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Even as they advanced the health care effort with the help of an inspirational appearance from a gravely ill Senator John McCain, Senate Republicans expressed strong support for Mr. Sessions after the president persisted in his tough attacks on his own cabinet officer. They seemed to be making clear that Mr. Trump would not face a friendly reception in the Senate should he dump Mr. Sessions and seek confirmation of a replacement.

I think the attorney general is doing a fine job, and I think he made the right decision to recuse himself from the Russia matter, said Senator Mitch McConnell, the Kentucky Republican and majority leader.

He was just one in the chorus of Republicans declaring that they had their former colleagues back.

While some may argue that he should not have recused himself from the Russia investigation, Attorney General Sessions demonstrated good judgment by doing so and removed all appearances of a potential conflict, said Senator Thom Tillis, a North Carolina Republican who sits on the Judiciary Committee, which would consider any potential successor to Mr. Sessions. The attorney generals recusal was ultimately made in the best interests of the Department of Justice and the country.

Senator Richard C. Shelby, who for years served alongside Mr. Sessions as his Republican colleague from Alabama, rallied to his defense on Twitter.

Jeff Sessions is a man of integrity, loyalty, and extraordinary character, Mr. Shelby said.

Privately, Senate Republicans were aghast at Mr. Trumps harsh treatment of the attorney general, saying they had never seen a similar Washington spectacle. They professed rising alarm that Mr. Trump would fire Mr. Sessions and seek the dismissal of the special counsel, Robert S. Mueller III, decisions that several Republicans said they would consider disastrous. The offensive on behalf of Mr. Sessions seemed like an orchestrated effort to deter the president from shaking up the Justice Department.

Republicans also made clear that with Mr. Trump in the White House and their party in full control of Congress, they could not afford to miss the opportunity to undo the health care law. Given the years they have spent railing against it, they have more invested in the outcome than does the president.

We have a duty to act, Mr. McConnell said as his solemn colleagues waited at their desks to vote on opening debate on repeal legislation. The president is ready with his pen.

Confronting one of the most serious leadership challenges of his career, Mr. McConnell used all the tools at his disposal special benefits for some states, appeals to party loyalty, plain old arm-twisting to win the vote by the narrowest margin possible.

With Vice President Mike Pence breaking the tie and cries of shame, shame ringing in the chamber and the hallway from a prolonged protest, 50 Republican senators voted to roll the dice and move forward on an unusual debate whose final end was impossible to predict. But it was a victory for Mr. McConnell to even get this far after the effort to repeal the health law appeared dead multiple times and his legislative skills were being called into question.

He was aided by Mr. McCain, who flew to the capital just days after being diagnosed with brain cancer. Mr. McCain spoke eloquently of the importance of the Senate, its recent failures and his desire to see the institution return to its more traditional give-and-take between the parties. Yet he cast a decisive vote to move ahead with a legislative health care process that has been archly partisan, conducted by Republicans behind closed doors with no input from Democrats and a limited amount from the Republican rank and file.

Why dont we try the old way of legislating in the Senate, the way our rules and customs encourage us to act? he asked. If this process ends in failure, which seems likely, then lets return to regular order.

But there is little that is regular about Washington these days as Republicans struggle to govern while keeping a wary eye on their partner in the White House.

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A version of this article appears in print on July 26, 2017, on Page A14 of the New York edition with the headline: Trump and Congressional G.O.P.: Its Complicated.

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Trump and Congressional Republicans: It's Complicated - New York Times