward Obamacare in place.